Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: A single institution experience

Background

Although there is an extensive body of literature on the role of neoadjuvant chemoradiotherapy (CRT) in the management of rectal cancer, its role in primary locally advanced adherent colon cancer (LAACC) is unclear.

Objective

To analyzed the outcomes of neoadjuvant CRT and multivisceral resection in the management of LAACC patietns.

Methods

We retrospectively reviewed our institutional Colorectal Carcinoma Database for 33 patients with potentially resectable, non-metastatic primary LAACC who received neoadjuvant CRT followed by multivisceral resection. CRT consisted of external beam radiation (45–50 Gy in 25 daily fractions) and concurrent 5-FU infusion (225 mg/m²/day).

Results

There were 21 males and 12 females. Median age was 64 (31–83) and median follow-up was 36 months. All patients had microscopically clear resection margins (R0). Complete pathologic response was documented in 1 patient (3%) and 66% had ypT4b disease. Post-operative complications were observed in 36% of patients with no 30-day mortality. The 3-year overall survival and 3-year disease-free survival were 85.9% and 73.7% respectively. Two patients developed a local recurrence.

Conclusions

Neoadjuvant CRT and en-bloc multivisceral resection may result in high rates of R0 resection and excellent local control with acceptable morbidity and mortality in selected patients with LAACC.     

Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma

Purpose

Cancer registry survival analyses have shown that adolescent and young adult patients with low socioeconomic status (SES) have reduced survival compared to those with higher SES. The objective of this study was to determine whether neighborhood- (nSES) and/or individual-level SES (iSES) also predicted current quality of life in adolescent and young adult survivors.

Methods

The Socioeconomics and Quality of Life study surveyed adolescent and young adult survivors of leukemia and lymphoma at least one year post-diagnosis using population-based ascertainment. Factor analysis was used to create a multidimensional age-relevant iSES score and compared with a preexisting census-block-group derived nSES score. Four quality of life domains were assessed: physical health, psychological and emotional well-being, social relationships, and life skills. Nested multivariable linear regression models were run to test the associations between both SES measures and quality of life and to compare the explanatory power of nSES and iSES.

Results

Data from 110 individuals aged 16–40 were included in the final analysis. After adjustment for sociodemographic confounders, low nSES was associated only with poorer physical health, whereas low iSES was related to poorer quality of life in all four domains with iSES accounting for an additional 14, 12, 25, and 10 % of the variance, respectively.

Conclusions

Measures of SES at the individual as compared to the neighborhood level may be stronger indicators of outcomes in adolescents and young adults, which has important implications for SES measurement in the context of cancer surveillance.     

“You’re too young for this”: Adolescent and Young Adults’ Perspectives on Cancer Survivorship

Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult. Future intervention development for adolescent and young adult survivors should involve patient voices at each stage of the research process.     

In vitro CT comparisons of dissected phleboliths and retrieved ureteral calculi

Purpose: This project was designed to assess the accuracy of radiologists in distinguishing between pelvic phleboliths and ureteral calculi by CT scanning in vitro. Materials and methods: Twenty-five phleboliths were dissected from autopsy specimens, and 23 ureteral calculi were retrieved intact and all calcifications made available for this study. Calcifications were suspended in ordinary butter and subjected to CT scanning using both bone and soft tissue windows. A panel of three radiologists blinded to the correct diagnoses independently assessed the images. The questions asked were: was the calcification a phlebolith or a stone? was it round or irregular? did it have a central “hole” or not? Confidence levels for each observer and each question were rated on a semicontinuous scale from 0 to 100 and receiver-operating characteristic (ROC) curves computed. Results: ROC curves for distinguishing between ureteral stones and calculi ranged from .78 to .99. As a subset, ROC curves for roundness alone, assuming phleboliths tended to be round and calculi not, ranged from .85 to .98. These ROC curves for roundness alone correlated closely with overall performance in distinguishing ureteral stones from phleboliths. ROC curves for determining central radiolucencies, however, although the latter were assumed to be hypothetically present in phleboliths, were degenerate for two observers, and only .57 for the third. Conclusions: Under optimal in vitro conditions, pelvic phleboliths and ureteral calculi do possess characteristics, especially shape, that many permit discrimination by CT scanning.     

Incidence of hereditary spherocytosis in a population of jaundiced neonates

As most of hereditary spherocytosis-affected individuals experience jaundice at birth, it seemed of interest to evaluate the proportion of hereditary spherocytosis in 402 severely jaundiced neonates with a bilirubinemia level prompting phototherapy. Red cell dehydration, a hallmark of spherocytosis whether constitutional or acquired, was demonstrated in 74 of them, among whom 23 disclosed a typical pattern of spherocytosis upon red cell deformability studies. Acquired spherocytosis of immune origin was diagnosed in 19/23 and hereditary spherocytosis in 4, making the proportion of hereditary spherocytosis-affected individuals among a severely jaundiced population of neonates amount to 1%, an incidence at least 30-fold that of the overall population.     

Attempt of conservative treatment efficiency evaluation of inhabitants of Wroclaw

2979 inhabitants of Wroc?aw aged from 18-80 years, in this 1581 women and 1398 men, have been examined stomatologically. Clinical material has been collected and analysed, average values of D, M, F in women and men in 5 age groups have been calculated. Indicators D/DMF, M/DMF and M/DMF as well as percentage of people under examination with toothlessness and frequency they take advantage of stomatological care have been calculated. The results point out higher D/DMF medicinal demand in men than in women. Along with the age of persons under examination percentage of extracted teeth in the DMF, M/DMF values increases and the proportion of effective healing to the demand F/DMF decreases. Over 80% of persons under examination take occasionally advantage of stomatological care without pain symptoms.     

CT demonstration of irrigant extravasation following percutaneous nephrolithotomy

Two patients with extensive irrigant solution extravasation following percutaneous nephrolithotomy documented by computed tomography (CT) are described. This complication of percutaneous nephrolithotomy often can be avoided by careful attention to technique. CT can accurately confirm the diagnosis.