15 research outputs found
PO-1012: Comparative study of surgery with or without intraoperative multicatheter breast implant for PBI
Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy
Background: The impact of neoadjuvant treatment and their subsequent early complications in the treatment of rectal cancer has not been adequately assessed. The aim of this prospective study was to evaluate early postoperative morbidity and mortality among patients with rectal cancer treated with adjuvant radiotherapy and chemotherapy followed by surgery, compared with patients treated with surgery alone. We also identified independent risk factors associated with early major complications.
Methods: Between 1995 and 2004, 273 consecutive patients underwent treatment for rectal cancer. A total of 170 patients (group A) received preoperative radiotherapy with a total of 45–50.4 Gy (180 cGy per day) and 5-fluorouracil-based chemotherapy, followed by surgery; 103 patients (group B) were treated with surgery alone. Dependent variables related to patients, treatment, radiotherapy, and tumor were analyzed.
Results: Both groups were similar with regard to age, sex, body mass index, American Society of Anesthesiologists (ASA) score, and tumor location but not for ileostomy (27% in group A vs. 6.8% in group B). The number of complications was similar in both groups (43.1% in group A vs. 44.6% in group B). No differences in wound infection (8.2% vs. 7.8%), intraabdominal abscess (4.7% vs. 4.9%), anastomotic dehiscence (4.2% vs. 3.8%), postoperative hemorrhage (3.5% vs. 3.9%), urinary complications (6.5% vs. 4.9%), paralytic ileus (8.9% vs. 9.7%), or general complications (7.1% vs. 9.6%) were found. The global mortality in the first 30 days after surgery was .7%. An ASA score of III–IV and surgery duration longer than 3 hours were identified as independent prognostic factors for early complications.
Conclusions: Preoperative chemoradiation in patients with rectal cancer treated with surgery is not associated with a higher incidence of early postoperative complications. The patient~s preoperative clinical condition and lengthy surgery time are prognostic factors for early complications
Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery
The Physiological and Operative Severity Score for the enUmeration of
Mortality and morbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM)
have been used to predict morbidity and mortality rates among patients with
rectal cancer undergoing surgery. These calculations need some adjustment,
however. The aim of this study was to assess the applicability of POSSUM to a
group of patients with rectal cancer undergoing surgery, analysing surgical
morbidity by means of several variables. METHODS: between January 1995 and
December 2004, 273 consecutive patients underwent surgery for rectal cancer.
Information was gathered about the patients, tumour and therapy. To assess the
prediction capacity of POSSUM, subgroups for analysis were created according to
variables related to operative morbidity and mortality. RESULTS: The global
morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7%
(6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively).
POSSUM predictions may be more accurate for patients younger than 51 years, older
than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery
duration of less than 180 minutes and for those receiving neoadjuvant therapy.
CONCLUSION: POSSUM is a good instrument to make results between different
institutions and publication comparable. We found prediction errors for some
variables related to morbidity. Modifications of surgical variables and
specifications for neoadjuvant therapy as well as physiological variables
including life style may improve future prediction of surgical risk. More
research is needed to identify further potential risk factors for surgical
complications
PO-1012: Comparative study of surgery with or without intraoperative multicatheter breast implant for PBI
Presence of Activated (Phosphorylated) STAT3 in Radiation Necrosis Following Stereotactic Radiosurgery for Brain Metastases
Brain radiation necrosis (RN) is a subacute or late adverse event following radiotherapy,
involving an exacerbated inflammatory response of the brain tissue. The risk of symptomatic RN
associated with stereotactic radiosurgery (SRS) as part of the treatment of brain metastases (BMs)
has been a subject of recent investigation. The activation of the signal transducer and activator of
transcription 3 (STAT3) was shown in reactive astrocytes (RA) associated with BMs. Given that the
pathophysiological mechanisms behind RN are not fully understood, we sought to investigate the
role of STAT3 among other inflammatory markers in RN development. A mouse model of RN using
clinical LINAC-based SRS was designed to induce brain necrosis with the administration of 50 Gy in
a single fraction to the left hemisphere using a circular collimator of 5 mm diameter. Immunohis-
tochemistry and multiplex staining for CD4, CD8, CD68, GFAP, and STAT3 were performed. For
validation, eleven patients with BMs treated with SRS who developed symptomatic RN and required
surgery were identified to perform staining for CD68, GFAP, and STAT3. In the mouse model, the
RN and perinecrotic areas showed significantly higher staining for F4/80+ and GFAP+ cells, with
a high infiltration of CD4 and CD8 T-lymphocytes, when compared to the non-irradiated cerebral
hemisphere. A high number of GFAP+pSTAT3+ and F4/80+pSTAT3+ cells was found in the RN
areas and the rest of the irradiated hemisphere. The analysis of human brain specimens showed
that astrocytes and microglia were actively phosphorylating STAT3 in the areas of RN and gliosis.
Phosphorylated STAT3 is highly expressed in the microglia and RA pertaining to the areas of brain
RN. Targeting STAT3 via inhibition represents a promising strategy to ameliorate symptomatic RN in
BM patients undergoing SRS
Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy
Background: The impact of neoadjuvant treatment and their subsequent early complications in the treatment of rectal cancer has not been adequately assessed. The aim of this prospective study was to evaluate early postoperative morbidity and mortality among patients with rectal cancer treated with adjuvant radiotherapy and chemotherapy followed by surgery, compared with patients treated with surgery alone. We also identified independent risk factors associated with early major complications.
Methods: Between 1995 and 2004, 273 consecutive patients underwent treatment for rectal cancer. A total of 170 patients (group A) received preoperative radiotherapy with a total of 45–50.4 Gy (180 cGy per day) and 5-fluorouracil-based chemotherapy, followed by surgery; 103 patients (group B) were treated with surgery alone. Dependent variables related to patients, treatment, radiotherapy, and tumor were analyzed.
Results: Both groups were similar with regard to age, sex, body mass index, American Society of Anesthesiologists (ASA) score, and tumor location but not for ileostomy (27% in group A vs. 6.8% in group B). The number of complications was similar in both groups (43.1% in group A vs. 44.6% in group B). No differences in wound infection (8.2% vs. 7.8%), intraabdominal abscess (4.7% vs. 4.9%), anastomotic dehiscence (4.2% vs. 3.8%), postoperative hemorrhage (3.5% vs. 3.9%), urinary complications (6.5% vs. 4.9%), paralytic ileus (8.9% vs. 9.7%), or general complications (7.1% vs. 9.6%) were found. The global mortality in the first 30 days after surgery was .7%. An ASA score of III–IV and surgery duration longer than 3 hours were identified as independent prognostic factors for early complications.
Conclusions: Preoperative chemoradiation in patients with rectal cancer treated with surgery is not associated with a higher incidence of early postoperative complications. The patient~s preoperative clinical condition and lengthy surgery time are prognostic factors for early complications
Situación actual de la quimioterapia neoadyuvante en el carcinoma broncogénico de células no pequeñas
Immune mechanisms mediating abscopal effects in radioimmunotherapy
Radiotherapy of cancer has been traditionally considered as a local therapy without noticeable effects outside the
irradiated fields. However, ionizing radiation exerts multiple biological effects on both malignant and stromal
cells that account for a complex spectrum of mechanisms beyond simple termination of cancer cells. In the era
of immunotherapy, interest in radiation-induced inflammation and cell death has considerably risen, since
these mechanisms lead to profound changes in the systemic immune response against cancer antigens. Immuno-
therapies such as immunomodulatory monoclonal antibodies (anti-PD-1, anti-CTLA-4, anti-CD137, anti-OX40,
anti-CD40, anti-TGFβ), TLR-agonists, and adoptive T-cell therapy have been synergistically combined with radio-
therapy in mouse models. Importantly, radiation and immunotherapy combinations do not only act against the
irradiated tumor but also against distant non-irradiated metastases (abscopal effects). A series of clinical trials are
exploring the beneficial effects of radioimmunotherapy combinations. The concepts of crosspriming of tumor
neoantigens and immunogenic cell death are key elements underlying this combination efficacy. Proinflamatory
changes in the vasculature of the irradiated lesions and in the cellular composition of the leukocyte infiltrates in
the tumor microenvironment contribute to raise or dampen cancer immunogenicity. It should be stressed that
not all effects of radiotherapy favor antitumor immunity as there are counterbalancing mechanisms such as
TGFβ, and VEGFs that inhibit the efficacy of the antitumor immune response, hence offering additional therapeu-
tic targets to suppress. All in all, radiotherapy and immunotherapy are compatible and often synergistic
approaches against cancer that jointly target irradiated and non-irradiated malignant lesions in the same patient
High-dose BCNU and autologous progenitor cell transplantation given with intra-arterial cisplatinum and simultaneous radiotherapy in the treatment of high-grade gliomas: benefit for selected patients
A phase II study of postoperative high-dose carmustine
(HDBCNU), intracarotid cisplatin (CDDP), and radical
radiotherapy in patients with high-grade glioma was
performed. Patients underwent 4-6 consecutive days of
blood hematopoietic progenitor cell (HPC) apheresis
without prior mobilization. Chemotherapy included
intracarotid CDDP, 60 mg/m2, and BCNU, 900 mg/m2.
HPC were infused 48 h after HDBCNU. Whole brain
irradiation, up to 50 Gy, was started on the 8th day
after HPC infusion. With a median follow-up time of 44
months, median overall survival was 15.5 months. Eight
patients (23.5%) are alive free of disease 2-6 years after
treatment (seven out of 25 patients with glioblastoma
multiforme and one out of nine patients with anaplastic
astrocytoma). Survival was influenced by young age,
good performance and complete surgical resection. Two
patients (5.8%) died of therapy-related complications.
Acute hematological toxicity of HDBCNU was moderate, with a full recovery on day 26. No acute pulmonary
or hepatic toxicity was found. Late severe neurological
toxicity was observed in one third of patients surviving
beyond 2 years. We conclude that HDBCNU, 900
mg/m2, intracarotid CDDP and radical radiotherapy
appear to benefit some patients with high-grade
gliomas, and phase III studies should preferentially
select young patients with resectable tumors