Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial

Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient’s liver metastases as surgically removable. Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11⋅9 per cent) and control (25, 11⋅0 per cent) arms (P = 0⋅775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33⋅7 per cent) versus 54 of 472 (11⋅4 per cent) respectively (P = 0⋅001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38⋅1 per cent) versus 66 of 228 (28⋅9 per cent) respectively (P < 0⋅001). Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM

Território café do Cerrado: transformações na estrutura produtiva e seus impactos sobre o pessoal ocupado

O desenvolvimento da agricultura brasileira ao longo do século XX e início deste século XXI provocou grandes transformações no processo produtivo de diversas cadeias agropecuárias. Neste contexto, o Cerrado Mineiro merece destaque particular, pois se consolidou como uma das regiões cafeicultoras mais modernas do país, com a adoção de um conjunto de inovações tecnológicas, cujo resultado foi a obtenção de elevada produtividade e qualidade do café. Entretanto, para se alcançar tal grau de desenvolvimento tecnológico, a estrutura produtiva passou por grandes transformações desde o início dos anos 70 até 2000, inclusive no que diz respeito às relações de trabalho. O objetivo deste artigo é apontar como se deram essas transformações, qual o impacto sobre a produção e o emprego, bem como sobre a organização dos cafeicultores em torno do fortalecimento da cadeia do café. Para alcançar esses objetivos, foi realizada revisão bibliográfica de trabalhos de especialistas da área, além da utilização de dados dos censos agropecuários de 1970 a 2006 e pesquisa de campo junto a produtores e lideranças representativas dos cafeicultores, pesquisadores agronômicos, técnicos de assistência técnica e empresas líderes na comercialização de insumos e equipamentos. Concluiu-se que o processo de modernização da atividade do café no Cerrado Mineiro provocou impactos significativos na ampliação da área produtiva, na produtividade, na geração de novos postos de trabalho em atividades mais qualificadas e redução das menos qualificadas.<br>The development of the Brazilian agriculture over the twentieth century and at the beginning of this century led to major changes in the production process of different agricultural chains. Coffee in the Cerrado Mineiro region deserves special attention in this context; therefore, it has been established as one of the most modern in Brazil, with the adoption of a set of technological innovations, which has resulted in high yield and quality of the coffee. However, to reach this situation, the production structure has changed significantly since the early 1970's until 2000. This study aims to point out how such transformations occurred and the consequent impacts on production as well the relations of production and employment. To reach these objectives, data from agricultural census from 1970 to 2006 was used, along with specialized work and field research with the application of semi-structured questionnaires with a representative leadership (from coffee growers and workers) and leading companies in the market of inputs and coffee equipment. The conclusion is that the modernization process of the coffee activity in the Cerrado Mineiro region has caused significant impacts on the generation of employed people, generating new activities and a demand for a workforce which is more qualified

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial

Background Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. Methods Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient's liver metastases as surgically removable. Results Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11 center dot 9 per cent) and control (25, 11 center dot 0 per cent) arms (P = 0 center dot 775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33 center dot 7 per cent) versus 54 of 472 (11 center dot 4 per cent) respectively (P = 0 center dot 001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38 center dot 1 per cent) versus 66 of 228 (28 center dot 9 per cent) respectively (P < 0 center dot 001). Conclusion Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial

Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient’s liver metastases as surgically removable. Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11⋅9 per cent) and control (25, 11⋅0 per cent) arms (P = 0⋅775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33⋅7 per cent) versus 54 of 472 (11⋅4 per cent) respectively (P = 0⋅001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38⋅1 per cent) versus 66 of 228 (28⋅9 per cent) respectively (P < 0⋅001). Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM