Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

PURPOSE: Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal resection is considered the standard of care for treating locally advanced rectal cancer. This study aimed to investigate the efficacy and feasibility of adding induction chemotherapy to neoadjuvant CRT in locally advanced rectal cancer. METHODS: This phase-II clinical trial included 54 patients with newly diagnosed, locally advanced (clinical T3–4 and/or N1–2, M0) rectal cancer. All patients were treated with 3 cycles of preoperative chemotherapy using the XELOX (capecitabine + oxaliplatin) regimen before and after a concurrent standard long course of CRT (45–50.4 Gy) followed by standard radical surgery. Pathologic complete response (PCR) rate and toxicity were the primary and secondary end-points, respectively. RESULTS: The study participants included 37 males and 17 females, with a median age of 59 years (range, 20–80 years). Twenty-nine patients (54%) had clinical stage-II disease, and 25 patients (46%) had clinical stage-III disease. Larger tumor size (P = 0.006) and distal rectal location (P = 0.009) showed lower PCR compared to smaller tumor size and upper rectal location. Pathologic examinations showed significant tumor regression (6.1 ± 2.7 cm vs. 1.9 ± 1.8 cm, P < 0.001) with 10 PCRs (18.5%) compared to before the intervention. The surgical margin was free of cancer in 52 patients (96.3%). Treatment-related toxicities were easily tolerated, and all patients completed their planned treatment without interruption. Grade III and IV toxicities were infrequent. CONCLUSION: The addition of induction chemotherapy to neoadjuvant CRT is an effective and well-tolerated treatment approach in patients with rectal cancer.

Enlarged right atrium falsely interpreted as a mediastinal mass: a case report

Right atrial dilation due to left heart disease is a common complication among adults. The present review aimed to describe a case of massively dilated right atrium in a female patient presenting with valvular heart disease and no atrial fibrillation. The results of chest X-ray revealed a large opacity filling the lower right hemithorax, falsely interpreted as a mediastinal mass. During the transesophageal echocardiography, severe enlargement of the right atrium was detected, and open mitral and tricuspid valve replacements were performed successfully

Pneumomediastinitis following internal jugular vein central line insertion: case report and review of literature

Complications related to central venous catheters [CVCs] in the postoperative period can be fatal. We recently had a case of pneumomediastinitis. A 77 years old woman with left femoral neck fracture due to a fall was admitted to Rajaee Hospital. The next day after the operation the patient presented with tachypnea and respiratory distress. Tracheal intubation was performed and mechanical ventilation was started. The central line was inserted in left internal jugular vein. Anteroposterior chest radiography revealed air space shadowing in left lung at middle and lower lobes probably due to infiltration, consolidation or collapse. The CT scan reported that pneumomediastinum was detected in superior and anterior of mediastinum. Minimal pleural effusion and consolidation was also detected in right. Lung, especially in the dependent area. The tip of the catheter was seen at the anterior part of mediastinum. Clinical findings described before declared that the patient had suffered from aspiration pneumonia which may have been occurred during the surgery. The central venous line was removed after proving its malpositioning. The patient recovered with conservative treatment and was discharged from the hospital six days after surgery. This case highlights the clinical importance of comparing CT scan to the chest x-ray accuracy in diagnosing the chest complications