Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer

Background: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. Methods: Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). Results: In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) −10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI −10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI −11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n

Neoadjuvant single-dose irradiation in low-risk breast cancer

The aim of this thesis is to assess whether single-dose partial breast irradiation before surgery could be used as a safe and effective treatment for low-risk breast cancer patients. The majority of low-risk breast cancer patients is currently treated with breast-conserving surgery followed by whole or partial breast irradiation in 15 doses. The current treatment leads to excellent oncologic outcomes, such as 10-year survival, but can also lead to toxicity, such as pain, and can worsen the performance status and quality of life. The main difference between the current treatment and the treatment investigated in this thesis is the timing of irradiation. We performed irradiation prior to surgery, meaning the tumor itself is treated, instead of possible residual tumor cells. This enables a smaller irradiated volume and a higher dose per fraction, leading to a single dose to give the necessary amount of irradiation. Breast-conserving surgery was performed six to eight months after irradiation to optimize the effect of irradiation on tumor destruction. The pathway to performing this novel radiotherapy approach is described in this thesis, as well as the results of the treatment. Complete tumor destruction was observed in over 40% of the patients with only mild toxicity. We conclude that single-dose partial breast irradiation before breast-conserving surgery is a feasible treatment option for low-risk breast cancer patients. More research towards this treatment is necessary to enable accurate prediction of tumor destruction after single-dose irradiation. In which patient will complete tumor destruction be achieved, and might surgery be omitted