Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have res...Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy.Although,preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors,many controversial matters in management of rectal cancer still need to be defined.These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy,the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection.In this article,after an extensive search in PubMed and Embase databases,we critically review the current strategies and the most debatable matters in treatment of rectal cancer.展开更多
AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with V...AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (104 cells/rabbit) via supraumbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartateaminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial aspect at 7 d after treatment. At all time points evaluated, all except one biochemical parameters tested within the reference range (P > 0.05); a significant increase was detected in the alkaline phosphatase level of the control group 3 on D11 (P < 0.05). At 24 h post-treatment, the aspirintreated groups showed extensive coagulation necrosis accompanied by a remarkable absence of viable tumor foci; at 7 d after treatment, the tumors had completely disappeared in these animals and fibrous necrotic nod- ules had developed. In contrast, throughout the study course, the tumors of the control groups remained unchanged, showing tumor nodules without necrosis at the time point corresponding to 24 h post-treatment and increased amounts of tumor nodules at the time point corresponding to 7 d post-treatment. Quantitative analysis of the remaining tumor area revealed that the aspirin-treated groups had significantly smaller tumor foci at 24 h post-treatment (8.5% ± 0.7%) andat 7 d after treatment (11.0% ± 4.2%), compared to those in the control groups (24 h: 98.5% ± 1.5% and 7 d: 94.0% ± 2.7%; both,P < 0.005). CONCLUSION: Intralesional injection of a 10% aspirin solution causes destruction of VX2 hepatic tumors in rabbits without evidence of relapse at 7 d after treat- ment administration.展开更多
Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies ...Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.展开更多
It is estimated in Western industrialized countries that inflammatory bowel disease(IBD)has a prevalence of 1 for every 200 inhabitants.In the past,the fat mass disproportionate increase in relation to the fat-free ma...It is estimated in Western industrialized countries that inflammatory bowel disease(IBD)has a prevalence of 1 for every 200 inhabitants.In the past,the fat mass disproportionate increase in relation to the fat-free mass was considered uncommon in patients with IBD,due to the observation of the disease being more common with weight loss and malnutrition.However,more in-depth investigations demonstrate that the fat/lean mass disproportion stands out both in prevalence in patients with new diagnoses of ulcerative colitis or Crohn's disease as well as a factor of poor prognosis to the natural evolution of the disease or to the therapeutic response.Another important aspect associated with obesity in IBD is the increased risk of drug clearance[including anti-tumor necrosis factor(TNF)and anti-integrin agents],resulting in short half-life and low trough drug concentrations,since the levels of TNF secreted by adipocytes sequester anti-TNF agents,which could result in suboptimal response to biologics.In view of these characteristic aspects of the inflammatory process of IBD,the identification of cellular functioning is necessary,which can be associated with the staging of the underlying disease,biochemical parameters,and body composition,helping as an indicator for a more accurate clinical and nutritional conduct.展开更多
文摘Management of rectal cancer has markedly evolved over the last two decades.New technologies of staging have allowed a more precise definition of tumor extension.Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy.Although,preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors,many controversial matters in management of rectal cancer still need to be defined.These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy,the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection.In this article,after an extensive search in PubMed and Embase databases,we critically review the current strategies and the most debatable matters in treatment of rectal cancer.
文摘AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (104 cells/rabbit) via supraumbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartateaminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial aspect at 7 d after treatment. At all time points evaluated, all except one biochemical parameters tested within the reference range (P > 0.05); a significant increase was detected in the alkaline phosphatase level of the control group 3 on D11 (P < 0.05). At 24 h post-treatment, the aspirintreated groups showed extensive coagulation necrosis accompanied by a remarkable absence of viable tumor foci; at 7 d after treatment, the tumors had completely disappeared in these animals and fibrous necrotic nod- ules had developed. In contrast, throughout the study course, the tumors of the control groups remained unchanged, showing tumor nodules without necrosis at the time point corresponding to 24 h post-treatment and increased amounts of tumor nodules at the time point corresponding to 7 d post-treatment. Quantitative analysis of the remaining tumor area revealed that the aspirin-treated groups had significantly smaller tumor foci at 24 h post-treatment (8.5% ± 0.7%) andat 7 d after treatment (11.0% ± 4.2%), compared to those in the control groups (24 h: 98.5% ± 1.5% and 7 d: 94.0% ± 2.7%; both,P < 0.005). CONCLUSION: Intralesional injection of a 10% aspirin solution causes destruction of VX2 hepatic tumors in rabbits without evidence of relapse at 7 d after treat- ment administration.
文摘Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.
文摘It is estimated in Western industrialized countries that inflammatory bowel disease(IBD)has a prevalence of 1 for every 200 inhabitants.In the past,the fat mass disproportionate increase in relation to the fat-free mass was considered uncommon in patients with IBD,due to the observation of the disease being more common with weight loss and malnutrition.However,more in-depth investigations demonstrate that the fat/lean mass disproportion stands out both in prevalence in patients with new diagnoses of ulcerative colitis or Crohn's disease as well as a factor of poor prognosis to the natural evolution of the disease or to the therapeutic response.Another important aspect associated with obesity in IBD is the increased risk of drug clearance[including anti-tumor necrosis factor(TNF)and anti-integrin agents],resulting in short half-life and low trough drug concentrations,since the levels of TNF secreted by adipocytes sequester anti-TNF agents,which could result in suboptimal response to biologics.In view of these characteristic aspects of the inflammatory process of IBD,the identification of cellular functioning is necessary,which can be associated with the staging of the underlying disease,biochemical parameters,and body composition,helping as an indicator for a more accurate clinical and nutritional conduct.
