Irinotecan versus oxaliplatin for adjuvant colon cancer therapy: Why do the results differ?

Chemotherapy for colon cancer has evolved substantially over the past 5 years with the addition of new drugs such as oxaliplatin and irinotecan. Though chemotherapy regimens based on oxaliplatin and irinotecan are considered to be equivalent in the advanced-disease setting, oxaliplatin-based regimens appear more effective in adjuvant therapy after resection. The MOSAIC and NSABP C-07 trials demonstrated survival improvement with the addition of oxaliplatin, whereas the CALGB 89803, ACCORD-02, and PETACC-3 trials did not reveal the same benefit with irinotecan. This discrepancy may stem from differences in the mechanism of action, drug resistance, toxicity, or trial design. These results challenge the conventional wisdom that agents effective in the advanced setting will work postoperatively. With the availability of new, targeted agents, it is clear that the results of randomized phase 3 trials must be analyzed before extrapolating efficacy from the metastatic setting to the adjuvant setting in colon cancer.     

The crypto-hem test in screening for colon cancer

The paper discusses the reliability of crypto-hem test (detection of occult blood in feces) in diagnosing large bowel tumors in the course of a mass screening. 1573 healthy subjects aged 45 years and older were examined. The results were positive in 24 (2%) out of 1190 screenees who were involved in the test and in 58 (4.9%) subjects the results were suspicious. Tumors were detected in 23 (95.9%) test-positive screenees: cancer--12.5, polyps--54.2 and villous tumor--29.2%. Crypto-hem test proved instrumental in mass screening. Due to its application, symptom-free rectal cancer was diagnosed in 0.2, villous tumor--0.6, and single adenomatous polyps--1.1%.     

Expected long-term impact of the German screening colonoscopy programme on colorectal cancer prevention: Analyses based on 4,407,971 screening colonoscopies

AimEndoscopy based screening programmes for colorectal cancer (CRC) are being implemented in an increasing number of countries. In Germany, screening colonoscopy at age 55 or older has been offered since the end of 2002. We aimed to estimate the long-term impact of this offer on CRC prevention.MethodsWe estimated numbers of prevented CRC cases by expected age and year of their (prevented) occurrence over four decades (2005–2045) by four state Markov models (non-advanced adenoma, advanced adenoma, preclinical CRC, clinically manifest CRC). Estimates are based on screening colonoscopies reported to the German screening colonoscopy registry in 2003–2012 (N = 4,407,971), transition rates between the four states and general population mortality rates.ResultsNumbers of prevented clinically manifest CRC cases are projected to increase from <100 in 2005 to approximately 6500 in 2015, 12,600 in 2025, 15,400 in 2035 and 16,000 in 2045, compared to approximately 58,000 incident cases observed in 2003. The annual number of prevented cases is expected to be higher among men than among women and to strongly vary by age. The vast majority of prevented cases would have occurred at age 75 or older.ConclusionsDespite modest participation rates, the German screening colonoscopy programme will lead to substantial reductions in the CRC burden. The reductions will be fully disclosed in the long run only and predominantly affect numbers of incident cases above 75 years of age. Screening offers would need to start at younger ages in order to achieve more effective CRC prevention at younger ages.     

Use of colonoscopy for colorectal cancer screening: evidence from the 2000 National Health Interview Survey.

BACKGROUND: The use of colonoscopy as a primary screening tool for colorectal cancer is gaining momentum owing to several studies suggesting superior effectiveness and the recent, favorable decision by Medicare to cover all routine screening colonoscopies. This study documents the use of colonoscopy versus other tests to screen for colorectal cancer. MATERIALS AND METHODS: Data from the 2000 National Health Interview Survey were analyzed. Fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy done for any reason and for routine screening only were analyzed for those >/=50 years without previously diagnosed colorectal cancer (n = 12,505). RESULTS: The proportion of the total eligible population receiving any of the recommended tests for all possible reasons and for screening purposes only is 34.6% and 25.1%, respectively. For routine screening purposes, the test most commonly utilized was FOBT (55.6%) followed by colonoscopy (29.1%) and sigmoidoscopy (15.3%). When usage was assessed for all reasons, FOBT was still most commonly utilized (45.8%) followed by colonoscopy (38.7%) and sigmoidoscopy (15.5%). The elderly, non-White males and those with private insurance have a higher probability of receiving colonoscopy than FOBT. Several regional differences exist, including higher probability of undergoing sigmoidoscopy versus colonoscopy in the West. CONCLUSIONS: Only one fourth (upper limit one third) of the study population complied with colorectal cancer screening recommendations. Nearly one third of the routine screening tests done in 2000 were colonoscopies. This study provides baseline values that can be used to project future colonoscopy demand and identify potential supply barriers.     

Mass screening for the early detection of colon cancer in patients with endometrial cancer

A mass screening has been performed for the early detection of colon cancer by evaluating Hemocult II slides of blood relatives of patients with endometrial cancer. Though the defect of this screening is that the subject of the investigation, which was undertaken in all parts of Japan, is restricted, one case of colon cancer, two cases of colon polyposis, two cases of hemorrhoids, and one case of colon diverticulum have been uncovered by this screening. The rate of discovery of colon cancer proved to be 0.45%, a rate that is higher than seen in usual screening method. It has been concluded that blood relatives of patients with endometrial cancer should be screened, since they represent a high risk group for developing colon cancer.     

多学科合作是胃癌的最佳诊治模式

肿瘤流行病学调查显示,胃癌的总发病率有所下降,但仍然是全球第一、二号肿瘤杀手而成为世界性的健康问题.胃癌病例占新诊断癌肿病例的10%,占癌肿死亡病例的12%[1].近几十年,胃癌外科治疗取得了不俗的进步[2,3].这些进步与胃癌多学科综合治疗观念获得普遍认可有密切关系.