Resultados del tratamiento a pacientes con cáncer anal en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo" / Results of Treating Of Anal Cancer Patients at Comandante Manuel Fajardo Surgical Clinical University Hospital

Introducción: El cáncer anal es el de menor incidencia del tubo digestivo, pero en los últimos años ha presentado un discreto incremento. Objetivo: Identificar los resultados del tratamiento empleado para el cáncer anal en el Servicio de Coloproctología del Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo". Métodos: Se realizó un estudio descriptivo y observacional con pacientes diagnosticados y tratados por cáncer anal en el período 2014-2019. Se estudiaron variables como antecedentes patológicos, factores de riesgo, síntomas, estadio de la enfermedad, tratamientos, entre otras. Resultados: La media de edad fue 58,4±14,7 años y el 75,3 por ciento fueron mujeres. El 52,1 por ciento presentaban antecedentes patológicos y el factor de riesgo más frecuente fue la edad (> 50 años: 80,8 por ciento). La localización más usual fue en el conducto anal y los estadios II y III. El sangrado se manifestó en el 58,9 por ciento de los pacientes. Se aplicó como tratamiento quimiorradioterapia (87,7 por ciento), exéresis local (17,8 por ciento) y cirugía abdominoperineal (8,2 por ciento). Se realizó colostomía al 14 por ciento de los individuos y el 72,6 por ciento estuvieron libres de colostomía más de un año. El tiempo libre de colostomía fue de 87,5 por ciento, con tratamiento de 5 años y más. De los pacientes fallecidos (24,7 por ciento), en el 55,6 por ciento la causa fue progresión de la enfermedad y la metástasis más frecuente fue la hepática. Conclusiones: La quimiorradioterapia fue el principal tratamiento con el que se obtuvo una aceptable tasa de sobrevida en los pacientes con cáncer anal(AU)

Introduction: Anal cancer is the one with the lowest incidence of the digestive tract, but in recent years it has slightly increased. Objective: To identify the results of the treatment used for anal cancer in the Coloproctology Service of Comandante Manuel Fajardo Surgical Clinical University Hospital. Methods: A descriptive and observational study was carried out with patients diagnosed and treated for anal cancer in the 2014-2019 period. Variables such as pathological history, risk factors, symptoms, stage of the disease, treatments, among others, were studied. Results: The mean age was 58.4 ± 14.7 years and 75.3 percent were women. 52.1 percent had pathological antecedents and the most frequent risk factor was age (> 50 years: 80.8 percent). The most usual location was in the anal canal and stages II and III. Bleeding appeared in 58.9 percent of the patients. Chemoradiation therapy (87.7 percent), local exeresis (17.8 percent) and abdominoperineal surgery (8.2 percent) were applied. Colostomy was performed in 14 percent of individuals; 72.6 percent were free of colostomy for more than one year. The colostomy-free time was 87.5 percent, with treatment of 5 years and more. 24.7 percent died, the disease progression was the cause of death in 55.6 percent of the diseased subjects, while the most frequent cause was liver metastasis. Conclusions: Chemoradiotherapy was the main treatment with which an acceptable survival rate was obtained in patients with anal cancer(AU)

How to Achieve a Higher Pathologic Complete Response in Patients With Locally Advanced Rectal Cancer Who Receive Preoperative Chemoradiation Therapy

The current standard of care for treating patients with locally advanced rectal cancer includes preoperative chemoradiation therapy (PCRT) followed by a total mesorectal excision and postoperative adjuvant chemotherapy. A subset of these patients has achieved a pathologic complete response (pCR) and they have shown improved disease-free and overall survival compared to non-pCR patients. Thus, many efforts have been made to achieve a higher pCR through PCRT. In this review, results from various ongoing and recently completed clinical trials that are being or have been conducted with an aim to improve tumor response by modifying therapy will be discussed.

Application value of different sequences magnetic resonance imaging in rectal cancer re-staging after neoadjuvant chemoradiation therapy / 中国医师进修杂志

Objective@#To evaluate the value of different sequences magnetic resonance imaging (MRI) in rectal cancer re-staging after neoadjuvant chemoradiation therapy (NCRT).@*Methods@#The clinical data of 117 patients with rectal cancer who underwent NCRT before surgery operation in Peking University cancer hospital from January 2016 to December 2018 were retrospectively analyzed. Among 117 patients, 101 patients underwent MRI scanning before and after NCRT, and 16 patient underwent MRI scanning after NCRT; T2 weighted imaging (T2WI) and diffusion weighted imaging (DWI) scanning were performed in all patients, and dynamic contrast enhancement (DCE) scanning was performed in 96 patients. T2WI, T2WI combined with DWI, T2WI combined with DCE were used for T re-staging of rectal cancer after NCRT respectively, and the results of which were compared with those of pathology after operation.@*Results@#The sensitivity of diagnosis of ypT0-2 rectal cancer after NCRT using T2WI combined with DWI, T2WI combined with DCE respectively was significantly higher than that using T2WI: 52.7% (29/55) and 30.4% (14/46) vs. 10.9% (6/55), and there was statistical difference (P<0.05). The accuracy rate and specificity of diagnosis of ypT3 and ypT4 rectal cancer after NCRT using T2WI combined with DWI were significantly higher than that using T2WI, with an accuracy rate of 60.7% (71/117) vs. 47.0%(55/117) and 92.3% (108/117) vs. 80.3% (94/117), and a specificity of 55.9% (33/59) vs. 23.7% (14/59) and 92.9% (105/113) vs. 80.5% (91/113), and there were statistical differences (P<0.05). The accuracy rate of down-staging after NCRT using T2WI combined with DWI was significantly higher than that using T2WI: 72.3% (73/101) vs. 58.4% (59/101), and there was statistical difference (P<0.05); there was no significant difference in accuracy rate between using T2WI and using T2WI combined with DWI and between using T2WI combined with DWI and using T2WI combined with DCE (P > 0.05).@*Conclusions@#T2WI combined with DWI is superior to T2WI in re-staging of rectal cancer after NCRT.

Chemoradiation therapy induces in vivo changes in gene promoter methylation & gene transcript expression in patients with invasive cervical cancer

Background & objectives: Invasive cervical cancer patients are primarily treated with chemoradiation therapy. The overall and disease-free survival in these patients is variable and depends on the tumoral response apart from the tumour stage. This study was undertaken to assess whether in vivo changes in gene promoter methylation and transcript expression in invasive cervical cancer were induced by chemoradiation. Hence, paired pre- and post-treatment biopsy samples were evaluated for in vivo changes in promoter methylation and transcript expression of 10 genes (ESR1, BRCA1, RASSF1A, MYOD1, MLH1, hTERT, MGMT, DAPK1, BAX and BCL2L1) in response to chemoradiation therapy. Methods: In patients with locally advanced invasive cervical cancer, paired pre- and post-treatment biopsies after 10 Gy chemoradiation were obtained. DNA/RNA was extracted and gene promoter methylation status was evaluated by custom-synthesized methylation PCR arrays, and the corresponding gene transcript expression was determined by absolute quantification method using quantitative reverse transcription PCR. Results: Changes in the gene promoter methylation as well as gene expression following chemoradiation therapy were observed. BAX promoter methylation showed a significant increase (P<0.01) following treatment. There was a significant increase in the gene transcript expression of BRCA1 (P<0.01), DAPK1 and ESR1 (P<0.05), whereas MYOD1 and MLH1 gene transcript expression was significantly decreased (P<0.05) following treatment. Interpretation & conclusions: The findings of our study show that chemoradiation therapy can induce epigenetic alterations as well as affect gene expression in tissues of invasive cervical cancer which may have implications in determining radiation response.

Value of endorectalultrasonography in preoperative assessment of rectal cancer post neoadjuvantchemoradiation therapy / 中华医学超声杂志（电子版）

Objective To investigate the value of endorectal ultrasonography (ERUS) inpreoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy.Methods From Jan.2016 to Dec.2016,90 rectal cancer patients who underwent preoperative neoadjuvant chemoradiation therapy and total mesorectal excision surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed,and all patients underwent ERUS examination post neoadjuvant chemoradiation therapy.Of these,64 patients were evaluated by ERUS pre and post neoadjuvant chemoradiation therapy and 26 patients were evaluated only post neoadjuvant chemoradiation therapy.Wilcoxon rank sum test for paired sample was performed to compare the distance from inferior margin of tumor to anal margin,the length and thickness of the tumor pre and post neoadjuvant chemoradiation therapy respectively in rectal cancer.Taken pathologic findings as golden standard,the accuracy of T staging assessed by ERUS post neoadjuvant chemoradiation therapy was evaluated.Results Compared with pre neoadjuvant chemoradiation therapy,the distance from inferior margin of tumor to anal margin significantly increased after neoadjuvant chemoradiation therapy [(58.63±21.71) mm vs (51.68± 19.81) mm],and the length [(26.10± 10.07) mm vs (40.82±9.18) mm] and thickness [(9.73±2.50) mm vs (14.92±5.30) mm] of tumor also evidently decreased post neoadjuvant chemoradiation therapy,respectively (Z were 4.996,6.153 and 6.076,all P ＜ 0.01).The final pathological T stage was pathologic complete response (pCR) or pT0 in 15 patients,pT1 in 3 patients,pT2 in 30 patients and pT3 in 42 patients.The diagnostic accuracy of T staging of rectal cancer post neoadjuvant chemoradiation therapy for ERUS was uT0 82.2％ (74/90),uT1 96.7％ (87/90),uT2 66.7％ (60/90),uT3 67.8％ (61/90) and uT4 96.7％ (87/90),and the overall accuracy was 82.2％ (74/90).Conclusion ERUS could effectively record the morphological changes of rectal cancer pre and post neoadjuvant chemoradiation therapy,which may contribute to the re-evaluation of the distance from inferior tumor margin to anal margin and the range and depth of tumor involvement pre surgical resection.

Effects of three-dimensional and two-dimensional laparoscopic surgeries for rectal cancer after neoadjuvant chemoradiation therapy / 中华消化外科杂志

Objective To compare the clinical effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries for rectal cancer (RC) after neoadjuvant chemoradiation therapy (nCRT).Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients with RC who received laparoscopic surgery after nCRT in the Liaoning Cancer Hospital from January 2013 to January 2014 were collected.Of 126 patients,63 undergoing 3D laparoscopic surgery and 63 undergoing 2D laparoscopic surgery were respectively allocated into the 3D and 2D groups.Surgery was performed by the same doctors' team.Patients received surgery at 6-8 weeks after nCRT,and surgery followed the principle of total mesorectal excision.Observation indicators:(1) intra-and post-operative situations;(2) postoperative pathological examination;(3)follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect local tumor recurrence and patients' survival up to January 2017.Patients received reexaminations once every 3 months within 1 year postoperatively and once every 6 months after 2-3 years postoperatively.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Comparisons of count data were analyzed using the chi-square test.Comparison of ordinal data was done by the nonparametric test.Survival curve was drawn using the Kaplan-Meier method.Survival was analyzed using the Logrank test.Results (1) Intra-and post-operative situations:all the patients underwent successful laparoscopic surgery for RC,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss,time to anal exsufflation and number of patients with postoperative urinary dysfunction were (125±10)minutes,(54±23)mL,(44±5)hours,0 in the 3D group and (137±12)minutes,(62±20)mL,(46±5) hours,5 in the 2D group,respectively,with statistically significant differences between the 2 groups (t=5.777,2.038,2.575,x2 =7.138,P＜0.05).Number of patients with preserving anus,number of lymph node dissected,number of patients with anastomotic fistula and duration of hospital stay were 60,14.9±2.1,2,(9.5±0.8)days in the 3D group and 58,14.3± 1.7,4,(9.9±2.0)days in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.133,t=1.606,x2 =0.175,t =1.329,P＞0.05).Two and 4 patients with anastomotic leakage in the 3D and 2D groups received defunctioning stoma,and finally anastomotic leakage healed,without anastomotic stenosis.Of 5 patients with urinary dysfunction in the 2D group,4 received indwelling catheter for 3 weeks and then can micturate autonomously after indwelling catheter removal,1 received indwelling catheter for 3 months and then can micturate autonomously after indwelling catheter removal,without suprapubic cystostomy.(2) Postoperative pathological examination:0 and 4 patients in the 3D and 2D groups had positive circumferential margin,with a statistically significant difference (x2=5.676,P＜0.05).One and 2 patients in the 3D and 2D groups had positive distal margin,with no statistically significant difference (x2 =1.606,P＞0.05).Number of patients with stage Ⅱ and Ⅲ of postoperative pathological staging were 30,33 in the 3D group and 32,31 in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.127,P＞0.05).(3) Follow-up and survival situations:126 patients were followed up for 36.0-48.0months,with a median time of 39.5 months.During the follow-up,0 and 3 patients in the 3D and 2D groups were complicated with local tumor recurrence,with a statistically significant difference between the 2 groups (x2 =4.232,P＜0.05).One-and 3-year overall survival rates were 98.4％,82.5％ in the 3D group and 96.8％,79.4％ in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.206,P＞0.05).One-and 3-year disease-free survival rates were 92.7％,77.8％ in the 3D group and 90.5％,73.0％in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.421,P＞0.05).Conclusion Compared with 2D laparoscopic surgery,3D laparoscopic surgery for RC after nCRT is safe and feasible,it can also shorten operation time,reduce intraoperative bleeding,alleviate the influence of intestinal peristalsis function,protect pelvic nerves better and improve operation quality.

Treatment strategy of complete response cases after neoadjuvant radiotherapy in rec-tal cancer / 中国肿瘤临床

Objective:To discuss treatment of complete response cases after neoadjuvant radiotherapy in rectal cancer. Methods:This retrospective study analyzed clinical data of 84 rectal cancer cases with pre-operative neoadjuvant chemoradiotherapy in our hospital from January 2010 to Augnst 2014. Results:After neoadjuvant chemoradiotherapy, 33 patients presented clinically complete response at a rate of 39.3%. After post-operative pathologic examination, among clinically complete response cases, six cases exhibited patho-logically complete responses at a rate of 18.2%. No recurrence or disease progression occurred within 12-36 months of post-operative follow up. Conclusion:Neoadjuvant chemoradiotherapy can significantly lower tumor stage and promote clinically complete remission of some patients. However, for clinically complete remission cases, further radical surgery should be provided.

Preoperative chemoradiation therapy for upper gastric cancer：a retrospective study for its efficacy and safety / 中国肿瘤临床

Objective:To investigate the efficacy, safety, and overall survival of advanced upper gastric cancer patients who received preoperative chemoradiation therapy. Methods:A total of 62 patients who received preoperative chemotherapy or chemoradiation therapy in the Department of Gastrointestinal Surgery of Beijing Cancer Hospital&Institute were retrospectively observed to determine the efficacy and safety and to perform survival analysis of preoperative chemoradiation therapy. Results:Results of the postoperative pathology showed that the number of patients with T4 and N3 stages was significantly lower in the preoperative chemoradiation therapy group than in the preoperative chemotherapy group (P<0.05). In addition, the differences between the two groups in terms of safety and toxicity were not significant (P≥0.05). Analysis also showed that the differences between the two groups in terms of survival were not significant (P≥0.05). Conclusion:Patients with advanced upper gastric cancer can gain a potential survival advantage from preoperative chemoradiation therapy. Compared with preoperative chemotherapy, preoperative chemoradiation therapy was performed without increased risk of toxicity and insecurity. Preoperative chemoradiation therapy can also improve the local control ratio, especial y the control ratio of lymphatic metastasis. However, the final results of survival analysis depend on long-term follow-up of patients.

Application of intra-arterial infusion chemotherapy in concurrent chemoradiation therapy of local advanced cervical cancer / 实用放射学杂志

Objective To investigate the feasibility and clinical efficacy of intra-arterial infusion chemotherapy within concurrent chemoradiation therapy (CCRT)for local advanced cervical cancer (LACC:Stage Ⅰb2 - Ⅳa).Methods 42 LACC patients were treated with CCRT combining with intra-arterial infusion chemotherapy (CCRT group),and another 60 LACC patients were under-went radiotherapy alone (control group).The clinical efficacy,adverse reactions and overall survivals (OAS)were evaluated,be-tween the two groups,respectively.Results Overall response rate was 92.8% in CCRT group.Of 42 patients,24 had achieved complete response (CR)in CCRT group (57.1%).The 5-year overall survival rate in CCRT group was 76.2%,which was signifi-cantly higher than that of control group (49.3%),respectively (P =0.01).Multivariate COX proportional hazards model revealed that the clinical stage(P =0.01 6),pelvic positive lymph nodes (P =0.007)were independent factors of monitoring prognosis of LACC patients treated with CCRT combining with intra-arterial infusion chemotherapy.Conclusion CCRT with intra-arterial infu-sion chemotherapy is a safe and effective method for LCCA,and clinical stage and pelvic positive lymph node were independent fac-tors of the prognosis of patients.

Efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer / 中华消化外科杂志

Objective To explore the efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.Methods The clinical data of 108 patients with T3 rectal cancer who were admitted to Shanghai Cancer Center of Fudan University from 2010 to 2012 were retrospectively analyzed.The TNM stage of tumor,extramural depth of tumor invasion (mrT3 stage),involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor were the main items of evaluation using the high-resolution MRI.A total of 108 patients underwent surgical resection of tumor after neoadjuvant chemoradiation therapy.The tumor complete response after neoadjuvant chemoradiation therapy was evaluated by tumor node metastasis (TNM) stage and tumor regression grade (TRG).The categorical data and multivariate analysis were done by the single factor analysis of variance (ANOVA) and Logistic regression analysis.Results The positive response rate of the T3a,T3b and T3c in the patients were 61.5％ (16/26),36.9％ (24/65) and 11.8％ (2/17) after neoadjuvant chemoradiation therapy,respectively.The mrT3,mrN and tumor diameter were the potential factors affecting response of neoadjuvant chemoradiation therapy by the univariate analysis of pathological restaging (x2 =50.474,30.985,8.318,P ＜ 0.05).The mrT3 was an independent risk factor affecting response of neoadjuvant chemoradiation therapy by the multivariate analysis of pathological restaging (OR =4.473,95 ％ confidence interval:2.003-9.991,P ＜ 0.05).There was no significant difference between the mrT3 stage,N stage,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor before therapy and the response after neoadjuvant chemoradiation therapy based on the tumor regression grade(TRG) (x2 =6.264,6.159,2.949,2.189,6.335,P ＞ 0.05).Conclusion The mrT3 in patients undergoing high-resolution MRI before neoadjuvant chemoradiation therapy could predict the tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.

Prognostic value of lymph node status evaluated by computed tomography for patients with cervical cancer treated with radical chemoradiation therapy / 肿瘤研究与临床

Objective To investigate the prognostic value of lymph node status evaluated by computed tomography (CT) in cervical carcinoma treated with radical chemoradiation therapy.Methods 209 patients with FIGO stage Ⅰ B-ⅣA uterine cervical carcinoma treated with radical chemo radiation therapy were enrolled.Lymph node status was evaluated based on site,number and size respectively by CT.Kaplan-Meier method was used to analyze the impact of lymph node status as well as other pathoclinical factors on overall survival (OS).Cox regression model was used to explore the relationship between independent prognostic factors and OS.Results Lymph node metastasis rates for stage Ⅰ B,Ⅱ,Ⅲ and ⅣA patients were 16.7 ％ (1/6),48.2 ％ (68/141),57.4 ％ (31/54) and 87.5 ％ (7/8),respectively.Variate analysis showed that FIGO stage,anemia before treatment,para-aortic lymph node metastasis,and the number (≥3) and size (maximum diameter ≥ 2.0 cm) of CT positive lymph node were significant unfavorable prognostic factors for OS (P ＜ 0.05).FIGO stage,the number of lymph nodes metastasis,pathologic diagnosis and treatment regimen were identified to be independent prognostic factors in multivariate analysis.Conclusion Under current therapeutic strategy of concomitant chemoradiotherapy,lymph node metastatic status evaluated by pretreatment CT is still a significant and independent prognostic factor for cervical cancer.

Pancreas club international joint symposium on pancreatic cancer 2012, Kyoto: down staging chemo+/-radiotherapy for borderline resectable pancreatic cancer

This manuscript summarized one section out of the international symposium, Pancreatic Cancer 2012, which was held last October 4th through 6th in Kyoto (Japan) under the theme, "We are the Team: Opening the Door to the Next Step for Pancreatic Cancer Therapy." Borderline resectable pancreatic cancer (BRPC) is a specific clinical presentation with features in between those of resectable and locally advanced pancreatic cancers. The classification of pancreatic cancer is an important issue given that a cancer may look resectable but be high-risk for R1 or R2 resection. Considering that margin-negative resection is a fundamental requirement for curing pancreatic cancer, this issue is one of the most interesting to pancreatic surgeons. At Pancreatic Cancer 2012 in Kyoto, BRPC was also discussed at the Pancreatic Club International Joint Symposium. In this manuscript, the contents of the presented topics are briefly summarized to facilitate understanding of recent issues in managing BRPC.

Satisfaction survey of pain management for severe mucositis caused by cancer therapy for head and neck cancer

<b>Purpose</b>: Head and neck cancer patients receiving chemoradiation therapy often suffer from severe mucositis. Chemoradiation therapy-induced mucositis is usually accompanied by severe and intractable pain that impairs quality of life. To establish an effective method for treatment of mucositis pain, we retrospectively investigated the relationships of radiation dose with severity of mucositis and opioid consumption. We also conducted a survey on satisfaction of pain treatment. <b>Methods</b>: Study 1: Fourteen patients who underwent chemoradiation therapy of 70 Gy for head and neck cancer from 2005 to 2009 participated in the study. The relationship of severity of mucositis with opioid use was studied. Study 2: Seven patients who had mucositis of over grade 3 and had completed radiation therapy participated in the study. We carried out a questionnaire survey about satisfaction of each pain treatment. <b>Results</b>: Study 1: Increase of radiation dose significantly worsened the severity of mucositis. Opioid consumption for treating pain was significantly greater in the pharynx cancer group than in the oral cancer group. Study 2: Oral care treatment was preferred to systemic administration of analgesics including opioids. <b>Conclusions</b>: In the oral cancer group, oral care treatment was thought to be useful for pain treatment. Oral cancer patients needed less opioids than did pharynx cancer patients.

Update and Debate Issues in Surgical Treatment of Middle and Low Rectal Cancer

Based on a review of the literature, this paper provides an update on surgical treatment of middle and low rectal cancer and discusses issues of debate surrounding that treatment. The main goal of the surgical treatment of rectal cancer is radical resection of the tumor and surrounding lymphatic tissue. Local excision of early rectal cancer can be another treatment option, in which the patient can avoid possible complications related to radical surgery. Neoadjuvant chemoradiation therapy (CRT) has been recommended for patients with cT3-4N0 or any T N+ rectal cancer because CRT shows better local control and less toxicity than adjuvant CRT. However, recent clinical trials showed promising results for local excision after neoadjuvant CRT in selected patients with low rectal cancer. In addition, the "wait and see" concept is another modality that has been reported for the management of tumors that show complete clinical remission after neoadjuvant CRT. Although radical surgery for middle and low rectal cancer is the cornerstone therapy, an ultralow anterior resection with or without intersphincteric resection (ISR) has become an alternative standard surgical method for selected patients. Many studies have reported on the oncological safety of the ISR, but few of them have addressed the issue the functional outcome. Furthermore, an abdominoperineal resection (APR) has problems with high rates of tumor perforations and positive circumferential resection margins, and those factors have contributed to its having a high rate of local recurrence and a poor survival rate for rectal cancer compared with sphincter-saving procedures. Recently, great efforts have been made to reduce these problems, and the total levator excision or the extended APR concept has emerged. Surgical management for low rectal cancer should aim to radically excise the tumor and to preserve as much of the sphincter function as possible by using multidisciplinary approaches. However, further prospective clinical trials are needed for tailored treatment of rectal cancer patients.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Comparison of concurrent chemoradiation therapy with weekly cisplatin versus monthly fluorouracil plus cisplatin in FIGO stage IIB-IVA cervical cancer / 부인종양

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Comparison of concurrent chemoradiation therapy with weekly cisplatin versus monthly fluorouracil plus cisplatin in FIGO stage IIB-IVA cervical cancer / 부인종양

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.

Variable uterine uptake of FDG in adenomyosis during concurrent chemoradiation therapy for cervical cancer

To avoid improper tumor volume contouring in radiation therapy (RT) and other invasive procedures, we report a case of uterine adenomyosis showing increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) mimicking malignant tumor in a 44-year-old woman during concurrent chemoradiation therapy (CCRT) for uterine cervical cancer. The adenomyosis was not associated with her menstrual cycle or with normal endometrium uptake, and it resolved one month after completion of RT. This case indicates that uterine adenomyosis in a premenopausal woman may show false positive uptake of 18FDG-PET/CT associated with CCRT.

Clinicopathologic Characteristics of Anal Cancer

PURPOSE: This study was performed to evaluate clinicopathologic features in anal canal carcinoma. METHODS: Among the 43 patients who were diagnosed with anal cancer at Kangnam St. Mary's Hospital, from June 1990 to June 2008, 31 patients were analyzed retrospectively. Concurrent chemoradiotherapy was performed on twenty-one patients with anal cancer. Chemotherapy with 5-FU/mitomycin and radiotherapy were started at the same time. An external beam radiation dose to the primary lesion and pelvis was modified from 4,500 to 6,000 cGy. RESULTS: Among the 31 patients with anal cancer, the dominant histologic type was squamous cell carcinoma (n=25), followed by adenocarcinoma (n=6). Twenty-nine (93.5%) of these cancers were located in the anal canal and 2 (6.5%) in the anal margin. Among the 25 patients with squamous cell carcinoma, 20 cases were treated by concurrent chemoradiotherapy. The 5-year survival rate among squamous cell carcinoma cases was 83.3% for the concurrent chemoradiation group and 50.0% for the no concurrent chemoradiation group, which was statistically significant (P=0.05). Among the squamous cell carcinoma patients, there was no significant difference in survival rates between concurrent chemoradiation group (n=17) and concurrent chemoradiation with surgical resection group (n=8) (87.5% vs 68.8%; P=0.596). CONCLUSION: In the squamous cell carcinoma treatment, concurrent chemoradiation therapy can offer better outcomes.