​Author(s): Topps A.R.; Barr S.P.; Pikoulas P.; Maxwell A.J.; Pritchard S.A.
Source: Annals of Surgical Oncology; Oct 2017 ; p. 1-6
Publication Date: Oct 2017
Publication Type(s): Article In Press
Abstract:Background: Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference. Methods: All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference. Results: A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group. Conclusions: CNB is safe and should be the preferred technique for UNS to improve sensitivity.Copyright © 2017 Society of Surgical Oncology
Database: EMBASE

​Author(s): Sharma V.; Junejo M.; Mitchell P.J.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 39
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available  at Colorectal Disease -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: A malignant polyp is a retrospective diagnosis of an endoscopically excised polyp with positive histological finding of malignancy. ACPGBI guidelines (2013) recommend follow-up endoscopy at 3 months. Our primary aim was to assess concordance with these guidelines, with the secondary aim to assess early recurrence. Methods: Retrospective analysis of all malignant polyps treated endoscopically between April 2012 and April 2015 within a regional cancer network. Results: 177 patients were identified of whom 37 underwent surgery. 140 patients underwent endoscopic surveillance with recurrence in 5 patients. Median age of observed patients was 68.5 years. 93.6% of polyps were located in the rectum or sigmoid (n = 67 and 64 respectively). Median size of excised polyps was 15 mm. Endoscopic surveillance within three months was undertaken in 86 patients (61.4%) and within six months in 116 patients (82.9%). By 12 months 125 patients (89.3%) had undergone endoscopic surveillance. 3/86 (3.5%) patients having 3-month surveillance had endoscopic abnormality which resulted in surgical intervention. Positive residual disease was identified in 2 out of these 3 patients. 3 recurrences were identified late (>3 months) with two on cross sectional imaging (6 and 12 months respectively), and one on endoscopy at 12 months. A normal endoscopy at 3 months provided a negative predictive value of 96.4% for disease recurrence. Conclusion: A normal endoscopy at three months excluded the risk of recurrence/ residual disease for the vast majority of patients, however less than 2/3 patients with malignant polyps are appropriately followed up with a three-month endoscopy as per the ACPGBI guidelines.
Database: EMBASE

Author(s): Athanasiou, Christos; Robinson, Jonathan; Yiasemidou, Marina; Lockwood, Sonia; Markides, Georgios A

Source: International journal of surgery (London, England); Mar 2017

Publication Type(s): Journal Article Review

Abstract:
BACKGROUND
Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes.METHODSMedline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated.

RESULTS
Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17).CONCLUSIONSLPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.
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Database: Medline

Author(s): Nightingale, J.M.; Murphy, F.; Eaton, C.; Borgen, R.

Source: Radiography; Feb 2017; vol. 23 (no. 1); p. 38-47

Publication Date: Feb 2017

Publication Type(s): Academic Journal
​
Database: CINAHL

​Source: British journal of cancer; Sep 2016; vol. 115 (no. 7); p. 789-796

Publication Type(s): Journal Article

Author(s): Dalgleish, Angus G; Stebbing, Justin; Adamson, Douglas Ja; Arif, Seema Safia; Bidoli, Paolo; Chang, David; Cheeseman, Sue; Diaz-Beveridge, Robert; Fernandez-Martos, Carlos; Glynne-Jones, Rob; Granetto, Cristina; Massuti, Bartomeu; McAdam, Karen; McDermott, Raymond; Martín, Andrés J Muñoz; Papamichael, Demetris; Pazo-Cid, Roberto; Vieitez, Jose M; Zaniboni, Alberto; Carroll, Kevin J; Wagle, Shama; Gaya, Andrew; Mudan, Satvinder S

Abstract:Immune Modulation and Gemcitabine Evaluation-1, a randomised, open-label, phase II, first-line, proof of concept study (NCT01303172), explored safety and tolerability of IMM-101 (heat-killed Mycobacterium obuense; NCTC 13365) with gemcitabine (GEM) in advanced pancreatic ductal adenocarcinoma.         Patients were randomised (2 : 1) to IMM-101 (10 mg ml(-l) intradermally)+GEM (1000 mg m(-2) intravenously; n=75), or GEM alone (n=35). Safety was assessed on frequency and incidence of adverse events (AEs). Overall survival (OS), progression-free survival (PFS) and overall response rate (ORR) were collected. IMM-101 was well tolerated with a similar rate of AE and serious adverse event reporting in both groups after allowance for exposure. Median OS in the intent-to-treat population was 6.7 months for IMM-101+GEM v 5.6 months for GEM; while not significant, the hazard ratio (HR) numerically favoured IMM-101+GEM (HR, 0.68 (95% CI, 0.44-1.04, P=0.074). In a pre-defined metastatic subgroup (84%), OS was significantly improved from 4.4 to 7.0 months in favour of IMM-101+GEM (HR, 0.54, 95% CI 0.33-0.87, P=0.01).         IMM-101 with GEM was as safe and well tolerated as GEM alone, and there was a suggestion of a beneficial effect on survival in patients with metastatic disease. This warrants further evaluation in an adequately powered confirmatory study.

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Citation: Journal of Clinical Oncology, May 2016, vol./is. 34/(no pagination), 1527-7755 (May 2016)
 
Author(s): Ghaneh P., Wong W.L., Titman A., Plumpton C., Vinjamuri S., Johnson C., Hilal M.A., Higginson A., Smith A.M., Scarsbrook A., McKay C., Suttcliffe R., Kocher H., Cunningham D., Pereira S.P., Davidson B., Chang D., Khan S., Halloran C., Neoptolemos J.P.
 
Language: English
 
Abstract: Background: Pancreatic cancer diagnosis and staging is challenging. FDG PET/CT adds anatomic localization to functional data. The aim of this study was to determine the impact of FDG PET/CT in addition to standard diagnostic workup in patients with suspected pancreatic cancer. Methods: Patients with suspected pancreatic cancer underwent FDG PET/CT following multi-detector CT (MDCT). FDG PET/CT scans were reviewed and quality assured centrally. Diagnosis, staging and planned management were recorded before and after FDG PET/CT. Reference standard was histology or clinical outcome. Primary outcome measure was incremental diagnostic value of FDG PET/CT in addition to MDCT. Sample size was 500 patients, following interim analysis; 80% power to detect increase in sensitivity from 81 % to 90% and specificity from 66% to 80%. Secondary outcome measures were changes in diagnosis, staging, and management; cost effectiveness was estimated. Results: Between January 2011 and April 2013 589 patients with suspected pancreatic cancer underwent MDCT and FDG PET/CT in 18 UK centres. 550 patients had complete data and in range FDG PET/CT. 261 patients (47%) had pancreatic ductal adenocarcinoma (PDAC). For the diagnosis of PDAC, both sensitivity (92.7% [95% CI 89.6%, 95.9%] compared to 88.5% [95% CI 84.6%, 92.4%], p=0.010) and specificity (75.8% [95% CI 70.8%, 80.7%] compared to 70.6% [95% CI 65.3%, 75.8%] p=0.023) were significantly higher for FDG PET/CT than MDCT. FDG PET/CT correctly changed the staging of PDAC in 56 patients (14%) (p=0.001). FDG PET/CT influenced management in 250 (45%) of patients. FDG PET/CT stopped futile resection in 58 patients (20%) due to have surgery. FDG PET/CT was associated with a QALY gain of 0.0157 (95% CI -0.0101, 0.0430) and cost saving of 645 (95% CI -1314, 2743). In the base case model FDG PET/CT dominated MDCT alone and is likely to be cost effective for the UK NHS. Conclusions: FDG PET/CT provided significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and had a significant influence on the staging and management of patients. FDG PET/CT was cost effective at current reimbursement rates for FDG PET/CT to the UK NHS.
 
Publication Type: Journal: Conference Abstract
 
Source: EMBASE
 
Full Text:
Available in Journal of Clinical Oncology
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​Citation: Lancet (London, England), Mar 2016, vol. 387, no. 10024, p. 1163-1177, 1474-547X (March 19, 2016)
 
Author(s): James, Nicholas D, Sydes, Matthew R, Clarke, Noel W, Mason, Malcolm D, Dearnaley, David P, Spears, Melissa R, Ritchie, Alastair W S, Parker, Christopher C, Russell, J Martin, Attard, Gerhardt, de Bono, Johann, Cross, William, Jones, Rob J, Thalmann, George, Amos, Claire, Matheson, David, Millman, Robin, Alzouebi, Mymoona, Beesley, Sharon, Birtle, Alison J, Brock, Susannah, Cathomas, Richard, Chakraborti, Prabir, Chowdhury, Simon, Cook, Audrey, Elliott, Tony, Gale, Joanna, Gibbs, Stephanie, Graham, John D, Hetherington, John, Hughes, Robert, Laing, Robert, McKinna, Fiona, McLaren, Duncan B, O'Sullivan, Joe M, Parikh, Omi, Peedell, Clive, Protheroe, Andrew, Robinson, Angus J, Srihari, Narayanan, Srinivasan, Rajaguru, Staffurth, John, Sundar, Santhanam, Tolan, Shaun, Tsang, David, Wagstaff, John, Parmar, Mahesh K B, STAMPEDE investigators
 
Abstract: Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone. Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544). 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy. Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research. Copyright © 2016 James et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.
 
Source: Medline

Citation: Clinical case reports, Feb 2016, vol. 4, no. 2, p. 214-215 (February 2016)
 
Author(s): Zhou, Zhaowei, Zhang, Da
 
Abstract: Umbilical tumors are relatively rare and can be classified as benign or malignant. The term "Sister Mary Joseph nodule" is used to describe an umbilical neoplasm associated with advanced metastatic intra-abdominal malignancy. It generally has a poor prognosis.
 
Source: Medline
 
Full Text:
Available from Directory of Open Access Journals in Clinical Case Reports
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