7540 Background: Human melanoma cells express high affinity glucocorticoid receptors, and adrenal... more 7540 Background: Human melanoma cells express high affinity glucocorticoid receptors, and adrenalectomy has been shown to have anti-melanoma effects in animal models. We observed long-term regressi...
ABSTRACT Aim: With evolving treatment possibilities for patients with peritoneal carcinomatosis (... more ABSTRACT Aim: With evolving treatment possibilities for patients with peritoneal carcinomatosis (PC) of colorectal cancer (CRC), adequate prognostication and patient selection for treatment becomes increasingly important. The prognostic relevance of commonly identified histological subtypes in patients with PC of CRC being adenocarcinoma (AC), mucinous adenocarcinoma (MC) and signet-ring cell carcinoma (SC) is currently unclear and was investigated in the current population-based study. Methods: This nationwide study involved 3551 patients diagnosed with synchronous PC from CRC between 2005-2011 in the Netherlands, as recorded in a nationwide registry. Kaplan-Meier analysis and log-rank testing were performed to estimate survival. Subsequently a Cox proportional hazard model was used to calculate hazard ratios for the risk of death. Results: The majority of the CRC patients was diagnosed with AC (n = 2465, 69%), whereas MC and SC were found in 836 (24%) and 250 (7%) patients respectively. SC was more frequently found in younger patients, advanced stage and poor differentiation grade. SC was associated with the highest risk of death, with a median survival of 6.8 months. For MC, median survival varied between 10 months in colon and 11 months in rectal cancer. The median survival in AC was respectively 7.1 months in colon cancer and 10.6 months in rectal cancer. Conclusions: Histological subtype is an important prognostic factor in patients with synchronous PC of CRC. This knowledge will aid clinicians in counseling of patients and clinical decision-making regarding possible treatment options. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT Aim: Patients with stage II colon cancer are considered high risk in case of pathologica... more ABSTRACT Aim: Patients with stage II colon cancer are considered high risk in case of pathological T4 (pT4), poor or undifferentiated grade, emergency surgery, Methods: All patients with high risk stage II colon cancer diagnosed in the area of the Eindhoven Cancer Registry between 2008-2012 were included. Vascular invasion was not included. Multivariable logistic regression was used to assess the association between high risk factors and CT administration. 3-year OS according to CT was based on Kaplan-Meier curves and Cox regression was used to discriminate the independent effect of CT on the risk of death. A subsample was created using propensity score matching (PSM) in which patients who did not receive CT were matched to patients who did. Results: 922 patients were identified of whom 151 (16%) received CT. In multivariable analysis, patients were more likely to receive CT in case of a pT4 tumor (n = 188) (pT4 vs. pT3 30 vs. 11%, OR 4.82, 95% CI 3.04-7.65), Conclusions: Most high risk factors were associated with increased use of CT, although the absolute proportion of CT given was low. In this observational study CT receipt was associated with improved OS. Future studies should focus on how quality of life is affected by CT and what influence this has on choice of treatment. Disclosure: All authors have declared no conflicts of interest.
European Journal of Surgical Oncology (EJSO), 2015
Since the introduction of total mesorectal surgery the outcome of rectal cancer patients has impr... more Since the introduction of total mesorectal surgery the outcome of rectal cancer patients has improved significantly. Involvement of the circumferential resection margin (CRM) is an important predictor of increased local recurrence, distant metastases and decreased overall survival. Abdomino perineal excision (APE) is associated with increased risk of CRM involvement. Aim of this study was to analyze reporting of CRM and to identify predictive factors for CRM involvement. A population-based dataset was used selecting 2153 patients diagnosed between 2008 and 2013 with primary rectal cancer undergoing surgery. Variation in CRM reporting was assessed and predictive factors for CRM involvement were calculated and used in multivariate analyses. Large variation in CRM reporting was found between pathology departments, with missing cases varying from 6% to 30%. CRM reporting increased from 77% in 2008 to 90% in 2012 (p < 0.001). CRM involvement significantly decreased from 12% to 6% over the years (p < 0.001). In multivariate analysis type of operation, low anterior resection or APE, did not influence the risk of CRM involvement. Clinical T4-stage [odds ratio (OR) = 3.51; 95% confidence interval (CI) = 1.85-6.65) was associated with increased risk of CRM involvement, whereas neoadjuvant treatment (5 × 5 gray radiotherapy [OR 0.39; CI 0.25-0.62] or chemoradiation therapy [OR 0.30; CI 0.17-0.53]) were associated with significant decreased risk of CRM involvement. Although significant improvements are made during the last years there still is variation in reporting of CRM involvement in the Southern Netherlands. In multivariate analysis APE was no longer associated with increased risk of CRM involvement.
Background: Five percent of gastrointestinal stromal tumors (GISTs) are primarily localized in th... more Background: Five percent of gastrointestinal stromal tumors (GISTs) are primarily localized in the rectum. We analyzed the outcome of multimodality treatment for rectal GIST in a multicenter retrospective series. Methods: All surgically treated patients with a rectal GIST were identified from four specialized centers in the Netherlands. Primary endpoints were disease-free survival (DFS) and overall survival (OS). Results: Thirty-two patients (22 men and 10 women) with rectal GISTs were identified. Twenty-two patients received imatinib before surgery for a median of 9 (range 2-53) months (Group 1). Ten patients received no imatinib because of small tumor size or lack of availability (Group 2). Median tumor size before treatment was 9.3 (range 6-17) cm in Group 1 and median 6 (range 4-14) cm in Group 2. A complete resection was possible in 17/22 (77%) patients in Group 1 versus 7/10 (70%) in Group 2. Median DFS was not reached in Group 1, while it was 36 months in Group 2. Median OS was not reached in both groups. Conclusions: Preoperative imatinib leads to downsizing of the tumors in Group 1. However, it has not led to less extensive surgery. The DFS is longer in patients treated with pre-and post-operative imatinib, without an effect on OS.
When local recurrent rectal cancer is diagnosed without signs of metastases, a potentially curati... more When local recurrent rectal cancer is diagnosed without signs of metastases, a potentially curative resection can be performed. This study was designed to compare the results of preoperative radiotherapy followed by surgery with surgery only. Between 1985 and 2003, 117 patients with recurrent rectal cancer were prospectively entered in our database. Ninety-two patients were suitable for resection with curative intent. Preoperative radiation with a median dosage of 50 Gy was performed in 59 patients; 33 patients did not receive preoperative radiotherapy. The median age of the patients was respectively 66 and 62 years. The median follow-up of patients alive for the total group was 16 (range, 4-156) months. Tumor characteristics were comparable between the two groups. Complete resections were performed in 64 percent of the patients who received preoperative radiation and 45 percent of the nonirradiated patients. A complete response after radiotherapy was found in 10 percent of the preoperative irradiated patients (n = 6). There were no differences in morbidity and reintervention rate between the two groups. Local control after preoperative radiotherapy was statistically significantly higher after three and five years (P = 0.036). Overall survival and metastases-free survival were not different in both groups. Complete response to preoperative radiotherapy was predictive for an improved survival. Preoperative radiotherapy for recurrent rectal cancer results in a higher number of complete resections and an improved local control compared with patients treated without radiotherapy. Preoperative radiotherapy should be standard treatment for patients with recurrent rectal cancer.
Nederlands tijdschrift voor geneeskunde, Jan 27, 2001
ABSTRACT A 74-year-old man was admitted to hospital because of jaundice and malaise of several we... more ABSTRACT A 74-year-old man was admitted to hospital because of jaundice and malaise of several weeks' duration. Five years earlier he had sustained a stroke from which he had recovered almost completely. On physical examination he was overweight and had an enlarged liver. Laboratory values were consistent with cholestasis and hepatitis. An abdominal ultrasound showed multiple nodular abnormalities in the liver consistent with a malignancy. Rapidly developing abnormalities in blood coagulation were thought to be a contraindication to hepatic biopsy. The patient deteriorated and sustained a new stroke. The physicians were convinced that he had cancer and could not be cured. They planned further diagnostic studies, but at the same time made an advance directive for non-resuscitation. Three days after admission the patient was found dead; no consent for an autopsy was obtained. If it is suspected that a patient is suffering from a malignant disease, the malignancy should be demonstrated or excluded as quickly as possible in the least uncomfortable way. Also, the patient and his family should be informed of any restriction on the possibilities of treatment.
Nederlands tijdschrift voor geneeskunde, Jan 7, 1998
Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 19... more Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 1979-1996. University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands. Retrospective and follow-up analysis. Medical records of patients with histologically proven hepatocellular adenoma were analysed with respect to complaints, diagnostic approach and therapeutical management. Follow-up took place at the outpatient department where history-taking, physical examination, ultrasonography and hepatitis B and C serology tests were performed. In the period 1979-1996, 20 patients with hepatocellular adenoma were treated. Eight patients (mean tumour size 3.2 cm (1.5-5)) were treated conservatively, 12 (mean tumour size 8.1 cm (6-10)) underwent hepatic resection; four because of rupture of the tumour. Serum liver enzyme values did not contribute to the diagnosis. Of the lesions 78% were diagnosed correctly by ultrasonography and 71% by computer tomography. Median follow-up of the patients ...
7540 Background: Human melanoma cells express high affinity glucocorticoid receptors, and adrenal... more 7540 Background: Human melanoma cells express high affinity glucocorticoid receptors, and adrenalectomy has been shown to have anti-melanoma effects in animal models. We observed long-term regressi...
ABSTRACT Aim: With evolving treatment possibilities for patients with peritoneal carcinomatosis (... more ABSTRACT Aim: With evolving treatment possibilities for patients with peritoneal carcinomatosis (PC) of colorectal cancer (CRC), adequate prognostication and patient selection for treatment becomes increasingly important. The prognostic relevance of commonly identified histological subtypes in patients with PC of CRC being adenocarcinoma (AC), mucinous adenocarcinoma (MC) and signet-ring cell carcinoma (SC) is currently unclear and was investigated in the current population-based study. Methods: This nationwide study involved 3551 patients diagnosed with synchronous PC from CRC between 2005-2011 in the Netherlands, as recorded in a nationwide registry. Kaplan-Meier analysis and log-rank testing were performed to estimate survival. Subsequently a Cox proportional hazard model was used to calculate hazard ratios for the risk of death. Results: The majority of the CRC patients was diagnosed with AC (n = 2465, 69%), whereas MC and SC were found in 836 (24%) and 250 (7%) patients respectively. SC was more frequently found in younger patients, advanced stage and poor differentiation grade. SC was associated with the highest risk of death, with a median survival of 6.8 months. For MC, median survival varied between 10 months in colon and 11 months in rectal cancer. The median survival in AC was respectively 7.1 months in colon cancer and 10.6 months in rectal cancer. Conclusions: Histological subtype is an important prognostic factor in patients with synchronous PC of CRC. This knowledge will aid clinicians in counseling of patients and clinical decision-making regarding possible treatment options. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT Aim: Patients with stage II colon cancer are considered high risk in case of pathologica... more ABSTRACT Aim: Patients with stage II colon cancer are considered high risk in case of pathological T4 (pT4), poor or undifferentiated grade, emergency surgery, Methods: All patients with high risk stage II colon cancer diagnosed in the area of the Eindhoven Cancer Registry between 2008-2012 were included. Vascular invasion was not included. Multivariable logistic regression was used to assess the association between high risk factors and CT administration. 3-year OS according to CT was based on Kaplan-Meier curves and Cox regression was used to discriminate the independent effect of CT on the risk of death. A subsample was created using propensity score matching (PSM) in which patients who did not receive CT were matched to patients who did. Results: 922 patients were identified of whom 151 (16%) received CT. In multivariable analysis, patients were more likely to receive CT in case of a pT4 tumor (n = 188) (pT4 vs. pT3 30 vs. 11%, OR 4.82, 95% CI 3.04-7.65), Conclusions: Most high risk factors were associated with increased use of CT, although the absolute proportion of CT given was low. In this observational study CT receipt was associated with improved OS. Future studies should focus on how quality of life is affected by CT and what influence this has on choice of treatment. Disclosure: All authors have declared no conflicts of interest.
European Journal of Surgical Oncology (EJSO), 2015
Since the introduction of total mesorectal surgery the outcome of rectal cancer patients has impr... more Since the introduction of total mesorectal surgery the outcome of rectal cancer patients has improved significantly. Involvement of the circumferential resection margin (CRM) is an important predictor of increased local recurrence, distant metastases and decreased overall survival. Abdomino perineal excision (APE) is associated with increased risk of CRM involvement. Aim of this study was to analyze reporting of CRM and to identify predictive factors for CRM involvement. A population-based dataset was used selecting 2153 patients diagnosed between 2008 and 2013 with primary rectal cancer undergoing surgery. Variation in CRM reporting was assessed and predictive factors for CRM involvement were calculated and used in multivariate analyses. Large variation in CRM reporting was found between pathology departments, with missing cases varying from 6% to 30%. CRM reporting increased from 77% in 2008 to 90% in 2012 (p < 0.001). CRM involvement significantly decreased from 12% to 6% over the years (p < 0.001). In multivariate analysis type of operation, low anterior resection or APE, did not influence the risk of CRM involvement. Clinical T4-stage [odds ratio (OR) = 3.51; 95% confidence interval (CI) = 1.85-6.65) was associated with increased risk of CRM involvement, whereas neoadjuvant treatment (5 × 5 gray radiotherapy [OR 0.39; CI 0.25-0.62] or chemoradiation therapy [OR 0.30; CI 0.17-0.53]) were associated with significant decreased risk of CRM involvement. Although significant improvements are made during the last years there still is variation in reporting of CRM involvement in the Southern Netherlands. In multivariate analysis APE was no longer associated with increased risk of CRM involvement.
Background: Five percent of gastrointestinal stromal tumors (GISTs) are primarily localized in th... more Background: Five percent of gastrointestinal stromal tumors (GISTs) are primarily localized in the rectum. We analyzed the outcome of multimodality treatment for rectal GIST in a multicenter retrospective series. Methods: All surgically treated patients with a rectal GIST were identified from four specialized centers in the Netherlands. Primary endpoints were disease-free survival (DFS) and overall survival (OS). Results: Thirty-two patients (22 men and 10 women) with rectal GISTs were identified. Twenty-two patients received imatinib before surgery for a median of 9 (range 2-53) months (Group 1). Ten patients received no imatinib because of small tumor size or lack of availability (Group 2). Median tumor size before treatment was 9.3 (range 6-17) cm in Group 1 and median 6 (range 4-14) cm in Group 2. A complete resection was possible in 17/22 (77%) patients in Group 1 versus 7/10 (70%) in Group 2. Median DFS was not reached in Group 1, while it was 36 months in Group 2. Median OS was not reached in both groups. Conclusions: Preoperative imatinib leads to downsizing of the tumors in Group 1. However, it has not led to less extensive surgery. The DFS is longer in patients treated with pre-and post-operative imatinib, without an effect on OS.
When local recurrent rectal cancer is diagnosed without signs of metastases, a potentially curati... more When local recurrent rectal cancer is diagnosed without signs of metastases, a potentially curative resection can be performed. This study was designed to compare the results of preoperative radiotherapy followed by surgery with surgery only. Between 1985 and 2003, 117 patients with recurrent rectal cancer were prospectively entered in our database. Ninety-two patients were suitable for resection with curative intent. Preoperative radiation with a median dosage of 50 Gy was performed in 59 patients; 33 patients did not receive preoperative radiotherapy. The median age of the patients was respectively 66 and 62 years. The median follow-up of patients alive for the total group was 16 (range, 4-156) months. Tumor characteristics were comparable between the two groups. Complete resections were performed in 64 percent of the patients who received preoperative radiation and 45 percent of the nonirradiated patients. A complete response after radiotherapy was found in 10 percent of the preoperative irradiated patients (n = 6). There were no differences in morbidity and reintervention rate between the two groups. Local control after preoperative radiotherapy was statistically significantly higher after three and five years (P = 0.036). Overall survival and metastases-free survival were not different in both groups. Complete response to preoperative radiotherapy was predictive for an improved survival. Preoperative radiotherapy for recurrent rectal cancer results in a higher number of complete resections and an improved local control compared with patients treated without radiotherapy. Preoperative radiotherapy should be standard treatment for patients with recurrent rectal cancer.
Nederlands tijdschrift voor geneeskunde, Jan 27, 2001
ABSTRACT A 74-year-old man was admitted to hospital because of jaundice and malaise of several we... more ABSTRACT A 74-year-old man was admitted to hospital because of jaundice and malaise of several weeks' duration. Five years earlier he had sustained a stroke from which he had recovered almost completely. On physical examination he was overweight and had an enlarged liver. Laboratory values were consistent with cholestasis and hepatitis. An abdominal ultrasound showed multiple nodular abnormalities in the liver consistent with a malignancy. Rapidly developing abnormalities in blood coagulation were thought to be a contraindication to hepatic biopsy. The patient deteriorated and sustained a new stroke. The physicians were convinced that he had cancer and could not be cured. They planned further diagnostic studies, but at the same time made an advance directive for non-resuscitation. Three days after admission the patient was found dead; no consent for an autopsy was obtained. If it is suspected that a patient is suffering from a malignant disease, the malignancy should be demonstrated or excluded as quickly as possible in the least uncomfortable way. Also, the patient and his family should be informed of any restriction on the possibilities of treatment.
Nederlands tijdschrift voor geneeskunde, Jan 7, 1998
Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 19... more Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 1979-1996. University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands. Retrospective and follow-up analysis. Medical records of patients with histologically proven hepatocellular adenoma were analysed with respect to complaints, diagnostic approach and therapeutical management. Follow-up took place at the outpatient department where history-taking, physical examination, ultrasonography and hepatitis B and C serology tests were performed. In the period 1979-1996, 20 patients with hepatocellular adenoma were treated. Eight patients (mean tumour size 3.2 cm (1.5-5)) were treated conservatively, 12 (mean tumour size 8.1 cm (6-10)) underwent hepatic resection; four because of rupture of the tumour. Serum liver enzyme values did not contribute to the diagnosis. Of the lesions 78% were diagnosed correctly by ultrasonography and 71% by computer tomography. Median follow-up of the patients ...
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