Comprehensive Treatment Algorithms of the Swiss Peritoneal Cancer Group for Peritoneal Cancer of Gastrointestinal Origin

Peritoneal cancer (PC) is a dire finding, yet in selected patients, long-term survival is possible. Complete cytoreductive surgery (CRS) together with combination immunochemotherapy is essential to achieve cure. Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are increasingly added to the multimodal treatment. The Swiss Peritoneal Cancer Group (SPCG) is an interdisciplinary group of expert clinicians. It has developed comprehensive treatment algorithms for patients with PC from pseudomyxoma peritonei, peritoneal mesothelioma, gastric, and colorectal origin. They include multimodal neoadjuvant treatment, surgical resection, and palliative care. The indication for and results of CRS HIPEC and PIPAC are discussed in light of the current literature. Institutional volume and clinical expertise required to achieve best outcomes are underlined, while inclusion of patients considered for CRS HIPEC and PIPAC in a clinical registry is strongly advised. The present recommendations are in line with current international guidelines and provide the first comprehensive treatment proposal for patients with PC including intraperitoneal chemotherapy. The SPCG comprehensive treatment algorithms provide evidence-based guidance for the multimodal care of patients with PC of gastrointestinal origin that were endorsed by all Swiss clinicians routinely involved in the multimodal care of these challenging patients

Seismic monitoring in the Gugla rock glacier (Switzerland): ambient noise correlation, microseismicity and modelling

A network of seismometers has been installed on the Gugla rock glacier since October 2015 to estimate seismic velocity changes and detect microseismicity. These two processes are related to mechanical and structural variations occurring within the rock glacier. Seismic monitoring thus allows a better understanding of the dynamics of rock glaciers throughout the year. We observed seasonal variations in seismic wave velocity and microseismic activity over the 3 yr of the study. In the first part of our analysis, we used ambient noise correlations to compute daily changes of surface wave velocity. In winter, seismic wave velocities were higher, probably due to refreezing of the permafrost active layer and cooling of the uppermost permafrost layers, leading to increased overall rigidity of the medium. This assumption was verified using a seismic model of wave propagation that estimates the depth of P- and S-wave velocity changes from 0 down to 10 m. During melting periods, both a sudden velocity decrease and a decorrelation of the seismic responses were observed. These effects can probably be explained by the increased water content of the active layer. In the second part of our study, we focused on detecting microseismic signals generated in and around the rock glacier. This seismic activity (microquakes and rockfalls) also exhibits seasonal variations, with a maximum in spring and summer, which correlates principally with an exacerbated post-winter erosional phase of the front and a faster rock glacier displacement rate. In addition, we observed short bursts of microseismicity, both during snowfall and during rapid melting periods, probably due to pore pressure increase

Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients

Introduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting. Methods: Patients with stage IV ALK-rearranged NSCLC treated at six centers in Switzerland and Italy were identified and standard clinical variables collected. OS curves were constructed using the Kaplan-Meier method and compared with the log-rank test. Multivariate Cox proportional hazard analysis was applied to determine the correlations between clinical features and OS. In four patients, biopsies were subjected to NGS. Results: One-hundred and twenty-one patients with stage IV ALK-rearranged NSCLC diagnosed between 2011 and 2016 were included. With a median follow-up time of 39.5 months, the median OS from diagnosis of stage IV disease was 48.0 months. First-line treatment consisted of an ALK-TKI in 24% of patients, with crizotinib in 83% of them. Chemotherapy as first-line treatment did not influence OS (p = 0.955). The use of more than one ALK-TKI line positively correlated with OS (p = 0.016), as well as the use of alectinib or lorlatinib in any treatment line, as compared to the use of crizotinib ± ceritinib (p = 0.022). A never smoking history was an independent prognostic factor for OS (p = 0.032). Moreover, treatment with alectinib significantly improved OS. Conclusions: Targeted treatment for ALK-positive NSCLC patients lead to prolonged OS. Smoking status was a negative independent prognostic factor in a multi-variate analysis. The use of alectinib or lorlatinib in any treatment line improved overall outcome