Intake of dietary fiber, especially from cereal foods, is associated with lower incidence of colon cancer in the HELGA cohort

The role of dietary fiber on the risk of colon and rectal cancer has been investigated in numerous studies, but findings have been inconsistent. The purpose of this study was to examine associations between intake of dietary fiber and risk of incident colon (including distal and proximal colon) and rectal cancer in the prospective Scandinavian HELGA cohort and to determine if fiber source (vegetables, fruits, potatoes, cereals) impacted the association. We included 1,168 incident cases (691 colon, 477 rectal cancer), diagnosed during a median of 11.3 years, among 108,081 cohort members. Sex-specific incidence rate ratios (IRRs) of colon and rectal cancer were related to intake of total or specific fiber source using Cox proportional hazards models. For men, an inverse association was observed between intake of total fiber and the risk of colon cancer per an incremental increase of 10 g day(-1) , IRR (95% CI): 0.74 (0.64-0.86). Intake of cereal fiber per 2 g day(-1) was associated with an IRR of 0.94 (0.91-0.98), which was also seen for intake of cereal fiber from foods with high fiber content (≥ 5 g per 100 g product), where the IRR per 2 g day(-1) was 0.94 (0.90-0.98). In women, intake of cereal fiber per 2 g day(-1) was also associated with lower risk of colon cancer, 0.97 (0.93-1.00). No clear associations were seen for rectal cancer. Our data indicate a protective role of total and cereal fiber intake, particularly from cereal foods with high fiber content, in the prevention of colon cancer.     

直肠全系膜切除术治疗低位直肠癌术后常见吻合口并发症剖析及防治

目的探讨直肠全系膜切除术治疗低位直肠癌术后常见吻合口并发症的形成原因及防治方法。方法回顾性分析按TME原则手术的120例低位直肠癌行保肛手术的临床资料。结果术后发生吻合口漏7例,占5.8%,吻合口出血8例,占6.7%,吻合口狭窄5例,占4.2%。结论在低位直肠癌保肛手术中,严格掌握低位直肠癌行保肛手术的指征、充分的术前准备、保证吻合口的血供、正确选择和使用吻合器及引流管是降低吻合口并发症发生的关键,对术后吻合口漏视具体病情采用个体化治疗。     

直肠癌保留盆腔自主神经手术辅助术后放疗对提高患者生活质量的评估

Objective:Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery & to evaluate functional outcome,local recurrence.Methods:A prospective study was undertaken on Egyptian patients.Forty one patients participated in the study in the period from December 2002 till June 2004 where they underwent radical surgery but with preservation of the pelvic autonomic nerves this was followed by adjuvant pelvic radiotherapy.Results:Six months,1-year and 2-year follow-up of urinary function was complete in 32 out of 41(78%),30 out of 41 (73%) and 27 out of 41 patients (65%) respectively There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunction.None of the patients reported major incontinence.Six months,1-year and 2-year follow-up of sexual function revealed that 22 out of 41 patients (53%) were sexually active.Three out of 41 patients (7.3%) developed local recurrence.38 (92.7%) patients were free of local recurrence,regarding patients who received adjuvant radiotherapy 3 out of the 34 (8.8%) patients developed local pelvic recurrence while 9 patients (26.5%) developed distant metastases (3 of them did not receive adjuvant chemotherapy),while patients who received adjuvant chemotherapy,2 out of 20 patients (10%) developed local recurrence while distant metastases developed in 6 patients (30%).Conclusion:Preservation of the pelvic autonomic nerves minimizes bladder and sexual dysfunction especially in male patients after rectal cancer surgery.     

The utility of multimodality imaging with CT and MRI in defining rectal tumour volumes for radiotherapy treatment planning: a pilot study

Aims: This study compares the volumetric and spatial relationships of gross tumour volume (GTV) derived from CT (CT-GTV) and GTV derived from MRI (MR-GTV) to determine the utility of multi-modality imaging for radiotherapy treatment planning in rectal cancer. Methods and Materials: Fifteen patients with T3 rectal cancer were accrued over 18 months. The male : female ratio was 2:1. The average age was 60.3 years (range 38–79). All patients underwent a diagnostic MRI and CT and MRI simulation. Data sets were co-registered. A site specialised diagnostic radiologist contoured all volumes in consultation with a radiation oncologist. CT-GTV was contoured while blinded to MR data sets. MR-GTV was contoured independently 2–4 weeks later whilst blinded to its respective CT-GTV data. Tumour volumes were analysed for three anatomical subregions (sigmoid, rectal and anal). Reference points on tumour volumes were used for spatial comparison and analysis. Results: The mean CT-GTV/MR-GTV ratio was 1.2 (range 0.5–2.9). The tumour volume ratios for the rectal subregion were well correlated. CT-GTV provided adequate spatial coverage of tumour in reference to MR-GTV with the average mean discrepancy of 0.12 (range −0.08–0.38) or a maximum discrepancy of <0.4 cm (1.54 standard deviation). CT-GTV coverage was inadequate for tumours with MRI evidence of anal and sigmoid invasion. Conclusions: Conventional simulation CT imaging provided a reasonable estimate of the GTV. Multi-modality imaging with staging MRI can assist target volume definition where there is involvement of the sigmoid and anorectal region and avoid geographic misses. The role of a simulation MRI may aid in this process but remains investigational.     

Adjuvant chemoradiotherapy of advanced resectable rectal cancer: results of a randomised trial comparing modulation of 5-fluorouracil with folinic acid or with interferon-α

Background:

Standard adjuvant chemoradiotherapy of rectal cancer still consists of 5-fluorouracil (5-FU) only. Its cytotoxicity is enhanced by folinic acid (FA) and interferon-α (INFα). In this trial, the effects of FA and IFNα on adjuvant 5-FU chemoradiotherapy in locally advanced rectal cancer were investigated.

Methods:

Patients with R₀-resected rectal cancer (UICC stage II and III) were stratified and randomised to a 12-month adjuvant chemoradiotherapy with 5-FU, 5-FU+FA, or 5-FU+IFNα. All patients received levamisol and local irradiation with 50.4 Gy.

Results:

Median follow-up was 4.9 years (n=796). Toxicities (WHO III+IV) were observed in 32, 28, and 58% of patients receiving 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. No differences between the groups were observed for local or distant recurrence. Five-year overall survival (OS) rates were 60.3% (95% confidence interval (CI): 54.3–65.8), 60.4% (54.4–65.8), and 59.9% (53.0–66.1) for 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. A subgroup analysis in stage II (pT3/4pN0) disease (n=271) revealed that the addition of FA tended to reduce the 5-year local recurrence (LR) rate by 55% and increase recurrence-free survival and OS rates by 12 and 13%, respectively, relative to 5-FU alone.

Conclusions:

Interferon-α cannot be recommended for adjuvant chemoradiotherapy of rectal cancer. In UICC stage II disease, the addition of FA tended to lower LR and increased survival. The addition of FA to 5-FU may be an effective option for adjuvant chemoradiotherapy of UICC stage II rectal cancer.     

Factors Influencing Late Consultation Among Patients with Rectal Bleeding in University Kebangsaan Malaysia Medical Centre

Background: Patients’ delay in the presentation with rectal bleeding had been identified as a factor for latediagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting amedical practitioner and identifying associated factors. Materials and Methods: A cross-sectional study of 80patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 inthe endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaireincluded data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any selftreatment prior to medical consultation and patients’ opinion on causes of their own rectal bleeding. Results:The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6;95% CI 3.3-27.5), who did not seek anyone’s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment beforeseeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logisticregression revealed that less worry of rectal bleeding and not seeking anyone’s advice were important predictors(p < 0.05). The majority of patients attributed their bleeding to benign causes. Conclusion: A high proportion ofpatients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needsto focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.