The updated edition of the German, Austrian and Swiss Guidelines for Systemic Treatment of Gastric Cancer was completed in August 2023, incorporating new evidence that emerged after publication of ...the previous edition. It consists of a text-based “Diagnosis” part and a “Therapy” part including recommendations and treatment algorithms. The treatment part includes a comprehensive description regarding perioperative and palliative systemic therapy for gastric cancer and summarizes recommended standard of care for surgery and endoscopic resection. The guidelines are based on a literature search and evaluation by a multidisciplinary panel of experts nominated by the hematology and oncology scientific societies of the three involved countries.
Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated ...consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multimodal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting.
•Summary report of the expert consensus discussion and vote focussed on the primary treatment of gastric and gastro-oesophageal adenocarcinoma.•Expert consensus.•EUS needed in AEG II/III.•Laparoscopy in all gastric cancers and AEG II/III.•FLOT regimen standard in gastric cancer.
Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) causing severe damage of the luminal gastrointestinal tract. Differential diagnosis between both disease entities ...is sometimes awkward requiring a multifactorial pathway, including clinical and laboratory data, radiological findings, histopathology and endoscopy. Apart from disease diagnosis, endoscopy in IBD plays a major role in prediction of disease severity and extent (i.e. mucosal healing) for tailored patient management and for screening of colitis‐associated cancer and its precursor lesions. In this state‐of‐the‐art review, we focus on current applications of endoscopy for diagnosis and surveillance of IBD. Moreover, we will discuss the latest guidelines on surveillance and provide an overview of the most recent developments in the field of endoscopic imaging and IBD.
Background:
Gastric cancer is common malignancy and exhibits a poor prognosis. At the time of diagnosis, the majority of patients present with metastatic disease which precludes curative treatment. ...Non-invasive biomarkers which discriminate early from advanced stages or predict the response to treatment are urgently required. This study explored the cytokeratin-18 fragment M30 and full-length cytokeratin-18 M65 in predicting treatment response and survival in a randomized, placebo-controlled trial of advanced gastric cancer.
Methods:
Patients enrolled in the SUN-CASE study received sunitinib or placebo as an adjunct to standard therapy with leucovorin (Ca-folinate), 5-fluorouracil, and irinotecan in second or third line. Treatment response rates, progression-free survival and overall survival were assessed during a follow-up period of 12 months. Cytokeratin-18 fragments were analyzed in 52 patients at baseline and day 14 of therapy.
Results:
Levels of M30 correlated with the presence of metastasis and lymph node involvement and decreased significantly during chemotherapy. Importantly, baseline levels of M30 were significantly higher in patients who failed therapy. In addition, patients who did not respond to treatment were also identifiable at day 14 based on elevated M30 levels. By stepwise regression analysis, M30 at day 14 was identified as independent predictor of treatment response. Likewise, serum levels of full-length cytokeratin-18 M65 at baseline also correlated with treatment failure and progression-free survival. The addition of sunitinib did not exert any effects on serum levels of M30 or M65.
Conclusion:
The cytokeratin-18 fragment M30 at day 14 identifies patients that fail to second- or third-line therapy for advanced gastric cancer. Validation of this non-invasive biomarker in gastric cancer is warranted.
Intrahepatic cholangiocarcinomas (iCCAs) may be subdivided into large and small duct types that differ in etiology, molecular alterations, therapy, and prognosis. Therefore, the optimal iCCA ...subtyping is crucial for the best possible patient outcome. In our study, we analyzed 148 small and 84 large duct iCCAs regarding their clinical, radiological, histological, and immunohistochemical features. Only 8% of small duct iCCAs, but 27% of large duct iCCAs, presented with initial jaundice. Ductal tumor growth pattern and biliary obstruction were significant radiological findings in 33% and 48% of large duct iCCAs, respectively. Biliary epithelial neoplasia and intraductal papillary neoplasms of the bile duct were detected exclusively in large duct type iCCAs. Other distinctive histological features were mucin formation and periductal-infiltrating growth pattern. Immunohistochemical staining against CK20, CA19-9, EMA, CD56, N-cadherin, and CRP could help distinguish between the subtypes. To summarize, correct subtyping of iCCA requires an interplay of several factors. While the diagnosis of a precursor lesion, evidence of mucin, or a periductal-infiltrating growth pattern indicates the diagnosis of a large duct type, in their absence, several other criteria of diagnosis need to be combined.
Nach Darlegungen, dass keine verfassungsmässige Bundeskompetenz zum Erlass des Gesetzes in Bezug auf das BWIS besteht und wesentliche Begriffe im ergänzten BWIS mit der BV und der EMRK nicht ...übereinstimmen, wird nun gezeigt, dass verfahrensrechtlich ein Durcheinander besteht und unverzichtbare Verfahrensvorschriften fehlen, was beides zu unhaltbaren rechtlichen Konsequenzen führt. Schliessich wird belegt, dass die festgelegten Massnahmen einen terroristischen Anschlag nicht zu verhindern vermögen, was der Zweck der Novelle ist.
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Après avoir démontré que la Confédération ne dispose pas de la compétence constitutionnelle nécessaire pour mettre en œuvre les mesures de police et de sécurité édictées dans la LMSI, et que certains termes essentiels de la loi modifiée ne sont conformes ni à la Cst. ni à la CEDH, l’auteur explique qu’une certaine confusion subsiste encore sur le plan procédural. De plus, plusieurs dispositions indispensables font défaut entraînant ainsi des conséquences juridiques insoutenables. En outre, l’auteur soutient que ces mesures ne permettent pas de prévenir efficacement une attaque terroriste, ce qui constitue pourtant le but principal de la LMSI.
In einem ersten Beitrag wurde festgestellt, dass dem Bund für den Erlass der BWIS-Novelle im Rahmen des PMT-Gesetzes die verfassungsmässige Gesetzgebungskompetenz fehlt. In diesem Beitrag wird ...dargelegt, dass die Umschreibung «terroristische Aktivität» und damit «terroristischer Gefährder» nach Art. 23e BWIS in Bezug auf die Normbestimmtheit weder der Bundesverfassung noch der EMRK entspricht und mit anderen völkerrechtlichen Definitionen ebenso wenig übereinstimmt. Die Rechtsstaatlichkeitsanforderungen für grundrechtsbeschränkende Eingriffe werden nicht erfüllt.
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Dans une première contribution il a été constaté que la compétence législative constitutionnelle échappe à la Confédération pour promulguer la modification de la LMSI dans le cadre de la loi sur le MPT. Il sera démontré ci-après que les définitions de « l’activité terroriste » et celle de « terroriste potentiel » selon l’art. 23e LMSI ne correspondent ni à la définition de la Constitution fédérale ni à celle de la CEDH et qu’elles ne sont pas davantage conformes aux autres définitions du droit international. Les exigences relatives à l’État de droit, nécessaires pour autoriser les interventions qui restreignent les droits fondamentaux, ne sont pas remplies.
Für das vom Eidgenössischen Parlament am 25. September 2020 beschlossene Gesetz zur präventiven Terrorismusbekämpfungfehlt dem Bund die verfassungsmässige Kompetenz. Keine der vom Bund angeführten ...Begründungen seiner Zuständigkeit halten einer Prüfung stand. Der Erlass polizeigesetzlicher Bestimmungen zur Verhütung von Straftaten durch operationelle Realakte als Eingriffe in die Bewegungsfreiheit liegt in der Verantwortung der Kantone. Dies gilt auch im Bereich der präventiven Terrorismusbekämpfung als Teil des Staatsschutzes. Dieser an sich unbefriedigende Rechtszustand lässt sich nur durch eine Änderung der Bundesverfassung beheben. In einem folgenden Beitrag werden die polizeilichen Massnahmen zur Bekämpfung von Terrorismus (PMT) in Bezug auf ihre Verfassungs- und EMRK-Konformität sowie ihre Wirksamkeit beurteilt.
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