ABSTRACT
AIMS: To compare the long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer between stapled anastomosis and intersphincteric resection (ISR). METHODS: A total of 105 of 170 sphincter-preserving patients found to be disease-free and anal functional patients were assessed at 6.5 years (range 2.4-13.0 years) of follow-up after surgery. Of these subjects, 87 (double stapling technique [DST]: 41; ISR: 46) of the 105 patients (82.9%) responded to the questionnaire on the low anterior resection syndrome score (LARS score). RESULTS: The total LARS scores in the DST and ISR groups were not significantly different (Major/Minor/No LARS = 23/14/4 and 31/10/5, p = 0.431). When considering each item of the LARS, ISR was associated with poorer incontinence scores than DST. Conversely, the scores for the frequency of bowel movement, clustering and urgency were not different between the 2 groups. In addition, in the multivariate analysis, the tumor distance from the anal verge and postoperative period was independently associated with Major LARS. CONCLUSION: In this study, we demonstrate the long-term functional outcomes of irradiated lower rectal cancer reconstructed with DST and ISR. Bowel function improves over time; therefore, long-term patient follow-up is important.
Subject(s)
Anal Canal/surgery , Chemoradiotherapy, Adjuvant , Recovery of Function , Rectal Neoplasms/surgery , Rectum/surgery , Adult , Aged , Aged, 80 and over , Anal Canal/physiopathology , Anastomosis, Surgical , Fecal Incontinence/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications , Rectal Neoplasms/physiopathology , Rectal Neoplasms/therapy , Rectum/physiopathology , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: This is the first phase II study to evaluate the efficacy and tolerability of the first-line FOLFIRI, as well as the influence of uridine diphosphate glucuronosyl transferase 1, family polypeptide A1 gene (UGT1A1) 28/6 polymorphism, in Japanese metastatic colorectal cancer patients. METHODS: Fifty-two patients were enrolled in this study and were administrated FOLFIRI (irinotecan; 150 mg/m(2)) as first-line chemotherapy. Thirty-nine patients accepted the evaluation of UGT1A1 genotypes. In patients with UGT1A1 28 homozygosity, the starting dose was reduced (100 mg/m(2)) according to the Food and Drug Administration recommendation and our previous phase I study. RESULTS: After a median follow-up period of 22 months, complete response was achieved in 1.9%, partial response in 38.5 %, stable disease in 51.9% and progressive disease in 3.9%. The overall response rate was 40.4%, the disease control rate was 92.3% and the median overall survival time was 22.3 months. The major toxicity was grade 3-4 neutropenia in 44.2%. There was no definite relation between UGT1A1 28, 6 polymorphisms and toxicity. However, homozygosity for UGT1A1 28 or UGT1A1 6 and double heterozygosity for both UGT1A1 28 and UGT1A1 6 were significantly associated with severe neutropenia in metastatic colorectal cancer patients (P< 0.001). CONCLUSIONS: FOLFIRI is effective and tolerable for Japanese metastatic colorectal cancer patients. Homozygosity for UGT1A1 28 or 6 and heterozygosity for both UGT1A1 28 and 6 are associated with severe neutropenia.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Asian People/genetics , Camptothecin/analogs & derivatives , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/enzymology , Glucuronosyltransferase/genetics , Polymorphism, Single Nucleotide , Topoisomerase I Inhibitors/administration & dosage , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Camptothecin/administration & dosage , Camptothecin/adverse effects , Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , Disease-Free Survival , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Genetic Predisposition to Disease , Heterozygote , Homozygote , Humans , Irinotecan , Japan , Leucovorin/administration & dosage , Male , Middle Aged , Neoplasm Staging , Neutropenia/chemically induced , Neutropenia/diagnosis , Prospective Studies , Severity of Illness Index , Topoisomerase I Inhibitors/adverse effects , Treatment OutcomeABSTRACT
To analyze the root components of compounds causing drug addiction, we have developed our own GC/MS libraries(PESTICID.LIB consisting of 20 pesticides and Herbicides, and DRUG.LIB with 57 drugs). We have usually utilized standardized agents, but gastric contents, gastric specimens, serum and urine samples from patients were also used for the analyses. We were able to add libraries of various difficult to purchase psychotropic drugs and legally restricted agents by extracting them from the patient samples. Comments about the retention time, the base peak of the mass spectrum and 5 typical ion chromatograms in the libraries have been useful for laboratory analysis, and consequently have improved the accuracy of detection and identification. They were also found to be a useful guideline for discrimination of the unchanged materials and the metabolites. We are attempting to improve the accuracy of the library to avoid the effects of GC column conditions such as the column size, column temperature and different inserts by using a retention time index.
