Studio randomizzato di Fase II per la valutazione di un approccio di revisione chirurgica sistematica, associata a chemio-ipertermia intraperitoneale ed.

Slides:

Advertisements

Similar presentations

High Resolution studies

Advertisements

Is there a role for surgery in metastatic colorectal cancer?

Miles DW et al. SABCS 2009;Abstract 41.

Pre-operative Imatinib for metastatic, recurrent and locally advanced GISTs E. Efthimiou, S Mudan E. Efthimiou, S Mudan On behalf of the Sarcoma Group.

David Burdett May 11, 2004 Package Binding for WS CDL.

NTDB ® Annual Report 2009 © American College of Surgeons All Rights Reserved Worldwide Percent of Hospitals Submitting Data to NTDB by State and.

NTDB ® Annual Report 2010 © American College of Surgeons All Rights Reserved Worldwide National Trauma Data Bank 2010 Annual Report.

PP Test Review Sections 6-1 to 6-6

Copyright © 2012, Elsevier Inc. All rights Reserved. 1 Chapter 7 Modeling Structure with Blocks.

Audit of patients diagnosed with colorectal cancer within the eligible age group for bowel cancer screening Clare Westwood Colorectal Nurse Consultant.

PSA: Fact or Fiction The debate as it stands

TCCI Barometer September “Establishing a reliable tool for monitoring the financial, business and social activity in the Prefecture of Thessaloniki”

PROCESS vs. WA State SCS Study A Comparison of Study Design, Patient Population, and Outcomes August 29,2007.

 Non-colon › Esophagogastric › Pancreatic › Hepatobiliary.

IN THE NAME OF GOD. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy The American Journal.

PSSA Preparation.

How do we delay disease progress once it has started?

UK Renal Registry 17th Annual Report Figure 5.1. Trend in one year after 90 day incident patient survival by first modality, 2003–2012 cohorts (adjusted.

Jakopovich Ivan, Jakopovich Neven Dr Myko San – Health from Mushrooms Co. Zagreb, Croatia.

Mario Scartozzi Clinica di Oncologia Medica Ancona HIGHLIGHTS IN COLORECTAL CANCER MANAGEMENT TREATMENT OF METASTATIC DISEASE.

PROSTATE CANCER Dr Samad Zare Assistant Proffesor of Urology Shaheed Sadoughi University of Medical Sciences.

Adjuvant chemotherapy in resectable liver-limited metastasis colorectal cancer 指導VS: 鄧豪偉財團法人台灣癌症臨床研究發展基金會.

A Phase III Trial Comparing FULV to FULV + Oxaliplatin in Stage II or III Carcinoma of the Colon: Results of NSABP-C-07 Norman Wolmark, MD Colorectal Cancer.

NSABP PROTOCOL C-10: RESULTS A Phase II Trial of 5-Fluorouracil, Leucovorin and Oxaliplatin (mFOLFOX6) Plus Bevacizumab for Patients with Unresectable.

62 years old man Main complaint: Back pain at night but not during the day Loss of appettite Weight loss.

Management of Colorectal Liver Metastasis

Dr. LP Si Tseung Kwan O Hospital. Introduction CA stomach is the 4 th most commonly diagnosed malignancy worldwide 2 nd most common cause of cancer-related.

Neoadjuvant Adjuvant Curative Palliative Neoadjuvant Radiation therapy the results of a phase III study from Beijing demonstrated a survival benefit.

A REVISIT TO MANAGEMENT OF GASTROINTESTINAL STROMAL TUMOUR (GIST) Joint Hospital Surgical Grand Round 17 Jan 2015 Grace Liu Pamela Youde Nethersole Eastern.

Lars Påhlman Dept. Surgery, Colorectal unit, University Hospital, Uppsala, Sweden How to handle peritoneal carcinomatosis found at laparotomy.

Vascular issues associated with bevacizumab Stuart M. Lichtman, MD, FACP 65+ Clinical Geriatric Program Associate Attending Memorial Sloan-Kettering Cancer.

Phase III study of first-line XELOX plus bevacizumab (BEV) for 6 cycles followed by XELOX plus BEV or single agent (s/a) BEV as maintenance therapy in.

Resection For Lung Metastases M62 Coloproctology Course.

Definition of oxaliplatin sensitivity in pts with advanced colorectal cancer previously treated with oxaliplatin-based therapy A. de Gramont, B. Chibaudel,

III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale. Storia naturale, scenari clinici ed.

Oxaliplatin/5FU/LV in adjuvant colon cancer: Updated efficacy results of the MOSAIC trial, including survival, with a median follow-up.

COLON CANCER A MAJOR ISSUE IN ALASKA. A common malignancy 200,000 cases in the U. S. in ,000 cases in the U. S. in 2008 Greater than 50 new cases.

Present and Future of Hyperthermic intraperitoneal chemo (HIPEC) in Colorectal Peritoneal Metastases Dominique ELIAS Cancer Campus, Grand-Paris.

Adjuvant Therapy of Colon Cancer 2005 Daniel G. Haller, M.D. Abramson Cancer Center at the University of Pennsylvania Philadelphia PA.

Is surgical resection of an asymptomatic primary colorectal tumor beneficial for patients with incurable Stage IV disease? A Phase II Trial of 5-Fluorouracil,

Outcome of Primary Tumor in Patients With Synchronous Stage IV Colorectal Cancer Receiving Combination Chemotherapy Without Surgery As Initial Treatment.

Potentially curative re-resection of recurrent CRC  Suture line recurrences  Isolated liver metastases  Isolated pulmonary metastases.

SYNCHRONOUS COLORECTAL AND LIVER RESECTION J Peter A Lodge MD FRCS HPB and Transplant Unit St James’s University Hospital Leeds LS9 7TF 2006 Association.

Gastric Cancer Gidon Almogy MD Department of General Surgery Hadassah University Hospital.

Treatment Regimens of HER2+ Adjuvant Patients (Actuals) Source: Genentech ASCO 2005 (data release) Nov 2006 (Approval)

T Andre, E Quinaux, C Louvet, E Gamelin, O Bouche, E Achille, P Piedbois, N Tubiana-Mathieu, M Buyse and A de Gramont. Updated results at 6 year of the.

MAX: International multi-centre randomised phase II/III study of capecitabine (Cap), bevacizumab (Bev) and mitomycin C (MMC) as first-line treatment for.

Management of the primary in Stage IV colorectal cancer Erin Kennedy, MD, PhD, FRCSC Colorectal Surgery Mount Sinai Hospital University of Toronto.

EORTC Tumor response to pre-operative chemotherapy (CT) with FOLFOX-4 for resectable colorectal cancer liver metastases (LM) Interim results of the EORTC.

Surgery of colorectal metastasis in the Optimox 1 study. A GERCOR Study. N. Perez-Staub, G. Lledo, F. Paye, B. Gayet, M. Flesch, A. Cervantes, A. Figer,

LCC COL-1 See Pathologic Stage, Adjuvant Therapy, and Surveillance (LCC COL-3) Φ Φ Φ π π π Colon Cancer.

Operative Management of Osteosarcoma Patients with Pulmonary Metastasis Jen Kramer, MD R2 Swedish Medical Center February 2011.

Adjuvant and Neoadjuvant Therapy in Non- Small Cell Lung Cancer Seminars in Oncology 2oo5;32 (suppl 2):S9-S15 Kyung Hee Medical Center Department of Thoracic.

Complete pathologic responses in the primary of rectal or colon cancer treated with FOLFOX without radiation A. Cercek, M. R. Weiser, K. A. Goodman, D.

R3 정상완. Introduction  EGC : Tumor invasion is limited to the mucosa or submucosa, regardless of lymph node involvement.  Accumulated histopathological.

HE-4 TRIAL Prospective phase II trial on the prognostic and predictive value of HE-4 regression during neoadjuvant chemotherapy for advanced ovarian, Fallopian.

Short-term outcome of neo-adjuvant chemotherapy

The role of simultaneous resection of synchronous liver metastasis and primary colorectal cancer Samuel Lo Department of Surgery.

Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer. A meta-analysis of two randomized trials E Mitry, A Fields,

Phase III study of irinotecan/5FU/LV (FOLFIRI) or oxaliplatin/5FU/LV (FOLFOX) +/- cetuximab for patients with untreated metastatic adenocarcinoma of the.

Aimery de Gramont Association between 3 year Disease Free Survival and Overall Survival delayed with improved survival after recurrence in patients receiving.

Surgical resection of metachronous liver metastases

Presentation transcript:

Studio randomizzato di Fase II per la valutazione di un approccio di revisione chirurgica sistematica, associata a chemio-ipertermia intraperitoneale ed eventuale chirurgia citoriduttiva,versus follow-up standard in pazienti ad alto rischio di sviluppare carcinosi peritoneale da carcinoma colo-rettale Shigeki Kusamura e Baratti Dario Società Lombarda di Chirurgia

Centro Nazionale per il Controllo e la Prevenzione delle Malattie Incidenza casi/anno (stima 2008) Carcinosi peritoneale ~ Carcinosi peritoneale isolata ~ Incidenza casi/anno (stima 2008) Carcinosi peritoneale ~ Carcinosi peritoneale isolata ~

Period January February randomized (1 completed) 47 studies 2 controlled 43 observational (3 multicentric) Median survival months 5-year survival 11-51% (median 19%) Operative morbidity % Operative death 0-12%

Most of the serious complications seem to be related to the extent of surgery, and may be related to the extent of peritoneal involvement Median OS 29 months Median OS 5.4 months Mortality rate: 8%

Median survival: 30.1 mths 5yr OS: 27% Morbidity: 31% Mortality: 3%

1.The earlier the better 2.Not optimal sensitivity of clinical, tumor markers and imaging in detecting early PC

Second-look surgery Systematic use of planned reoperation in asymptomatic patients with malignant disease who are theoretically at risk for developing recurrent or metastatic disease despite initial curative surgery Largerly employed in Epithelial Ovarian Cancer during the 90s Which candidates? Wangensteen OH Wis. Med J 1949

1. Singapore general hospital colorectal cancer (13%) developed PC synchronous metachronous Logistic regression analysis for development of metachronous PC

Population-based cohort study patients with colorectal cancer in Stockholm County 924 patients (8·3 %) had synchronous or metachronous PC Cumulative incidence of metachronous PC: 4.2% PC was the sole site of meta at the time of diagnosis in 177 of 7799

Hazard ratios for metachronous PC after resection of stage I-III colon cancer

Macroscopically resected minimal PC Macroscopically resected ovarian metastases Perforated primary tumor Adjuvant systemic oxaliplatin/ irinotecan for 6 months Follow-up for 6 months Negative re-staging Second-look surgery Annals of surgery, 2011

Syncr. PC n=25 Ovarian M n= 8 Perforated T N=8 TOTAL n=41 PC at second look operation n=15 (60%) PCI: 9+/-6 N=5 (62%) PCI: 7+/-5 N=3 (37%) PCI: 5+/-2 n=23 (56%) 5-year overall survival in 41 pts undergoing HIPEC±CRS= 90% MORTALITY: 2% Morbidity= 9.7% SUGERY + sCT Annals of surgery, 2011

INCLUSION CRITERIA resected minimal PC ovarian metastases perforated primary tumor T4 obstruction bleeding End-point: overall survival Accrual: 35 pts per arm Duration: 5 years Patients undergoing radical primary treatment and 3 months of adjuvant systemic CT

Colon cancer with high risk of PC Adjuvant systemic Folfox for 6 months Follow-up for 6 months Negative re-staging Second-look surgery Trial Comparing Simple Follow-up to Exploratory Laparotomy Plus "in PrincipleHIPEC in Colorectal Patients A phase III multicentric French study (ProphyloCHIP) Minimal PC, resected at the same time as the primary Ovarian metastases Rupture of the primary tumour Iatrogenic rupture of the primary tumour during surgery Follow-up