Metastatic gastroesophageal cancer in older patients – is this patient cohort represented in clinical trials?

Background Older patients are underrepresented in the clinical trials that determine the standards of care for oncological treatment. We conducted a review to identify whether there have been age-restrictive inclusion criteria in clinical trials over the last twenty five years, focusing on patients with metastatic gastroesophageal cancer. Methods A search strategy was developed encompassing Embase, PubMed and The Cochrane Library databases. Completed phase III randomised controlled trials evaluating systemic anti-cancer therapies in metastatic gastroesophageal malignancies from 1st January 1995 to 18th November 2020 were identified. These were screened for eligibility using reference management software (Covidence; Veritas Health Innovation Ltd). Data including age inclusion/exclusion criteria and median age of participants were recorded. The percentage of patients ≥ 65 enrolled was collected where available. The change over time in the proportion of studies using an upper age exclusion was estimated using a linear probability model. Results Three hundred sixty-three phase III studies were identified and screened, with 66 trials remaining for final analysis. The majority of trials were Asian (48%; n = 32) and predominantly evaluated gastric malignancies, (86%; n = 56). The median age of participants was 62 (range 18–94). Thirty-two percent (n = 21) of studies specified an upper age limit for inclusion and over half of these were Asian studies. The median age of exclusion was 75 (range 65–80). All studies prior to 2003 used an upper age exclusion (n = 12); whereas only 9 that started in 2003 or later did (17%). Among later studies, there was a very modest downward yearly-trend in the proportion of studies using an upper age exclusion (-0.02 per year; 95%CI -0.05 to 0.01; p = 0.31). Fifty-two percent (n = 34) of studies specified the proportion of their study population who were ≥ 65 years. Older patients represented only 36% of the trial populations in these studies (range 7–60%). Conclusions Recent years have seen improvements in clinical trial protocols, with many no longer specifying restrictive age criteria. Reasons for poor representation of older patients are complex and ongoing efforts are needed to broaden eligibility criteria and prioritise the inclusion of older adults in clinical trials.

Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC

The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC.

O Impacto dos Sintomas Orais Gerados por Quimioterapia e Radioterapia / The Impact of Oral Symptoms Generated by Chemotherapy and Radiotherapy

Os primeiros efeitos da radioterapia e da quimioterapia antineoplásica acontecem sobre as células do epitélio oral, as quais sofrem rápida proliferação. O tamanho destes efeitos depende de muitos fatores ligados ao tratamento, ao paciente e ao tumor. No que se trata do paciente, interferem nesse processo o seu estado geral de saúde, presença de comorbidades, sexo, estado nutricional, idade, fatores sociais e psicológicos, além de hábitos deletérios e patologias orofaciais preexistentes. Esses adoecimentos na integridade bucal devem-se a veracidade de que a radioterapia e quimioterapia não são capazes de destruir as células tumorais sem lesionar células normais. O tratamento oncológico pode provocar reações adversas na cavidade oral, e é comum, em pacientes oncológicos submetidos ao tratamento antineoplásico, o desenvolvimento de agravamentos orais agudos ou tardios.---The first effects of radiotherapy and antineoplastic chemotherapy happen on the cells of the oral epithelium, which quickly notice proliferation. The size of these effects depends on many factors related to the treatment, the patient, and the tumor. With regard to the patient, this process interferes with their general health status, presence of comorbidities, gender, nutritional status, age, social and psychological factors, in addition to deleterious habits and pre-existing orofacial pathologies. These illnesses in the oral integrity are due to the veracity that radiotherapy and chemotherapy are not capable of destroying tumor cells without normal cells. Oncological treatment can cause adverse reactions in the oral cavity, and it is common, in cancer patients, to antineoplastic treatment, to develop acute or late oral aggravations.

Combined BNCT and PET for theranostics

This short review summarizes the issue of boron distribution monitoring in boron neutron capture therapy (BNCT), which remains a serious drawback of this powerful oncological treatment. Here we present the monitoring methods that are presently used with particular emphasis on the positron emission tomography (PET) which has the highest potential to be used for the real-time monitoring of boron biodistribution. We discuss the possibility of using present PET scanners to determine the boron uptake in vivo before the BNCT treatment with the use of p-boronphenylalanine (BPA) labeled with 18F isotope. Several examples of preclinical studies and clinical trials performed with the use of [18F]FBPA are shown. We also discuss shortly the perspectives of using other radiotracers and boron carriers which may significantly improve the boron imaging with the use of the state-of-the-art Total-Body PET scanners providing a theranostic approach in the BNCT.

Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases

Background To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH). Study design Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx). Results Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (P=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, P=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (P=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (P=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (P=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (P=0.060) than the Major Hx group. Conclusions VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes.

AStudy on Selected Aspects of the Quality of Life of People in Remission after Cancer Treatment with the use of the Individual in-depth Interview Technique

Background: Acharacteristic feature of cancer is, among other things, that even after successful oncological treatment, the patient cannot close this chapter of life and the experience of being acancer patient. In oncology there is no unambiguous definition of apatient as ahealthy person. Methods: The study covered agroup of 20 people. In the con- ducted tests the diagnostic survey method was introduced. The technique of individual in-depth interviews was used. The re- spondent could fully express his or her own feelings, emotions, thoughts and experiences. Results. The respondents stated that positive emotions ap- peared with the completion of treatment, but indicated that the feelings were not related to the sense of healing but only to the completion of tiring therapeutic procedures. Some respondents complained about the feeling of chronic fatigue. Fatigue was not only related to the physical sphere, although everyone con- firmed that the side effects of the therapy persisted for some time. The respondents paid more attention to mental fatigue, which had various forms, e.g.: anxiety about possible relapse; functional losses; feeling of loss caused by radical treatment. Out of 20 respondents, 4 persons indicated aloss of health, es- pecially the sense of joy and happiness, self-esteem, self-con- fidence, social contacts, family and time. Conclusions: The research group consisted of 20 respondents, which limits the possibility of formulating generalized con- clusions, but indicates various directions of possible improve- ment and, most importantly, shows how the thinking about can- cer can be changed.