Cost Effectiveness of Watch and Wait Versus Resection in Rectal Cancer Patients with Complete Clinical Response to Neoadjuvant Chemoradiation

Background Watch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer. Methods In this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective. Results WW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0–250,000. Conclusions Our study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer.

Favourable Functional Outcomes In Idiopathic Inflammatory Myositis- A Single Centre Experience Over 15 Years

Background: To describe the long term clinical outcome and prognostic factors associated with outcome in a longitudinal cohort of idiopathic inflammatory myositis (IIM). Methods: In this retrospective cohort study, IIM patients were classified as per Bohan and Peter criteria. In those with ≥ 24 months of follow-up; treatment response, functional outcomes [health assessment questionnaire-disability index(HAQ-DI) and modified Rankin score(MRS)], Myositis damage index(MDI) at last follow-up was recorded. Results: The cohort consists of 175 patients, with a mean age of 40.9(+12.6) years, M:F 1:3.3; the IIM subsets were dermatomyositis(DM) 78(44.6%), overlap myositis(OM) 45(25.7%), antisynthetase syndrome(ASS) 11(6.3%), polymyositis(PM) 25(14.3%) and juvenile DM/OM in 15(8.6%) patients. Mortality rate was 13.4% and disease related deaths was 9.1%. Ninety-four patients have followed up for >24 months, the median (IQR) of 65(35,100.7) months. At last follow-up, 13.8% were in treatment free remission, 73.4%, 11.7% had complete clinical response and partial clinical response with treatment respectively. HAQ-DI and MRS were favourable in > 90% of patients. At last follow-up, one-third were off-steroids. Discontinuation of steroids was associated with HAQ-DI of 0 and lower MRS. Complete clinical response on/off medication at last follow-up was associated with HAQ-DI of 0[OR10.9; 95%CI(3.3,160)], better MRS[OR 3.2; 95%CI(1.4,7.3)] and lesser MDI[OR 1.7; 95% CI(1.1,2.7)] at the last follow-up as compared to partial response. Baseline parameters and IIM subsets did not significantly influence outcome.Conclusion: Our longitudinal cohort of IIM had a good outcome in all major myositis subsets. Partial clinical response on treatment is associated with worse functional outcomes and damage accrual.

Results of conservative treatment of locally advanced larynx squamous cell carcinoma using intraarterial regional polychemotherapy

The study objective is to evaluate the results of organ-preserving treatment of locally advanced larynx squamous cell carcinoma.Materials and methods. Analysis of 28 patients with locally advanced larynx squamous cell carcinoma (stages III-IV) who underwent treatment at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia between 2017 and 2020 was performed. At the first stage, 2-3 courses of combined inductive polychemotherapy per the DCF scheme with 21-day interval were performed (docetaxel 60 mg/m2, cisplatin 60 mg/m2 intraarterially bolus with detoxication with sodium thiosulfate, 5-fluorouracil 1000 mg/m2/day as 96-hour infusion). The second stage included external beam radiotherapy (60-70 Gy, 2 Gy per day 5 days a week) as monotreatment if complete clinical response after chemotherapy was achieved or with regional administration of cisplatin (60 mg/m2 once per 3 weeks) if after inductive stage full clinical response wasn»t observed.Results. In 20 (71.5 %) patients, complete clinical response was observed after inductive treatment; in 7 (25 %) patients, partial response was observed. Tumor stabilization was detected in 1 (3.5 %) patient. Two-year overall survival was 95.8 ± 4.1 %, progression-free survival was 90.1 ± 6.8 %.Conclusion. The proposed strategy of organ-preserving treatment of stage III-IV larynx cancer with substitution of systemic chemotherapy with regional intraarterial chemotherapy prior to radiotherapy is highly effective from the point of view of direct anti-tumor effect and recurrence-free and overall survival.

Cyclophosphamide rescue therapy for relapsed low-grade alimentary lymphoma after chlorambucil treatment in cats

Objectives The aims of this study were to evaluate the response, outcome and prognostic factors in cats with clinically presumed relapsed low-grade alimentary lymphoma (LGAL) receiving cyclophosphamide as a first-line rescue therapy after failing chlorambucil treatment. Methods The medical records of 20 cats (from three institutions, between 2002 and 2017) treated with cyclophosphamide for relapsed LGAL after initial treatment with chlorambucil were retrospectively reviewed. Progression-free survival (PFS), overall survival time (OST) and the association of select variables with measures of outcome were assessed. Adverse events (AEs) were also described. Results Eighteen cats (90%) achieved a complete clinical response (CR) for a median duration of 239 days. The median PFS was 215 days. The median OST was 1065 days. The only clinical factor associated with a longer PFS was achievement of a CR with cyclophosphamide treatment. Cyclophosphamide was associated with few and reversible constitutional, gastrointestinal and hematologic AEs. Conclusions and relevance Cyclophosphamide appears to be a safe and effective first-rescue therapeutic option for cats with relapsed LGAL.