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1.
Ann Surg ; 275(5): 933-939, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1883081

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of a modified CAL-WR. SUMMARY BACKGROUND DATA: The use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity. METHODS: This prospective multicenter study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pathological T1 (pT1) colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated. RESULTS: Of the 118 patients included (56% male, mean age 66 years, standard deviation ± 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo i-ii) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up. CONCLUSIONS: CAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR, therefore, deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.


Subject(s)
Adenoma , Carcinoma , Colonic Neoplasms , Colonic Polyps , Laparoscopy , Aged , Carcinoma/surgery , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Colonic Polyps/pathology , Colonic Polyps/surgery , Colonoscopy/methods , Female , Humans , Laparoscopy/methods , Male , Margins of Excision , Prospective Studies , Retrospective Studies
2.
Molecules ; 27(3)2022 Jan 28.
Article in English | MEDLINE | ID: covidwho-1686898

ABSTRACT

Cancer is the second most fatal disease worldwide, with colon cancer being the third most prevalent and fatal form of cancer in several Western countries. The risk of acquisition of resistance to chemotherapy remains a significant hurdle in the management of various types of cancer, especially colon cancer. Therefore, it is essential to develop alternative treatment modalities. Naturally occurring alkaloids have been shown to regulate various mechanistic pathways linked to cell proliferation, cell cycle, and metastasis. This review aims to shed light on the potential of alkaloids as anti-colon-cancer chemotherapy agents that can modulate or arrest the cell cycle. Preclinical investigated alkaloids have shown anti-colon cancer activities and inhibition of cancer cell proliferation via cell cycle arrest at different stages, suggesting that alkaloids may have the potential to act as anticancer molecules.


Subject(s)
Alkaloids/chemistry , Alkaloids/pharmacology , Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacology , Cell Cycle Checkpoints/drug effects , Colonic Neoplasms/drug therapy , Alkaloids/therapeutic use , Animals , Antineoplastic Agents/therapeutic use , Apoptosis/drug effects , Cell Proliferation/drug effects , Colonic Neoplasms/metabolism , Colonic Neoplasms/pathology , Drug Discovery , Humans
3.
Cancer Sci ; 112(7): 2915-2920, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1294969

ABSTRACT

Adjuvant chemotherapy has reduced the risk of tumor recurrence and improved survival in patients with resected colorectal cancer. Potential utility of circulating tumor DNA (ctDNA) prior to and post surgery has been reported across various solid tumors. We initiated a new type of adaptive platform trials to evaluate the clinical benefits of ctDNA analysis and refine precision adjuvant therapy for resectable colorectal cancer, named CIRCULATE-Japan including three clinical trials. The GALAXY study is a prospectively conducted large-scale registry designed to monitor ctDNA for patients with clinical stage II to IV or recurrent colorectal cancer who can undergo complete surgical resection. The VEGA trial is a randomized phase III study designed to test whether postoperative surgery alone is noninferior to the standard therapy with capecitabine plus oxaliplatin for 3 months in patients with high-risk stage II or low-risk stage III colon cancer if ctDNA status is negative at week 4 after curative surgery in the GALAXY study. The ALTAIR trial is a double-blind, phase III study designed to establish the superiority of trifluridine/tipiracil as compared with placebo in patients with resected colorectal cancer who show circulating tumor-positive status in the GALAXY study. Therefore, CIRCULATE-Japan encompasses both "de-escalation" and "escalation" trials for ctDNA-negative and -positive patients, respectively, and helps to answer whether measuring ctDNA postoperatively has prognostic and/or predictive value. Our ctDNA-guided adaptive platform trials will accelerate clinical development toward further precision oncology in the field of adjuvant therapy. Analysis of ctDNA status could be utilized as a predictor of risk stratification for recurrence and to monitor the effectiveness of adjuvant chemotherapy. ctDNA is a promising, noninvasive tumor biomarker that can aid in tumor monitoring throughout disease management.


Subject(s)
Circulating Tumor DNA/blood , Colorectal Neoplasms/blood , Neoplasm Recurrence, Local/blood , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Capecitabine/administration & dosage , Chemotherapy, Adjuvant , Colonic Neoplasms/blood , Colonic Neoplasms/genetics , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Double-Blind Method , Humans , Japan , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Oxaliplatin/administration & dosage , Prospective Studies , Pyrrolidines/administration & dosage , Thymine/administration & dosage , Trifluridine/administration & dosage
4.
JAMA Netw Open ; 3(12): e2030072, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1051185

ABSTRACT

Importance: Resource limitations because of pandemic or other stresses on infrastructure necessitate the triage of time-sensitive care, including cancer treatments. Optimal time to treatment is underexplored, so recommendations for which cancer treatments can be deferred are often based on expert opinion. Objective: To evaluate the association between increased time to definitive therapy and mortality as a function of cancer type and stage for the 4 most prevalent cancers in the US. Design, Setting, and Participants: This cohort study assessed treatment and outcome information from patients with nonmetastatic breast, prostate, non-small cell lung (NSCLC), and colon cancers from 2004 to 2015, with data analyzed January to March 2020. Data on outcomes associated with appropriate curative-intent surgical, radiation, or medical therapy were gathered from the National Cancer Database. Exposures: Time-to-treatment initiation (TTI), the interval between diagnosis and therapy, using intervals of 8 to 60, 61 to 120, 121 to 180, and greater than 180 days. Main Outcomes and Measures: 5-year and 10-year predicted all-cause mortality. Results: This study included 2 241 706 patients (mean [SD] age 63 [11.9] years, 1 268 794 [56.6%] women, 1 880 317 [83.9%] White): 1 165 585 (52.0%) with breast cancer, 853 030 (38.1%) with prostate cancer, 130 597 (5.8%) with NSCLC, and 92 494 (4.1%) with colon cancer. Median (interquartile range) TTI by cancer was 32 (21-48) days for breast, 79 (55-117) days for prostate, 41 (27-62) days for NSCLC, and 26 (16-40) days for colon. Across all cancers, a general increase in the 5-year and 10-year predicted mortality was associated with increasing TTI. The most pronounced mortality association was for colon cancer (eg, 5 y predicted mortality, stage III: TTI 61-120 d, 38.9% vs. 181-365 d, 47.8%), followed by stage I NSCLC (5 y predicted mortality: TTI 61-120 d, 47.4% vs 181-365 d, 47.6%), while survival for prostate cancer was least associated (eg, 5 y predicted mortality, high risk: TTI 61-120 d, 12.8% vs 181-365 d, 14.1%), followed by breast cancer (eg, 5 y predicted mortality, stage I: TTI 61-120 d, 11.0% vs. 181-365 d, 15.2%). A nonsignificant difference in treatment delays and worsened survival was observed for stage II lung cancer patients-who had the highest all-cause mortality for any TTI regardless of treatment timing. Conclusions and Relevance: In this cohort study, for all studied cancers there was evidence that shorter TTI was associated with lower mortality, suggesting an indirect association between treatment deferral and mortality that may not become evident for years. In contrast to current pandemic-related guidelines, these findings support more timely definitive treatment for intermediate-risk and high-risk prostate cancer.


Subject(s)
Antineoplastic Protocols , Breast Neoplasms , Colonic Neoplasms , Lung Neoplasms , Prostatic Neoplasms , Time-to-Treatment , Aged , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Breast Neoplasms/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Colonic Neoplasms/mortality , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Databases, Factual/statistics & numerical data , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Male , Middle Aged , Mortality , Neoplasm Staging , Prognosis , Prostatic Neoplasms/mortality , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data , United States/epidemiology
5.
BMJ Case Rep ; 13(12)2020 Dec 13.
Article in English | MEDLINE | ID: covidwho-975662

ABSTRACT

Multiple lymphomatous polyposis (MLP) is a rare condition, described in the literature as a presentation of extranodal mantle cell lymphoma. We report a rare case of follicular lymphoma presenting as MLP in a young woman with a short history of haematochezia who underwent colonoscopy. Immunohistochemistry on colonic biopsies confirmed follicular lymphoma. Microscopic examination found an extensive and dense lymphoid infiltrate, which demonstrated a follicular growth pattern. The neoplastic cells were positive with BCL2, BCL6, CD10 and CD20, and were negative with CD3, CD5, Cyclin D1 and SOX11. CT staging showed disseminated lymphadenopathy and the patient was commenced on chemotherapy. Endoscopic evaluation and histopathological analysis are vital for the accurate diagnosis of MLP. Our case demonstrates that follicular lymphoma should be considered as a differential, as not all cases of diffuse colonic MLP are related to mantle cell lymphoma. This distinction must be made to provide the best clinical management for the patient.


Subject(s)
Colonic Neoplasms/complications , Lymphoma, Follicular/complications , Antineoplastic Agents/therapeutic use , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Colonoscopy , Diagnosis, Differential , Female , Humans , Intestinal Polyposis , Lymphoma, Follicular/diagnosis , Lymphoma, Follicular/pathology , Lymphoma, Follicular/therapy , Middle Aged , Tomography, X-Ray Computed
6.
Eur J Cancer Care (Engl) ; 29(6): e13309, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-780845

ABSTRACT

INTRODUCTION: Today, COVID-19 pandemic is still the most critical problem in the global health agenda. Since the awareness of the public in general and particularly awareness of those with comorbidities, such as cancer, determine the rate of mortality, the primary goal of this study was to assess the knowledge, perceptions and attitude of the patients with cancer towards the COVID-19 pandemic. The secondary objective of this study was also to measure the effect of COVID-19 on cancer patients' ongoing treatments. METHODS: This study recruited 300 oncology patients through an outpatient community-based oncology clinic in one of the 30 major cities of Turkey, which had taken a lockdown at weekends during April 2020. A questionnaire measuring the knowledge, attitudes and preventive behaviour was completed by each patient either face-to-face or through telephone survey. RESULTS: In general, participants had a positive attitude towards protective measures. No delay for current cancer treatments or appointments has been observed in 98% of patients. More than half of the patients(52.3%) were using some kind of nutritional supplement to increase their body resistance. Nearly two-third of patients could not identify the three most common symptoms of COVID-19 (fever, cough, dyspnoea), and half of them were not aware of the routes of transmission (by contact and droplets). It was observed that patients with stage 1 cancer were tend to stay at home, while patients with stage 4 cancer were prone to leave their houses for the hospital at a higher ratio. The rate of people leaving houses was significantly higher for male patients and for patients with a university degree, whereas patients who were older than 65 were tend to go only to the hospital when they leave their houses. CONCLUSION: This study suggests that routine follow-up and guidance for cancer patients seems to provide significant benefit to increase the knowledge and awareness of patients with cancer.


Subject(s)
COVID-19/prevention & control , Hand Disinfection , Health Knowledge, Attitudes, Practice , Masks , Neoplasms/therapy , Adult , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Cross-Sectional Studies , Dietary Supplements , Educational Status , Female , Humans , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Male , Middle Aged , Neoplasm Staging , Neoplasms/pathology , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Surveys and Questionnaires , Transportation , Turkey , Young Adult
7.
BMC Gastroenterol ; 20(1): 269, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-713369

ABSTRACT

BACKGROUND: Cancer patients are at increased risk of novel coronavirus disease 2019 (COVID-19). Currently, surgeries for cancer patients with COVID-19 are generally suggested to be properly delayed. CASE PRESENTATION: We presented a 69-year-old Chinese female colon cancer patient with COVID-19, the first case accepted the surgical treatment during the pandemic in China. The patient developed a fever on January 28, 2020. After treatments with Ceftriaxone and Abidol, her fever was not moderated yet. A repeat chest computed tomography (CT) scan showed significantly exacerbated infectious lesions with a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. An abdomen CT scan indicated the tumor of ascending colon with local wrapped changes. She was diagnosed with 'Severe novel coronavirus pneumonia' and 'Incomplete bowel obstruction: Colon cancer?'. After actively anti-inflammatory and anti-viral therapies, a right colectomy with lymph node dissection was performed on March 11, followed by a pathological examination. The patient successfully recovered from COVID-19 pneumonia and incomplete bowel obstruction after surgery without any postoperative related complications and was discharged on the 9th day after operation. Significant degeneration, necrosis and slough of focal intestinal and colonic mucosal epithelial cells were observed under microscope. No surgeons, nurses or anesthetists in our team were infected with SARS-CoV-2. CONCLUSIONS: It is meaningful and imperative to share our experience of protecting health care personnels from SARS-CoV-2 infection and providing references for optimizing treatment of cancer patients, at least for the operative intervention with absolute necessity or surgical emergency, during the outbreak of COVID-19.


Subject(s)
Betacoronavirus/isolation & purification , Colectomy/methods , Colonic Neoplasms , Coronavirus Infections , Pandemics , Pneumonia, Viral , Aged , COVID-19 , Colon, Ascending/diagnostic imaging , Colon, Ascending/pathology , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Colonic Neoplasms/physiopathology , Colonic Neoplasms/surgery , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Female , Humans , Infection Control/methods , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Treatment Outcome
9.
J Gastrointest Surg ; 25(1): 252-259, 2021 01.
Article in English | MEDLINE | ID: covidwho-505757

ABSTRACT

BACKGROUND: The purpose of this study was to develop and validate a prediction model and clinical risk score for Intensive Care Resource Utilization after colon cancer surgery. METHODS: Adult (≥ 18 years old) patients from the 2012 to 2018 ACS-NSQIP colectomy-targeted database who underwent elective colon cancer surgery were identified. A prediction model for 30-day postoperative Intensive Care Resource Utilization was developed and transformed into a clinical risk score based on the regression coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The model was validated in a separate test set of similar patients. RESULTS: In total, 54,893 patients underwent an elective colon cancer resection, of which 1224 (2.2%) required postoperative Intensive Care Resource Utilization. The final prediction model retained six variables: age (≥ 70; OR 1.90, 95% CI 1.68-2.14), sex (male; OR 1.73, 95% CI 1.54-1.95), American Society of Anesthesiologists score (III/IV; OR 2.52, 95% CI 2.15-2.95), cardiorespiratory disease (yes; OR 2.22, 95% CI 1.94-2.53), functional status (dependent; OR 2.81, 95% CI 2.22-3.56), and operative approach (open surgery; OR 1.70, 95% CI 1.51-1.93). The model demonstrated good discrimination (AUC = 0.73). A clinical risk score was developed, and the risk of requiring postoperative Intensive Care Resource Utilization ranged from 0.03 (0 points) to 19.0% (8 points). The model performed well on test set validation (AUC = 0.73). CONCLUSION: A prediction model and clinical risk score for postoperative Intensive Care Resource Utilization after colon cancer surgery was developed and validated.


Subject(s)
COVID-19 , Colectomy , Colonic Neoplasms/surgery , Critical Care/statistics & numerical data , Intensive Care Units/statistics & numerical data , Patient Selection , Postoperative Complications/epidemiology , Adult , Age Factors , Aged , Clinical Decision Rules , Colonic Neoplasms/pathology , Comorbidity , Databases, Factual , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Neoadjuvant Therapy , Postoperative Complications/therapy , Proof of Concept Study , ROC Curve , Reproducibility of Results , Risk Assessment , Risk Factors , SARS-CoV-2 , Sex Factors
10.
Diagn Interv Imaging ; 101(6): 347-353, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-108794

ABSTRACT

The COVID-19 pandemic has deeply impacted the activity of interventional oncology in hospitals and cancer centers. In this review based on official recommendations of different international societies, but also on local solutions found in different expert large-volume centers, we discuss the changes that need to be done for the organization, safety, and patient management in interventional oncology. A literature review of potential solutions in a context of scarce anesthesiologic resources, limited staff and limited access to hospital beds are proposed and discussed based on the literature data.


Subject(s)
Betacoronavirus , Cancer Care Facilities/organization & administration , Coronavirus Infections/epidemiology , Neoplasms/therapy , Pandemics , Pneumonia, Viral/epidemiology , Aerosols , Age Factors , Anesthesia, General , Anesthesiology/statistics & numerical data , Biopsy/adverse effects , Biopsy/methods , COVID-19 , COVID-19 Testing , Carcinoma, Hepatocellular/therapy , Carcinoma, Renal Cell/therapy , Chemoembolization, Therapeutic/methods , Clinical Laboratory Techniques/methods , Colonic Neoplasms/pathology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Databases, Factual , Health Personnel/statistics & numerical data , Health Resources/organization & administration , Health Resources/supply & distribution , Hospital Bed Capacity/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Hyperthermia, Induced/methods , Kidney Neoplasms/therapy , Liver Neoplasms/therapy , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Neoplasms/complications , Palliative Care/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , SARS-CoV-2 , Triage
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