ESMO consensus guidelines for the management of patients with metastatic colorectal cancer

Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.     

Calibration of ionization chamber for 18F and 68Ga

In order to maintain the results of primary activity standardizations carried out in 2011 the LNMRI has determined the calibration factors for a pressurized 4π-ionization chamber for the nuclides ¹⁸F and ⁶⁸Ga. This ionization chamber is coupled to a 6517A Keithley electrometer which is controlled by a homemade LabVIEW program. This paper will describe the main issues related to the calibration of an ionization chamber system for positron emitters and short half-life radionuclides such as timing, current measurement, background, decay, and ²²⁶Ra check source measurements.     

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome measurements and statistical analysisStatements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).Results and limitationsOverall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.ConclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.     

Salvage surgery in head and neck cancer: Does it improve outcomes?

BackgroundStudies reporting outcomes of salvage surgery in locally advanced head and neck squamous cell carcinoma (LAHNSCC) have inherent biases like biological and temporal selection. Our study considered all patients deemed fit for salvage surgery and compared to those who underwent surgery versus those who refused it thus throwing light on the real world benefit of salvage surgery.MethodsThis was a post hoc analysis of a phase 3 randomized trial conducted between 2012 and 2018. Out of 536 LAHNSCC patients randomised in the study, 113 patients had residual disease or recurrent disease and were planned for salvage surgery in a multidisciplinary clinic. Patients were divided into 2 cohorts for comparison, willing for salvage surgery (n = 91) and unwilling for salvage surgery(n = 22). The primary endpoint was overall survival.ResultsThe median follow up was 28.7 months (95%CI 23.9–33.5 months). Out of the 91 patients who were willing for salvage surgery, 78 underwent same. The median survival in cohort of patients willing for salvage surgery was 22.0 months (95%CI 10.1–33.9) while it was 9.7 months (95%CI 6.6–12.8) in patients who were unwilling for salvage surgery (HR = 0.262 95%CI HR 0.147–0.469, p = 0.000).ConclusionSalvage surgery leads to a substantial improvement in outcomes in head and neck cancers and should be the de facto standard of care in patients who are eligible for the same.     

Evaluation of inter-observer variability according to RECIST 1.1 and its influence on response classification in CT measurement of liver metastases

ObjectiveThe aim of this study is the evaluation of inter-observer variability in the measurement of liver metastases according to RECIST and its influence on response classification.Patients and methodsA total of 100 radiologists measured liver target lesions, on pre- and post-chemotherapy CT scans of three patients. Each observer filled out a questionnaire about his personal and work features. The evaluations of a well experienced radiologist, considered as “the gold standard”, were compared to those taken by the observers.The percentage of the observers in agreement with the reviewer, in terms of the response category and in terms of inter-observer variability, was calculated for each patient.ResultsThe percentage of the inter-observer agreement was elevated. Most of the observers in agreement with the reviewer were senior radiologists, while those who disagreed were junior radiologist, but this result did not reach a statistical significance. More than 30% of observers disagreed with the reviewer at least in one of the three cases.ConclusionsRECIST measurements are reproducible on a large and heterogeneous population of radiologists. Age and expertise of the radiologist remain the most critical factors: this suggests a revision by well-experienced radiologists in clinical trials.     

A short-time method to measure the radon potential of porous materials

The radiological risk associated with the use of solid materials has been traditionally established according to their radon exhalation rates, the accumulation chamber technique being the most widely used for the determination of this quantity. However, this coupled methodology has two important drawbacks: the calculated exhalation rate value depends strongly on the experimental setup used; hence widely varying values can be calculated for the same material. Furthermore, this technique usually requires long monitoring times (between 1 and 4 weeks).In this paper, we present a fast and reproducible method for the determination of radon potential (as an alternative to the exhalation rate) based on the application of the accumulation chamber technique. Radon potential is proportional to the emanation coefficient, and can be calculated within measuring times of less than 24 h. The theoretical basis is developed and the experimental setup is discussed in detail in this paper.The procedures for the determination of different experimental parameters (leakage constant, slope correction) are shown as essential steps for the later determination of the radon potential. In addition, the robustness of the developed methodology is demonstrated, and the reproducibility tests carried out with the general system performance are shown. Finally, the radon potential for different materials is determined, allowing its prompt categorization according to its associated radiological risk.     

Prevalence of psychopathology in patients suffering from breast and gastrointestinal cancer

Prevalence of psychopathology in 107 in- and outpatients suffering from cancer was assessed by means of self-rating inventory (Symptom Check List (SCL-90)) and an interview. There were 86 women with breast cancer and 21 patients with gastrointestinal cancer (9 women and 12 men). Inventory was administered once after surgery. Psychopathology exceeding so called mean borderline values derived from control samples ranged from 2% to 33% of the patients in particular dimensions of the inventory. Maximal mean values of the psychopathology were found in the dimensions of somatisation, depression, anxiety, phobic anxiety, hostility and of items not included, reflecting mostly sleep and eating distortions. Mean values of the psychopathology were insignificantly lower in patients after mastectomy, compared with gastrointestinal cancer patients. No significant differencies between initial (I and II) and advanced (III and IV) stages of the illness were achieved in the patients from both investigated samples. Screened patients are suitable for psychiatric or psychologic therapeutic intervention.