Adjuvant hepatic arterial infusion pump chemotherapy and resection versus resection alone in patients with low-risk resectable colorectal liver metastases - the multicenter randomized controlled PUMP trial

Background Recurrences are reported in 70% of all patients after resection of colorectal liver metastases (CRLM), in which half are confined to the liver. Adjuvant hepatic arterial infusion pump (HAIP) chemotherapy aims to reduce the risk of intrahepatic recurrence. A large retrospective propensity score analysis demonstrated that HAIP chemotherapy is particularly effective in patients with low-risk oncological features. The aim of this randomized controlled trial (RCT) --the PUMP trial-- is to investigate the efficacy of adjuvant HAIP chemotherapy in low-risk patients with resectable CRLM. Methods This is an open label multicenter RCT. A total of 230 patients with resectable CRLM without extrahepatic disease will be included. Only patients with a clinical risk score (CRS) of 0 to 2 are eligible, meaning: patients are allowed to have no more than two out of five poor prognostic factors (disease-free interval less than 12 months, node-positive colorectal cancer, more than 1 CRLM, largest CRLM more than 5 cm in diameter, serum Carcinoembryonic Antigen above 200 μg/L). Patients randomized to arm A undergo complete resection of CRLM without any adjuvant treatment, which is the standard of care in the Netherlands. Patients in arm B receive an implantable pump at the time of CRLM resection and start adjuvant HAIP chemotherapy 4–12 weeks after surgery, with 6 cycles of floxuridine scheduled. The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall survival, hepatic PFS, safety, quality of life, and cost-effectiveness. Pharmacokinetics of intra-arterial administration of floxuridine will be investigated as well as predictive biomarkers for the efficacy of HAIP chemotherapy. In a side study, the accuracy of CT angiography will be compared to radionuclide scintigraphy to detect extrahepatic perfusion. We hypothesize that adjuvant HAIP chemotherapy leads to improved survival, improved quality of life, and

Una nueva megaflora (maderas y hojas fósiles) del Mioceno del suroeste de la Patagonia

A new megaflora composed of fossil woods and leaves is described. The bearing sediments overlie the Santa Cruz Formation (early Miocene), making it one of the youngest fossil megafloras described from southern Patagonia. The fossil woods is carbonized and found as clasts within a conglomerate. It includes a few specimens representing Araucariaceae (Agathoxylon sp.), Podocarpaceae (Phyllocladoxylon sp.), Cupressaceae (Cupressinoxylon sp.) and two indeterminable angiosperms with anatomical features consistent with Nothofagaceae. Most leaves are assigned to Nothofagaceae while a few specimens are related to Lauraceae, Typhaceae, Leguminosae, and a conifer. The recovered assemblage suggests a temperate climate similar to that of northern Patagonia today, inhabited by extant relatives of the fossils described herein.Una nueva megaflora compuesta por maderas y hojas fósiles es presentada. Los sedimentos portadores sobreyacen a la Formación Santa Cruz (Mioceno inferior), por lo tanto es una de las megafloras más jóvenes del sur patagónico descripta. Las maderas fósiles están carbonizadas y se encuentran como clastos de un conglomerado. Están representadas por unos pocos especímenes de Araucariaceae (Agathoxylon sp.), Podocarpaceae (Phyllocladoxylon sp.), Cupressaceae (Cupressinoxylon sp.) y dos angiospermas no determinadas que poseen una anatomía consistente con la de las Nothofagaceae. Las hojas son en su mayoría asignadas a las Nothofagaceae, acompañadas por Lauraceae, Typhaceae, Leguminosae y una conifera. El conjunto de fósiles sugiere un clima templado similar al actual de la Patagonia norte, donde viven parientes vivos de los fósiles descriptos.Fil: Pujana, Roberto Roman. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales; ArgentinaFil: Panti, Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales; ArgentinaFil: Cuitiño, José Ignacio. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; ArgentinaFil: García Massini, Juan Leandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Regional de Investigaciones Cientificas y Transferencia Tecnológica de Anillaco; ArgentinaFil: Mirabelli, Sebastian Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales; Argentin