Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature

Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.

Liquid biopsy in colorectal cancer:No longer young,but not yet old

Colorectal cancer(CRC)is one of the most prevalent cancers and the second leading cause of cancer-related deaths worldwide.The treatment strategy employed in CRC patients is becoming highly dependent on molecular characteristics present at diagnosis and during treatment.Liquid biopsy is an emerging field in the management of this cancer,and its relevance as a potential diagnostic,prognostic,monitoring,and therapeutic tool makes it a viable strategy in the clinical management of CRC patients.Liquid biopsy also has certain limitations,but these limitations seem to be at the reach of near-future technological development.In this letter,we focus on the clinical perspectives of liquid biopsy in CRC with particular regard to the various biomarkers recently identified that have been shown to be potentially useful in multiple aspects of early stage or metastatic CRC.

A path for diagnosis and therapy of colon cancer: a continuous quality improvement

Objective： Prognosis of colorectal cancer strongly depends on stage at diagnosis, which can be cured in most cases at an early stage. The results were supported by different screening programmes. Few data concerning analysis of different phases of Colorectal Cancer Program were reported in literature. The aim of this study is to analyze ＂step by step＂, from a longitudinal type, the Colorectal Cancer Program, active at our Institution, verifying compliance with standards of care.Methods： We compared two different populations during the same period： patients referring to our Clinical Oncology Unit coming from Regional Colorectal Cancer Screening Program and the other population that was not in any Colorectal Cancer Program.Results： Considering patients from the Regional Colorectal Cancer Screening Program（19 patients, corresponding to 24.0% of the general case study）, 3（15.8%） were deceased and 16（84.2%） were alive without evidence of the disease（NED）. Concerning patients that are not coming from Regional Colorectal Cancer Screening Program（61 patients, corresponding to 76.0% of the general case study）, 9（14.8%） were deceased, 43（70.5%） were NED, 8（13.1%） were alive with metastases and 1（1.6%） was lost during follow-up（PFU）. Conclusions： On the basis of this experience, we concluded for high-quality care for both populations. Any critical point should be carefully analyzed in order to implement quality of care.

Liquid biopsy in endometrial cancer

Liquid biopsy(LB)is an emerging tool for the evaluation of relapse in several cancers and nowadays is used in lung cancer for primary detection and molecular characterization when tumoral tissue is not available.It can represent an innovative biospecimen for the screening,diagnosis,and monitoring of all types of cancer and for monitoring of therapeutic efficacy.LB includes several biofluids such as blood,urine,peritoneal fluid/lavage,and analytes(circulating tumor cells,circulating tumor DNA,long noncoding RNA,microRNA,vesicles,mRNA,and protein)that can play different roles in diagnosis,prognosis,and patient management as well as in the improvement of the knowledge of cancer evolution.Endometrial cancer(EC)is a tumor usually detected at low stage with a good prognosis,but few low risk cases,unexpectedly,can evolve to bad prognosis.Up to now,no molecular target exists to treat advanced stage or to define the evolution of low stage EC.This review focuses on how the LB may help in the management and characterization of patients affected by EC.