Analysis of Boston department store advertising linage in Boston newspapers since 1928

Thesis (M.B.A.)--Boston University, 1947. This item was digitized by the Internet Archive

Colorectal cancer : aspects of multidisciplinary treatment, metastatic disease and sexual function

More than 6000 people in Sweden are diagnosed with colorectal cancer annually. One out of five patients already has metastases at diagnosis. However, the occurrences of metastases at specific locations, e.g. peritoneal carcinomatosis and ovarian metastases, are not well known. The development of surgical and oncological treatment strategies for primary tumours and metastatic disease has led to a need to discuss colorectal cancer patients in a multidisciplinary team (MDT). Although oncologic cure and overall survival are the main goals of treatment, quality of life and functional results are becoming increasingly important with the prolonged survival. While male sexual dysfunction after rectal cancer treatment has been well described, considerably less data have been published about the impact on women. In addition to surgical trauma, female androgen insufficiency could be a contributing factor to sexual dysfunction. Radiotherapy for rectal cancer may increase the risk of reduced ovarian androgen production, but there is scant information on this in the literature. Papers I-III are large population-based cohort studies reporting on the effects of the development and implementation of MDT-conferences in patients with metastatic disease (Paper I) and the epidemiology of peritoneal carcinomatosis and ovarian metastases in colorectal cancer patients (Papers II–III). MDT assessment and metastasis surgery were more common in rectal cancer patients than in colon cancer patients, and the proportion increased over time. Peritoneal carcinomatosis was common, and risk factors were colon cancer, advanced tumour and nodal stage, fewer than 12 examined lymph nodes, emergency surgery, and a non-radical resection of the primary tumour. Ovarian metastases were uncommon, especially in rectal cancer patients. Paper IV assesses feasibility and internal and external validity in a prospective, observational cohort study on sexual function and androgen levels in women with rectal cancer. The methods were workable and the patients’ compliance was good. Comparison of clinical data from the study cohort with that of women who were eligible for inclusion but not included revealed a selection bias. Having a partner and sexual activity was more common among women who answered all questions in the questionnaires about sexual function compared with those who did not. A power calculation based on data from the first included patients showed that a larger sample size than initially planned for was needed. In conclusion, an increasing proportion of patients with metastatic colorectal cancer were discussed by the MDT. Predictors for and the occurrence of peritoneal carcinomatosis and ovarian metastases were defined, which may help to decide on individual treatment and follow-up regimens. The analysis of baseline data from the study on sexual function and androgen levels in women with rectal cancer indicates feasible methods but a selection bias. Inclusion of new patients in the study continues

Increased risk of colorectal cancer in patients diagnosed with breast cancer in women

BackgroundEpidemiological studies have shown a potential association between sex hormones and colorectal cancer. The risk of colorectal cancer in breast cancer patients who may have been exposed to increased levels of endogenous sex hormones and/or exogenous sex hormones (e.g. anti-hormonal therapy) has not been thoroughly evaluated.MethodsUsing the National Swedish Cancer Register we established a population-based prospective cohort of breast cancer patients in women diagnosed in Sweden between 1961 and 2010. Subsequent colorectal cancers were identified from the same register. Standardized incidence ratios (SIRs) and 95% confidence intervals (95%CIs) were used to estimate the risk of colorectal cancer after a diagnosis of breast cancer. The association between breast cancer therapy and risk of colorectal cancer was evaluated in a subcohort of breast cancer patients treated in Stockholm between 1977 and 2007. Hazard ratios (HRs) and 95%CIs were estimated using Cox regression models.ResultsIn a cohort of 179,733 breast cancer patients in Sweden, 2571 incident cases of colorectal cancer (1008 adenocarcinomas in the proximal colon, 590 in the distal colon and 808 in the rectum) were identified during an average follow-up of 9.68 years. An increased risk of colorectal adenocarcinoma was observed in the breast cancer cohort compared with that in the general population (SIR=1.59, 95%CI: 1.53, 1.65). Adenocarcinoma in the proximal colon showed a non-significantly higher SIR (1.72, 95%CI: 1.61, 1.82) compared with the distal colon (1.46, 95%CI: 1.34, 1.58). In the subcohort of 20,171 breast cancers with available treatment data, 299 cases with colorectal cancers were identified. No treatment-dependent risk of colorectal cancer was observed among the breast cancer patients.ConclusionAn increased risk of colorectal adenocarcinoma - especially in the proximal colon - was observed in the breast cancer cohort. Breast cancer treatment did not alter this risk

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial

Background: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC). However, the effectiveness depends highly on the extent of disease and the treatment is associated with a considerable complication rate. These clinical problems underline the need for effective adjuvant therapy in high-risk patients to minimize the risk of outgrowth of peritoneal micro metastases. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) seems to be suitable for this purpose. Without the need for cytoreductive surgery, adjuvant HIPEC can be performed with a low complication rate and short hospital stay. Methods/Design: The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with colon cancer at high risk of peritoneal recurrence. This study will be performed in the nine Dutch HIPEC centres, starting in April 2015. Eligible for inclusion are patients who underwent curative resection for T4 or intra-abdominally perforated cM0 stage colon cancer. After resection of the primary tumour, 176 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously or shortly after the primary resection. Oxaliplatin will be used as chemotherapeutic agent, for 30 min at 42-43 degrees C. Just before HIPEC, 5-fluorouracil and leucovorin will be administered intravenously. Primary endpoint is peritoneal disease-free survival at 18 months. Diagnostic laparoscopy will be performed routinely after 18 months postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT imaging and CEA. Discussion: Adjuvant HIPEC is assumed to reduce the expected 25 % absolute risk of PC in patients with T4 or perforated colon cancer to a risk of 10 %. This reduction is likely to translate into a prolonged overall survival

Referral pathways and outcome of patients with colorectal peritoneal metastasis (CRPM)

Introduction Traditionally patients with colorectal peritoneal metastases (CRPM) were offered palliative chemotherapy and best supportive care. With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), patients in the UK have been referred to nationally approved centres. This study describes the pattern of referral and outcomes of patients managed through one UK centre. Methods and Methods: A prospective register recorded referrals, demographics, prior treatment pathways, and specialist multidisciplinary team (MDT) decisions (2002-2015). Peritoneal cancer index (PCI) was recorded intra-operatively; complete cytoreduction was deemed when a CC0/1 was achieved. Complications were classified using NCI CTCAE. v.4. Median overall survivals (OS) were described for those treated by CRS/HIPEC and in derived estimates for patients with isolated peritoneal metastases treated by chemotherapy alone in the ARCAD trials consortium. Results Two-hundred-eighty-six patients with CRPM were referred. Despite increasing numbers of referrals annually, the proportion of patients selected for CRS/HIPEC decreased from 64.5%, to 40%, and to 37.1% for 2002–09, 2010–12, and 2013–15, respectively (p < 0.017). CRS/HIPEC was undertaken in 117 patients with a median PCI of 7 and CC0/1 achieved in 86.3%. NCI CTCAE grade 3/4 complication rates were 9.4%; 30-day mortality was 0.85%. Median OS following CRS/HIPEC was 46.0 months: that for patients not receiving CRS/HIPEC was 13.2 months. Conclusion The evolution of the national peritoneal treatment centre over 14 years has been associated with increased referral numbers, refinement of selection for major surgery, matched with achievements of low complication rates and survival advantages in selected patients compared with traditional non-surgical treatments