Dynamic soluble changes in sVEGFR1, HGF, and VEGF promote chemotherapy and bevacizumab resistance: A prospective translational study in the BECOX (GEMCAD 09-01) trial.

Despite initial responsiveness, acquired resistance to both bevacizumab and chemotherapy in metastatic colorectal cancer is universal. We have recently published that in vitro, chronically oxaliplatin resistance upregulates soluble vascular endothelial growth factor receptor 1, downregulates vascular endothelial growth factor, and also promotes c-MET, b-catenin/transcription factor 4, and AKT activation. We tested whether variation in three serum biomarkers such as the natural c-MET ligand (hepatocyte growth factor), soluble vascular endothelial growth factor receptor 1, and vascular endothelial growth factor-A was associated with efficacy in metastatic colorectal cancer patients treated in the prospective BECOX study. Serum levels of vascular endothelial growth factor-A165, soluble vascular endothelial growth factor receptor 1, and hepatocyte growth factor were assessed by enzyme-linked immunosorbent assay method basally and every 3 cycles (at the time of computed tomography evaluation) in a preplanned translational study in the first-line BECOX trial in metastatic colorectal cancer patients treated with CAPOX plus bevacizumab. Response was evaluated by routine contrast-enhanced computed tomography by RECIST 1.1 by investigator assessment and by three blinded independent radiologists. Ratios between soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A and hepatocyte growth factor/vascular endothelial growth factor-A were established and variations through time were related to RECIST 1.1 by investigator assessment and independent radiologist. The BECOX trial included 68 patients, and 27 patients were analyzed in the translational trial. A total of 80 RECIST 1.1 evaluations were done by investigator assessment and 56 by independent radiologist. We found that a 3.22-fold increase in soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A by investigator assessment and a 3.06-fold increase in soluble vascular endothelial growth factor receptor 1/vascular endothelial growth factor-A by independent radiologist from previous determination were associated with responses compared with 1.38-fold increase by investigator assessment and 1.59 by independent radiologist in non-responders (p = 0.0009 and p = 0.03, respectively). Responders had a 3.36-fold increase in hepatocyte growth factor/vascular endothelial growth factor-A from previous determination by investigator assessment and 3.66-fold increase in hepatocyte growth factor/vascular endothelial growth factor-A by independent radiologist compared with 1.43-fold increase by investigator assessment and 1.53 by independent radiologist for non-responders (p = 0.002 and 0.003, respectively). In conclusion, a decrease in vascular endothelial growth factor-A and an increase in soluble vascular endothelial growth factor receptor 1 during chemotherapy and bevacizumab exposure can contribute to both chemotherapy (due to c-MET/b-catenin activation) and bevacizumab (due to low vascular endothelial growth factor requirements) resistance. Because hepatocyte growth factor levels decrease also during acquired resistance, alternative strategies to hepatocyte growth factor-ligand inhibition should be investigated.

SEOM/SERAM consensus statement on radiological diagnosis, response assessment and follow-up in colorectal cancer

Colorectal cancer (CRC) is one of the world’s most common cancers, and has one of the highest mortality rates. The last few decades have seen great progress in preventing, diagnosing and treating this disease, providing undeniable impact on patients’ prognosis and quality of life. At all these stages of CRC management, imaging techniques play an essential role. This article reviews some important issues concerning the use of various radiological techniques in the screening, diagnosis, staging, assessment of treatment response, and follow-up of patients with CRC. It also includes a number of practical recommendations on indications for use, technical requirements, minimum information required in the radiology report, evaluation criteria for the response to various drugs, and the recommended frequency at which different examinations should be performed. This consensus statement is the result of cooperation between the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Radiology (SERAM) (AU)

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SEOM/SERAM consensus statement on radiological diagnosis, response assessment and follow-up in colorectal cancer.

Colorectal cancer (CRC) is one of the world's most common cancers, and has one of the highest mortality rates. The last few decades have seen great progress in preventing, diagnosing and treating this disease, providing undeniable impact on patients' prognosis and quality of life. At all these stages of CRC management, imaging techniques play an essential role. This article reviews some important issues concerning the use of various radiological techniques in the screening, diagnosis, staging, assessment of treatment response, and follow-up of patients with CRC. It also includes a number of practical recommendations on indications for use, technical requirements, minimum information required in the radiology report, evaluation criteria for the response to various drugs, and the recommended frequency at which different examinations should be performed. This consensus statement is the result of cooperation between the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Radiology (SERAM).

Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease.

BACKGROUND: Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), are increasingly used for evaluation of Crohn's disease (CD). Aim To perform an assessment of the diagnostic accuracy of cross-sectional imaging techniques for diagnosis of CD, evaluation of disease extension and activity and diagnosis of complications, and to provide recommendations for their optimal use. METHODS: Relevant publications were identified by literature search and selected based on predefined quality parameters, including a prospective design, sample size and reference standard. A total of 68 publications were chosen. RESULTS: Ultrasonography is an accurate technique for diagnosis of suspected CD and for evaluation of disease activity (sensitivity 0.84, specificity 0.92), is widely available and non-invasive, but its accuracy is lower for disease proximal to the terminal ileum. MRI has a high diagnostic accuracy for the diagnosis of suspected CD and for evaluation of disease extension and activity (sensitivity 0.93, specificity 0.90), and is less dependent on the examiner and disease location compared with US. CT has a similar accuracy to MRI for assessment of disease extension and activity. The three techniques have a high accuracy for identification of fistulas, abscesses and stenosis (sensitivities and specificities >0.80), although US has false positive results for abscesses. As a result of the lack of radiation, US or MRI should be preferred over CT, particularly in young patients. CONCLUSIONS: Cross-sectional imaging techniques have a high accuracy for evaluation of suspected and established CD, reliably measure disease severity and complications; they may offer the possibility to monitor disease progression.

Caso de abdomen presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

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[Vascular graft-associated infection: successful management without graft removal]. / Infección asociada a prótesis vascular: manejo exitoso sin retirada de prótesis.

INTRODUCTION: Removal of graft with intravenous antibiotics is traditionally considered the most effective treatment of vascular graft-associated infections. However, an increasing number of reports suggests that this complication can be effectively treated without graft removal. METHODS: A prospective study to evaluate the outcome of conservative management of vascular graft-associated infection seen in our center was performed. The diagnosis of graft-associated infection was based on microbiological tests, and imaging studies. In our study, patients were hemodynamically stable with functioning vascular graft as per clinical and imaging evaluations. Conservative management included antibiotic treatment and local debridement without removal of vascular graft. RESULTS: Fourteen patients with vascular graft-associated infection were enrolled in our study. Eleven out of 14 patients (78.6%) responded successfully to conservative management. Treatment failure was reported in 3 patients, 2 of whom required graft removal. After a two-year follow-up, these 14 patients were clinically stable without recurrence of infection. CONCLUSIONS: Our study has revealed that conservative management of vascular graft-associated infection seems to be effective and should be considered in hemodynamically stable patients with functioning vascular graft.

Infección asociada a prótesis vascular: manejo exitoso sin retirada de prótesis / Vascular graft-associated infection: successful management without graft removal

Introducción. La retirada de prótesis con administración de antibióticos endovenosos es tradicionalmente considerada la forma más efectiva para tratar las infecciones asociadas a prótesis vasculares, sin embargo, un incrementado número de trabajos sugieren que esta complicación puede ser efectivamente tratada sin retirar la prótesis. Métodos. Se realiza un estudio prospectivo para evaluar la evolución de manejo conservador de infecciones asociadas a prótesis vasculares vistas en nuestro centro. El diagnóstico de infección asociada a prótesis fue basada en pruebas microbiológicas y en estudios de imagen. En nuestro estudio, los pacientes estuvieron hemodinámicamente estables con buen funcionamiento del injerto demostrado por evaluaciones clínicas y pruebas de imagen. El manejo conservador incluyó tratamiento antibiótico y desbridamiento local sin retirada de la prótesis vascular. Resultados. Incluimos a 14 pacientes con infección asociada a injerto vascular en nuestro estudio. Once de los 14 pacientes (78,6%) respondieron exitosamente al manejo conservador. Observamos fallo en el tratamiento en tres pacientes, dos de los cuales requirieron retirada del injerto. Después de un seguimiento de dos años, todos estos pacientes permanecen estables clínicamente y sin recidiva de la infección. Conclusiones. Como conclusión, nuestro estudio revela que el manejo conservador de prótesis vasculares infectadas parece ser eficaz y debería ser considerado en los pacientes estables hemodinámicamente con buen funcionamiento de la prótesis (AU)

Introduction. Removal of graft with intravenous antibiotics is traditionally considered the most effective treatment of vascular graft-associated infections. However, an increasing number of reports suggests that this complication can be effectively treated without graft removal. Methods. A prospective study to evaluate the outcome of conservative management of vascular graft-associated infection seen in our center was performed. The diagnosis of graft-associated infection was based on microbiological tests, and imaging studies. In our study, patients were hemodynamically stable with functioning vascular graft as per clinical and imaging evaluations. Conservative management included antibiotic treatment and local debridement without removal of vascular graft. Results. Fourteen patients with vascular graft-associated infection were enrolled in our study. Eleven out of 14 patients (78.6%) responded successfully to conservative management. Treatment failure was reported in 3 patients, 2 of whom required graft removal. After a two-year follow-up, these 14 patients were clinically stable without recurrence of infection. Conclusions. Our study has revealed that conservative management of vascular graft-associated infection seems to be effective and should be considered in hemodynamically stable patients with functioning vascular graft (AU)

Trisomía parcial del cromosoma 5p / Partial trisomy of chromosome 5p

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Pseudoaneurisma micótico por Mycobacterium tuberculosis / Mycotic pseudoaneurysm by Mycobacterium tuberculosis

La tuberculosis puede afectar a cualquier órgano de la economía, incluidas las arterias. Habitualmente esta afectación se produce por contigüidad de la arteria a un foco infeccioso adyacente, originándose fundamentalmente pseudoaneurismas.Describimos un caso de pseudoaneurisma tuberculoso de arteria ilíaca en probable relación con una peritonitis tuberculosa, que debutó como fiebre de origen desconocido. El diagnóstico de pseudoaneurisma se fundamentó en CT, confirmándose mediante estudio anatomopatológico y microbiológico obtenido en una primera intervención quirúrgica. A pesar del tratamiento tuberculostático, el paciente presentó rotura del pseudoa neurisma, lo que obligó a implantar un injerto. Creemos que no debe olvidarse la posibilidad de una afectación tuberculosa en un aneurisma micótico (AU)

[Mycotic pseudoaneurysm caused by Mycobacterium tuberculosis]. / Pseudoaneurisma micótico por Mycobacterium tuberculosis.

Mycobacterium tuberculosis can involve any organ of the body, including the arteries. Usually the mycobacteria infects the arterial wall spreading from a contiguous foci. We report a case of tuberculous pseudoaneurysm involving the iliac artery clinically manifested as fever of unknown origin. The diagnosis relied on abdominal CT-scanning. Tuberculous etiology was confirmed postoperatively by microbiologic and microscopic study. The antituberculous therapy was early started, but the patient died three months later as a consequence of a non-infectious abdominal aortic rupture. Clinicians should consider tuberculous etiology when the diagnosis of mycotic pseudoaneurysm is being entertained.