The role of postoperative chemotherapy in patients who undergoing surgery following chemoradiotherapy of initially unresectable rectal cancer

Introduction. Preoperative chemoradiotherapy (preCRT) improves local control of rectal cancer and such is parti­cularly merited for treating locoregionally advanced tumors. Nevertheless, the role of postoperative chemotherapy (postCT) in such patients is currently disputed. Materials. Subjects were 75 patients with unresectable cT3–4 and/or N+ tumors who underwent radical surgery following preCRT between January 2003 and December 2012 at the Oncology Centre in Bydgoszcz. PostCT was subsequently used in 32 (43%) of these patients. Results. There were 20 abdominoperineal resections (APR), 50 anterior resections (AR) and 5 Hartmann’s procedures (HART) performed in the patient group, where respectively 30%, 46% and 60%, received systemic treatment. Based on postoperative histopathological assessment, disease staging was assigned as follows: stage III for 32 (43%), patient­s,stage II for 22 (29%) and stage I for 15 (20%). Pathologic complete pathological response (pCR) was seen in 6 cases (8%). In the postCT+ group, disease stage III was observed in 13 (41%) patients. A three-year survival was observed in 43 patients; 25 (58%) and 18 (56%) of patients respectively undergoing either postCT– or postCT+. A five-year survival was noted in 26 patients; 19 (44%) and 7 (22%) in both groups, respectively. Conclusion. Together with the most recent reports, our study demonstrates that postoperative chemotherapy has no significant effect on the outcomes of oncological treatment in those patients having undergone preoperative chemoradiotherapy for locoregionally advanced rectal cancer

Rola chemioterapii pooperacyjnej u chorych operowanych po radiochemioterapii z powodu nieresekcyjnego pierwotnie raka odbytnicy

   Wstęp. Radiochemioterapia przedoperacyjna (pre-CRT) daje możliwość kontroli miejscowej raka odbytnicy. Ten rodzaj terapii jest szczególnie uzasadniony w zaawansowanych lokoregionalnie nowotworach. Współcześnie rola chemioterapii pooperacyjnej (post-CT) u tych chorych jest dyskutowana. Materiał. Od stycznia 2003 do grudnia 2012 r. w Centrum Onkologii w Bydgoszczy zoperowano radykalnie 75 chorych z nieresekcyjnymi guzami cT3–4 i/lub N+ po pre-CRT. U 32 z nich zastosowano jednocześnie post-CT, co stanowiło 43%. Wyniki. Wykonano 20 zabiegów APR (amputacja brzuszno-kroczowa), 50 AR (przednia resekcja) i 5 HART (operacja Hartmana) w obu grupach, gdzie pacjenci, u których zastosowano leczenie systemowe po zabiegu, stanowili odpo­wiednio 30%, 46% i 60%. W oparciu o wynik histopatologii (pooperacyjny) u 32 (43%) pacjentów stwierdzono III st. zaawansowania choroby, u 22 (29%) osób II st. zaawansowania, zaś u 15 (20%) — I st. zaawansowania. Całkowitą odpowiedź patologiczną (pCR) odnotowano w 6 (8%) przypadkach. U chorych pre-CRT + post-CT III st. zaawanso­wania potwierdzono u 13 (41%) osób. 3-letnie przeżycia obserwowano u 43 pacjentów — odpowiednio u 25 (58%) chorych poddanych wyłącznie pre-CRT oraz u 18 (56%), u których zastosowano również post-CT. 5-letnie przeżycia zaobserwowano u 26 chorych: odpowiednio 19 (44%) oraz 7 (22%). Wniosek. Na podstawie analizy materiału oraz w świetle najnowszych doniesień chemioterapia pooperacyjna u pacjentów poddanych radiochemioterapii przedoperacyjnej z powodu zaawansowanego lokoregionalnie raka odbytnicy nie wpływa znacząco na wyniki leczenia onkologicznego

Contemporary enteral and parenteral nutrition before surgery for gastrointestinal cancers: a literature review

Abstract Background Gastrointestinal cancers are among the most recognised oncological diseases in well-developed countries. Tumours located in the digestive tract may cause the fast occurrence of malnutrition. Main text The perioperative period is a special time for systemic metabolism. Thanks to published guidelines, early universal control nutritional status before treatment, patients may have a chance to get suitable nutritional intervention. Although the first line of the intervention—nutritional consultation as well as the fortification of a diet and oral nutritional support (ONS)—is not debatable, in a case of inability of undergoing an oral feeding, the choice of the way of administration in patients before a surgery may represent a serious clinical obstacle. Conclusions Although there is broad agreement in the staging, classification, and role of surgery and nutritional status for outcomes of treatment of gastrointestinal cancers, there the way of nutritional intervention in patients with gastrointestinal cancer are still discussed

Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Background and Objectives: Despite advances in treatment, local recurrence remains a great concern in patients with rectal cancer. The aim of this study was to investigate the incidence and risk factors of local recurrence of rectal cancer in our single center over a 7-year-period. Materials and Methods: Patients with stage I-III rectal cancer were treated with curative intent. The necessity for radiotherapy and chemotherapy was determined before surgery and/or postoperative histopathological results. Results: Of 365 rectal cancer patients, 76 (20.8%) developed recurrent disease. In total, 27 (7.4%) patients presented with a local tumor recurrence (isolated in 40.7% of cases). Radiotherapy was performed in 296 (81.1%) patients. The most often used schema was 5 × 5 Gy followed by immediate surgery (n = 214, 58.6%). Local recurrence occurred less frequently in patients treated with 5 × 5 Gy radiotherapy followed by surgery (n = 9, 4%). Surgical procedures of relapses were performed in 12 patients, six of whom were operated with radical intent. Only two (7.4%) patients lived more than 5 years after local recurrence treatment. The incidence of local recurrence was associated with primary tumor distal location and worse prognosis. The median overall survival of patients after local recurrence treatment was 19 months. Conclusions: Individualized rectal cancer patient selection and systematic treatment algorithms should be used clinical practice to minimize likelihood of relapse. 5 × 5 Gy radiotherapy followed by immediate surgery allows good local control in resectable cT2N+/cT3N0 patients. Radical resection of isolated local recurrence offers the best chances of cure

Early effects of Nivolumab and Ipilimumab combined immunotherapy in the treatment of metastatic melanoma in Poland : a multicenter experience

Nivolumab and ipilimumab combination became the first-line standard in advanced melanoma. We assessed its efficacy in a real-life study in Poland. In a one-year follow-up, we evaluated the medical records of 50 melanoma patients treated with that modality in five oncology centers. We recorded therapy outcomes and adverse events (AEs) after 3 and 12 months of therapy. At the first checkpoint, the disease control rate (DCR) was recorded in 58% (n = 29) of patients, but the same number of patients (n = 29, 58%) stopped immunotherapy due to disease progression (PD, n = 14, 48.3%), toxicity (n = 11, 37.9%) or death (n = 4, 13.8%). Among patients with DCR after the induction phase, 8 (27.6%) terminated due to toxicity, and 21 (72.4%) continued. However, at the 12-month checkpoint, only 14 patients (27% of all) were still receiving immunotherapy. In 7 (33.3%) it was discontinued due to PD (n = 2), toxicity (n = 2, 28.6% each), or death (n = 3, 42.9%). AEs occurred in 66.7% (n = 34) of patients; severe (grade 3 or 4) in half of them. Interestingly, those with AEs had an 80% lower risk of death (hazard ratio [HR] 0.2, 95% confidence interval [CI] 0.07–0.57, p = 0.001) and PD (HR 0.2, 95%CI 0.09–0.47, p < 0.0001). In the entire group of patients, after a 12-month follow-up, the median overall survival was not reached (NR, range: 6.8 months-NR) and progression-free survival was 6.3 (range: 3-NR) months. Our results demonstrate that combined immunotherapy is less effective in real-life than in pivotal trials. However, early responders will likely continue the therapy after a one-year follow-up. AEs occurrence might be a predictor of clinical effectiveness