SummaryBackground: Only responding patients benefit from preoperative therapy for locally advanced esophageal carcinoma. Early detection of non-responders may avoid futile treatment and delayed surgery. Patients and Methods: In a multi-center phase ll trial, patients with resectable, locally advanced esophageal carcinoma were treated with 2 cycles of induction chemotherapy followed by chemoradiotherapy (CRT) and surgery. Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG-PET) was performed at baseline and after induction chemotherapy. The metabolic response was correlated with tumor regression grade (TRG). A decrease in FDG tumor uptake of less than 40% was prospectively hypothesized as a predictor for histopathological non-response (TRG > 2) after CRT. Results: 45 patients were included. The median decrease in FDG tumor uptake after chemotherapy correlated well with TRG after completion of CRT (p = 0.021). For an individual patient, less than 40% decrease in FDG tumor uptake after induction chemotherapy predicted histopathological non-response after completion of CRT, with a sensitivity of 68% and a specificity of 52% (positive predictive value 58%, negative predictive value 63%). Conclusions: Metabolic response correlated with histopathology after preoperative therapy. However, FDG-PET did not predict non-response after induction chemotherapy with sufficient clinical accuracy to justify withdrawal of subsequent CRT and selection of patients to proceed directly to surgery. 18 F]Fluor-2-desoxy-d-glukose (FDG-PET) wurde vor Therapiebeginn und nach Abschluss der Induktionschemotherapie durchgeführt. Das metabolische Ansprechen wurde mit dem Tumorregressionsgrad (TRG) korreliert. Die Hypothese, dass weniger als 40% Abnahme des Wertes der FDG-Aufnahme ein früher prädiktiver Parameter für das Nichtansprechen sei (TRG > 2), wurde prospektiv geprüft. Ergebnisse: 45 Patienten wurden eingeschlossen. Die mittlere Abnahme der FDG-Anreicherung im Tumor korrelierte gut mit dem TRG nach Abschluss der CRT (p = 0,021). Eine Abnahme der FDG-Anreicherung von weniger als 40% sagte ein Nichtansprechen mit einer Sensitivität von 68% und einer Spezifität von 52% voraus (positiver Vorhersagewert 58%, negativer Vorhersagewert 63%). Schlussfolgerungen: Das metabolische Ansprechen nach präoperativer Therapie korrelierte insgesamt gut mit dem histopathologischen Ansprechen. Die FDG-PET sagte jedoch das Nichtansprechen im individuellen Fall nicht mit ausreichender Sicherheit voraus, um den vorzeitigen Abbruch der CRT und eine direkte Operation zu rechtfertigen.
BackgroundFor recurrent disease or primary therapy of advanced ovarian cancer, cytoreductive surgery (CRS) followed by adjuvant chemotherapy is a therapeutic option. The aim of this study was to evaluate the outcome for patients with epithelial ovarian cancer treated with hyperthermic intraoperative chemotherapy (HIPEC) and completeness of cytoreduction (CC).MethodsData were retrospectively collected from 111 patients with recurrent or primary ovarian cancer operated with the contribution of visceral surgical oncologists between 1991 and 2006 in a tertiary referral hospital.ResultsNinety patients received CRS and 21 patients CRS plus HIPEC with cisplatin. Patients with complete cytoreduction (CC0) were more likely to receive HIPEC. Overall, 19 of 21 patients (90.5 %) with HIPEC and 33 of 90 patients (36.7 %) with CRS had a complete cytoreduction (P < 0.001). Incomplete cytoreduction was associated with worse survival rates with a hazard ratio (HR) of 4.4 (95%CI: 2.3-8.4) for CC1/2 and 6.0 (95%CI: 2.9-12.3) for CC3 (P < 0.001). In a Cox-regression limited to 52 patients with CC0 a systemic concomitant chemotherapy (HR 0.3, 95%CI: 0.1-0.96, P = 0.046) but not HIPEC (HR 0.98 with 95 % CI 0.32 to 2.97, P = 0.967) improved survival. Two patients (9.5 %) developed severe renal failure after HIPEC with absolute cisplatin dosages of 90 and 95 mg.ConclusionsCompleteness of cytoreduction was proved to be crucial for long-term outcome. HIPEC procedures in ovarian cancer should be performed in clinical trials to compare CRS, HIPEC and systemic chemotherapy against CRS with systemic chemotherapy. Concerning the safety of HIPEC with cisplatin, the risk of persistent renal failure must be considered when dosage is based on body surface.
EPMR after TE is a safe option for T1 rectal cancer. This two-stage procedure has a lower morbidity than LAR and may reduce locoregional recurrence compared with TE alone.
Primary small bowel tumours are very uncommon accounting about 1% of all gastrointestinal tumours. Intestinal lipomas are a rare entity of benign tumours with an incidence at autopsy ranging from 0.04% to 4.5%, most being asymptomatic. Complications such as obstruction, haemorrhage, intussusception and perforation might demand invasive management. Among these, intussusception is the most rare complication of intestinal lipomas. Here, we present a case of intussusception in a 52-year-old female with a large intramural lipoma of the ileum.
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