Background
Despite improvements in the multimodality treatment for patients with locally recurrent rectal cancer (LRRC), oncological outcomes remain poor. This study evaluated the effect of induction ...chemotherapy and subsequent chemo(re)irradiation on the pathologic response and the rate of resections with clear margins (R0 resection) in relation to long-term oncological outcomes.
Methods
All consecutive patients with LRRC treated in the Catharina Hospital Eindhoven who underwent a resection after treatment with induction chemotherapy and subsequent chemo(re)irradiation between January 2010 and December 2018 were retrospectively reviewed. Induction chemotherapy consisted of CAPOX/FOLFOX. Endpoints were pathologic response, resection margin and overall survival (OS), disease free survival (DFS), local recurrence free survival (LRFS), and metastasis free survival (MFS).
Results
A pathologic complete response was observed in 22 patients (17%), a “good” response (Mandard 2–3) in 74 patients (56%), and a “poor” response (Mandard 4–5) in 36 patients (27%). An R0 resection was obtained in 83 patients (63%). The degree of pathologic response was linearly correlated with the R0 resection rate (
p
= 0.026). In patients without synchronous metastases, pathologic response was an independent predictor for LRFS, MFS, and DFS (
p
= 0.004,
p
= 0.003, and
p
= 0.024, respectively), whereas R0 resection was an independent predictor for LRFS and OS (
p
= 0.020 and
p
= 0.028, respectively).
Conclusions
Induction chemotherapy in addition to neoadjuvant chemo(re)irradiation is a promising treatment strategy for patients with LRRC with high pathologic response rates that translate into improved oncological outcomes, especially when an R0 resection has been achieved.
Aim
Patients with locally recurrent rectal cancer (LRRC) frequently present with either synchronous metastases or a history of metastases. This study was conducted to evaluate whether LRRC patients ...without metastases have a different oncological outcome compared to patients with a history of metastases treated with curative intent or patients with potentially curable synchronous metastases.
Method
All consecutive LRRC patients who underwent intentionally curative surgery between 2005 and 2017 in a large tertiary hospital were retrospectively reviewed and categorized as having no metastases, a history of (curatively treated) metastases or synchronous metastases. Patients with unresectable distant metastases were excluded from the analysis.
Results
Of the 349 patients who were analysed, 261 (75%) had no metastases, 42 (12%) had a history of metastases and 46 (13%) had synchronous metastases. The 3‐year metastasis‐free survival was 52%, 33% and 13% in patients without metastases, with a history of metastases, and with synchronous metastases, respectively (P < 0.001) A history of metastases did not influence overall survival (OS), but there was a trend towards a worse OS in patients with synchronous metastases compared with patients without synchronous metastases (hazard ratio 1.43; 95% CI 0.98–2.11).
Conclusion
LRRC patients with a history of curatively treated metastases have an OS comparable to that in patients without metastases and should therefore be treated with curative intent. However, LRRC patients with synchronous metastases have a poor metastasis‐free survival and worse OS; in these patients, an individualized treatment approach to observe the behaviour of the disease is recommended.
Background
A significant number of patients treated for locally recurrent rectal cancer have local or systemic failure, especially after incomplete surgical resection. Neoadjuvant treatment regimens ...in patients who have already undergone preoperative (chemo)radiotherapy for the primary tumour are limited. The objective of the present study was to evaluate the influence of a neoadjuvant regimen incorporating induction chemotherapy (ICT) in patients with locally recurrent rectal cancer who had preoperative (chemo)radiotherapy for the primary cancer or an earlier local recurrence.
Methods
Patients were treated with a sequential neoadjuvant regimen including three or four cycles of 5‐fluorouracil and oxaliplatin‐containing chemotherapy. When no progressive disease was found at evaluation, neoadjuvant treatment was continued with chemoradiation therapy (CRRT) using 30 Gy with concomitant capecitabine. If there was a response to ICT, the patient was advised to continue with systemic chemotherapy after CRRT as consolidation chemotherapy while waiting for resection. These patients were compared with patients who received CRRT alone in the same time interval.
Results
Of 58 patients who had ICT, 32 (55 per cent) had surgery with clear resection margins, of whom ten (17 per cent) exhibited a pathological complete response (pCR). The remaining 26 patients had 23 R1 and three R2 resections. In 71 patients who received CRRT, a similar rate of R0 (35 patients) and R1 (36) resection was found (P = 0·506), but only three patients (4 per cent) had a pCR (P = 0·015).
Conclusion
The incorporation of ICT in neoadjuvant regimens for locally recurrent rectal cancer is a promising strategy.
Promising responses
Real-life human eating behaviour does not take place in a vacuum, rather it happens in context. The context in which consumers eat their foods influences the acceptance of the consumed foods. ...Consequently, consumers’ hedonic and sensory ratings elicited in a natural consumption context will differ from those elicited under controlled sensory laboratory conditions. Moreover, foods are rarely consumed on one single occasion but are typically consumed repeatedly and ratings may change over repeated consumptions as well.
Often, consumer acceptance is tested explicitly, for example with liking ratings, especially when the testing is done outside the laboratory. Implicit tests such as facial expressions and physiological measurements of the autonomic nervous system can provide additional information on consumer acceptance. As a result of technological advantages, such tests are no longer limited to the laboratory but can also be used in natural consumption contexts.
Eighteen healthy Dutch consumers (18–65 years of age) tested four test foods plus a warm-up sample ten times on consecutive weekdays and on similar hours using their own laptop and webcam. Test locations alternated between the sensory laboratory and the participant’s own home. Explicit measures included liking scores and scores on ten sensory taste/flavour/texture attributes, and implicit measures included facial expressions, heart rate and consumption duration using Face ReaderTM. This study was the first to validate the Face ReaderTM for usage at home.
The liking scores and sensory profiles varied between test foods (p < 0.05), but not between test locations and only some specific sensory attributes showed systematic variation over repeated consumption. In contrast, implicit measures showed systematic effects of test foods, test locations, and repeated consumptions (p < 0.05). Compared to consumption in the laboratory, consumption at home was faster, triggered higher heart rates, and triggered more intense facial expressions of happiness, contempt, disgust and boredom.
Implicit tests were more sensitive to effects of test location and repeated consumption than explicit tests. Additional research is required to investigate the relevance of these measures to long term consumer acceptance of food products.
OBJECTIVE:To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy.
BACKGROUND:The PelvEx Collaborative provides large volume data from ...specialist centers to ascertain factors associated with improved outcomes.
METHODS:Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality.
RESULTS:One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23–85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma.
CONCLUSION:Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%–59%) reflects the diversity of tumor types.
Background
Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques ...in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.
Methods
A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.
Results
Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (
n
= 133) had open pelvic exenteration, while 21.8% (
n
= 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (
p
< 0.001), it was associated with a median of 1,750mls less blood loss. The morbidity rate for MIS exenterative group was 56.7% (
n
= 21/37) versus 88.5% (
n
= 85/96) in the open exenteration group, with pooled analysis observing a 1.17 relative risk increase in 30-day morbidity (
p
= 0.172) in the open exenteration group. In addition, the MIS cohort had a 6-day shorter length of hospital stay (
p
= 0.04).
Conclusion
MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.
Background
Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The ...aim of this study was to compare outcomes of exenteration over time.
Methods
This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher‐ and lower‐volume centres were also evaluated.
Results
Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3·5 to 12·8 per cent, and from 12·0 to 29·4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0·040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower‐ and higher‐volume centres. R0 resection rates significantly increased in low‐volume centres but not in high‐volume centres over time (low‐volume: from 62·5 to 80·0 per cent, P = 0·001; high‐volume: from 83·5 to 88·4 per cent, P = 0·660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2·5 units (P < 0·001). R0 resection rates did not increase in either low‐volume (from 51·7 to 60·4 per cent; P = 0·610) or higher‐volume (from 48·6 to 65·5 per cent; P = 0·100) centres. No significant differences in length of hospital stay, 30‐day complication, reintervention or mortality rates were observed over time.
Conclusion
Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.
An analysis of an international registry database, evaluating differences in outcomes following pelvic exenteration over a 10‐year time period.
Still significant major morbidity but increasing rate of radical resections over time
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