Efficacy of Cetuximab in Combination with FOLFIRI in a Patient with KRAS Wild-Type Metastatic Anal Cancer.

Anal canal cancer is a rare tumor without clear treatment evidence in the metastatic setting. In terms of the bad prognosis of patients with metastatic anal cancer, further therapeutic options are urgently needed. In this paper we present the case of a 64-year-old man suffering from undifferentiated squamous cell carcinoma with liver metastases. After progression on cisplatin and fluorouracil, tumor tissue was analyzed with respect to anti-EGFR therapy with cetuximab. There was no KRAS mutation and the EGFR expression level in the tumor tissue was 2+; ideal conditions for the immunotherapy. Encouraged by these results we started a therapy using FOLFIRI in combination with cetuximab. Fortunately the patient showed a partial response after 6 cycles. On patient's preference we did a therapy break of 6 weeks. Within this time period the disease was progressive indicating its aggressiveness. However, the same immunotherapy was able to stabilize the disease for a further 3 months. The patient died 21 months after diagnosis because of liver failure. Nevertheless, from our perspective the combination of FOLFIRI and cetuximab is quite a promising therapeutic option for patients with metastatic anal cancer. Potential predictive factors of the immunochemotherapy are discussed in this paper.

Improvement of quality of life after surgery on the thoracic aorta: effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest.

BACKGROUND: We have recently demonstrated that the use of deep hypothermic circulatory arrest (DHCA) during surgery for acute type A aortic dissections or thoracic aortic aneurysms adversely affect mid-term quality of life (QoL). The aim of this study is to assess the impact of DHCA duration and the potential effects of antegrade cerebral perfusion (ACP) on mid-term QoL. METHODS AND RESULTS: Between January 1994 and December 2002, 363 patients underwent surgery of the thoracic aorta with the use of DHCA at our institution. One hundred seventy-six (48.5%) presented with acute type A dissections and 187 (51.5%) presented with aortic aneurysms. ACP was used in 41 (11.3%) cases. All in-hospital data were assessed and a follow-up was performed in all survivors after 2.4+/-1.2 years. QoL was analyzed with the Short-Form 36 Health Survey Questionnaire (SF-36). In-hospital mortality was 8.6%. In comparison with patients having undergone DHCA <20 minutes, averaged QoL score was significantly decreased in patients with DHCA between 20 and 34 minutes (95.6+/-12.8 versus 81.9+/-15.7; P<0.01) and >35 minutes (61.8+/-18.3; P<0.01). Averaged QoL score was significantly better with the use of ACP, independently of the duration of DHCA. CONCLUSIONS: DHCA duration >20 minutes, and especially >35 minutes, adversely affects mid-term QoL in patients undergoing surgery of the thoracic aorta. The use of ACP, however, improved averaged QoL score at each time period and allows DHCA to be extended up to 30 minutes, without impairment in mid-term QoL.

Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?

OBJECTIVES: Risk-stratification in cardiac surgical procedures is of major interest. Recent studies have shown, that the EuroSCORE is a very good and reliable risk-stratification score in CABG and in valve surgery. The aim of the study was to evaluate the EuroSCORE in patients undergoing surgery on the thoracic aorta. METHODS: Three hundred and sixty-seven consecutive patients underwent surgery of the thoracic aorta and were scored, according to the additive and logistic EuroSCORE algorithm. We compared correlation of predicted and observed mortality and evaluated a modification of the EuroSCORE in order to improve the scoring system. Score validity was assessed by calculating the area under the receiver operating characteristic curve (ROC). RESULTS: Overall hospital mortality was 10.1%. Additive EuroSCORE predicted mortality was 2.3% for 3-6% risk, 12.9% for 7-8% risk, 18.4% for 9-12% risk and 27.3% for a risk >12%. The modified score predicted mortality was 1% for 3-6% risk, 8.2% for 7-8% risk, 12.1% for 9-14% risk, 18.6% for 15-24% risk and 28.6% for a risk >24%. Area under the ROC-curve was 0.68 for the EuroScore and 0.91 in the modified score, 0.72 and 0.86 in the logistic model. CONCLUSIONS: The modified score, taking into account aortic dissection (6 points) and preoperative malperfusion (12 points) significantly improves the predictive value of the EuroSCORE in patients undergoing thoracic aortic surgery.

Effects of deep hypothermic circulatory arrest on outcome after resection of ascending aortic aneurysm.

BACKGROUND: Aneurysm of the ascending aorta is a common finding especially in patients with aortic valve diseases. The aim of this study was to analyze early and midterm outcome in patients operated on for aneurysm of the ascending aorta with or without the use of deep hypothermic circulatory arrest (DHCA). METHODS: Between January 1996 and December 2000, 133 of 410 patients with thoracic aortic pathology were operated on for an aortic aneurysm limited mainly to the ascending aorta. Early and midterm outcomes were assessed and quality of life (QOL) evaluated using the Short-Form 36 Health Survey Questionnaire (SF-36). RESULTS: Sixty patients (group 1) were operated on with DHCA and 73 patients (group 2) without DHCA. In-hospital mortality was identical in both groups (9.6% versus 6.7%; p = not significant) whereas postoperative transient neurologic events were significantly more frequent in group 1 (6.7% versus 0%; p < 0.05). Midterm clinical outcome was not different between groups but QOL showed significant impairment in daily functional physical and emotional activity in group 1 patients compared with group 2 and an age-matched standard population. CONCLUSIONS: The risk of transient neurologic complications is significantly increased with the use of DHCA and QOL is impaired without benefits in the long-term outcome especially among older patients.