Proteinemia as a Prognostic Factor in Colorectal Cancers beyond Surgery and Chemotherapy

Background: Globally, 1,096,601, 704,376, and 48,541 new colon, rectum, and anus cancer cases were recorded in 2018, respectively. Besides, 551,269, 310,394 and 19,129 cases of colon, rectum, and anus cancer deaths occurred in the same year. As a result, these cancers ranked in the third level of cancer incidence, and in the second level of cancer mortality. As it is known, all cancer patients are subjected to cancerinduced and therapy-induced nutritional deficiencies (mainly of proteins and calories). The present study aimed to assess proteins level in colorectal cancer (CRC) patients who underwent surgery and chemotherapy. Methods: A combined retrospective and prospective study was performed. The present study enrolled 100 CRC patients with their data on surgical procedures and chemotherapy management. Assessments of the studied samples were conducted as a baseline before receiving chemotherapy and preoperatively as P0, while the period after that was termed as P1. The serum samples were collected to measure protein concentration. Total Protein Kit, Micro was used. Results: The mean age of the patients was 50.7±12.88 years old. Only 8% had a positive CRC family history. Rectosigmoid cancer represented the most frequent site, figured in 41% of the cases, followed by rectum cancer. Multiple sites of CRC metastasis were recorded in 15% of the patients. All patients received chemoradiation. Folinic acid (leucovorin), 5-FU, and oxaliplatin (FOLFOX) was the most used regimen, administered in 40% of the patients. Oxaliplatin and capecitabine (also called Xeloda) (XELOX) were administered in 14% of the patients. Folinic acid (leucovorin), 5-FU, oxaliplatin, and irinotecan (FOLFOXIRI) were administered in 16% of the patients. Single-agent oxaliplatin or carboplatin were administered in 6% of the patients, each. 5-FU plus leucovorin was administered to 12% of the patients. Three patients received irinotecan, and oxaliplatin (IROX). One patient received folinic acid (leucovorin), 5-FU and irinotecan (FOLFIRI). Also, Gemzar was administered to two patients only. A total of 80% of the patients underwent several surgical procedures. Anterior perineal resection (APR) and total mesorectal excision (TME) were the most common two surgeries, performed in 20 and in 30% of the patients, respectively. In P0 status, 44% of the patients suffered from low protein levels, and 13% of the patients were within the normal level. These findings were statistically different (p=0.03). After CRC management (i.e., P1 status), 70% of the patients had protein deficiency. These results have strong significant differences (p=0.000). The mean of protein concentration declined gradually after management, from 8.82±0.9 μg/L to 6.210.78 μg/L, with a strong association between a reduction in proteins levels towards deficiency and surgical procedures and chemotherapy protocols (p=0.000). Conclusion: The incidence of CRC is increasing annually, and the chance of being diagnosed with this type of cancer has risen in recent years. In the present study, the male to female ratio was 1:1.5, and the 5th decade of life was themost common age for the diagnosis of CRC. A negative family history and bowel inflammatory diseases (IBD) history did not exclude people from exposure to the incidence of CRC. Colorectal cancer with localized and moderately differentiated adenocarcinoma were the most common types in the present work. Tumor distance from the anal verge seems to be very important and plays a significant role in the choosing of surgical intervention types and chemoradiation protocols. Colorectal cancer acts as a complex condition and, in addition to its management, nutritional state influences it in different mechanisms. Most patients suffered from hypoproteinemia after surgery and chemoradiation. As a result, alteration in the treatment outcomes, delaying in wound healing, and an increase in postoperative complications may occur. (AU)

Modern chemoradiation practices for malignant tumors of the trachea: An institutional experience.

Background: Malignant tumors of the trachea are rare. A multimodality treatment approach is often necessary. Outcomes of radical non-surgical approaches are sparse. Radiation combined with sequential or concurrent chemotherapy is an important treatment option. Materials and Methods: We present an analysis of outcomes using modern radiotherapy and chemotherapy for tracheal tumors. Results: Radiation dose escalation using modern techniques is of benefit for these tumors. The results with chemotherapy are encouraging. Conclusions: Radiation plays a distinct role and should be a part of treatment for these tumors. The role of chemotherapy needs to be studied further.

Concurrent chemoradiotherapy plus consolidation chemotherapy compared with concurrent chemoradiotherapy alone in unresectable stage III non-mall-cell lung cancer

To evaluate the addition of consolidation chemotherapy to concurrent Chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer as regard efficacy and safety. Forty one patients were randomly assigned to either concomitant Chemoradiotherapy alone [arm 1, n = 19] or concomitant Chemoradiotherapy followed by consolidation chemotherapy [arm 2, n = 22]. In the concurrent arm, patients received weekly paclitaxel [45 mg/m[2]], carboplatin [100 mg/m[2]] and concomitant thoracic radiotherapy at a dose of 63 Gy in 34 fractions over 7 weeks. In the concurrent/consolidation arm, the same regimen was administered followed by two additional courses of paclitaxel [200 mg/m[2]] and carboplatin [300 mg/m[2]] every 3 weeks. Pre-treatment characteristics were well balanced between the two arms. Median survival was 13 months in the concurrent arm and 16.5 months in the concurrent/consolidation arm [p = 0.59]. One-, 2-, and 3- year survival rates were better in the concurrent/consolidation arm [63.6%, 36.4%, and 13.6% respectively] than in the concurrent arm [52.6%, 26.3%, and 10.5% respectively], p = 0.48. Grade 3/4 granulocytopenia occurred in 16% and 27% of patients on the concurrent and concurrent/consolidation arms respectively [p = 0.38]. The most common grade 3/4 non-hematological toxicity was esophagitis. It was more frequent in the consolidation arm than in the concurrent arm [32% v 21%], p = 0.43. Concurrent Chemoradiotherapy followed by consolidation chemotherapy represent the preferred regimen for the treatment of unresected stage III NSCLC. However, toxicity, particularly, non-hematological toxicity, remains a major obstacle

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation, 5-fluorouracil and oxaliplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006, 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a fourfield technique to a dose of 50.4Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130mg/m[2] on day 1 plus 30 minute infusion of 100mg/m[2] L-folinic acid and continuous infusion of fluorouracil 350mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction. Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [67.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%] the operative specimen was sterilized and in 2/44 patients [4.5%] only very few residual malignant cells difficult to find microscopically were detected. Pathological downstaging was diagnosed in 70.5% [31 out of 44 patient]. Local and distant progression occurred later in 9 patients and the 2-year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were 12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological downstaging and sphincter-saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen

Gastrointestinal non-Hodgkin's lymphoma clinico-pathologic study

The aim of this study is to determine the clinicopathologic features of primary gastrointestinal non-Hodgkin's lymphorma [GL NHL] at king Abdulaziz Universaty Hospital-Jeddah, and to compare our results to those reported in the literatures. Twenty three adult patients with primary GI NHL diagnosed over 5- years period [2000-2005] were retrospectively studied clinically and histopathotogicaliy. They were classified using the REAL/WHO histopathologic classification. Of the 23 patients with primary Gl NHL, 14 [60.9%] were Saudi, with male to female ratio of 1.3:1. The mean age of the male patients was 61.3 years ranging from [42-83] years with a SD +/- 13.09 while for females was 64 years, age range [50-75] with a SD +/- 9.14. Abdominal pain was the most common presenting symptoms [78.3%] and the most common primary site was the stomach [73.9%] followed by the small bowel [13 %]. The most frequent histologic subtype was the diffuse large-B cell lymphoma accounting for [60.9%] of all cases, followed by marginal-zone cell lymphoma [MALT type] which was Helicobacter pylori associated in [39.1%]. A large proportion of patients with primary GI NHL had early disease [Stage IE: 20%. Stage IIE 58.6%]. In regards to treatment 15 patients [65.2%] had chemotherapy, while only 2 patients [8.7%] were treated by Helicopter pylori eradication. The overall 5 years survival was [47.8%]. The data demonstrated that primary GI NHL is more common among males, mainly in their sixth decade. Abdominal pain is the most common diagnostic symptoms, with being the most common involved site. Diffuse large-B cell lymphoma is the most frequent histologic subtype, followed by extra-nodal marginal zone B-cell lymphoma [MALT type] Helicobacter associated. The majorities of the cases have early disease [Stage IE and IIE] and mostly treated by combination chemotherapy