EFFICACY OF 90Y-RADIOEMBOLIZATION IN METASTATIC COLORECTAL CANCER DEPENDING ON THE PRIMARY TUMOR SIDE

2020 ◽  
Author(s):  
Philipp Schindler ◽  
Max Masthoff ◽  
Fabian Harders ◽  
Hartmut Schmidt ◽  
Lars Stegger ◽  
...  
Keyword(s):  
Median Survival ◽  
Primary Tumor ◽  
Progressive Disease ◽  
Complete Response ◽  
Tumor Burden ◽  
Hepatic Tumor ◽  
Left Colon ◽  
Right Colon ◽  
90Y Radioembolization ◽  
The Right

Metastatic colorectal cancer (mCRC) is associated with different molecular biology, clinical characteristics and outcome depending on the primary tumor localization. We aimed to evaluate the effectiveness of 90Y-radioembolization (RE) for therapy of colorectal liver metastases depending on the primary tumor side. We performed a retrospective analysis of n=73 patients with mCRC and RE in our university liver center between 2009 and 2018. Patients were stratified according to the primary tumor side (left vs. right hemicolon), treatment response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) at follow-up after 3 months. Kaplan-Meier analysis was performed to analyze survival followed by Cox regression to determine independent prognostic factors for survival. Prior to RE all patients had received systemic therapy, with either stable or progressive disease, but no partial or complete response. In n=22/73 (30.1%) patients the primary tumor side was in the right colon, in n=51/73 (69.9%) patients in the left colon. Hepatic tumor burden was ≤25% in n=36/73 (49.3%) patients and >25% in n=37/73 (50.7%) patients. At 3 months, n=21 (33.8%) patients showed treatment response [n=2 (3.2%) complete response, n=19 (30.6%) partial response], n=13 (21.0%) stable disease, and n=28 (45.2%) progressive disease after RE. The median survival in case of primary tumor side in the left colon was significantly higher than for primary tumors in the right colon (8.7 vs. 6.0 months, p=0.033). The median survival for a hepatic tumor burden ≤25% was significantly higher compared with >25% (13.9 vs. 4.3 months, p<0.001). The median overall survival was 6.1 months. The median survival after RE in hepatic-metastatic CRC depends on the primary tumor side and the pre-procedural hepatic tumor burden.

scholarly journals Racial Disparities in Epigenetic Aging of the Right vs Left Colon

2020 ◽  
Author(s):  
Matthew Devall ◽  
Xiangqing Sun ◽  
Fangcheng Yuan ◽  
Gregory S Cooper ◽  
Joseph Willis ◽  
...  
Keyword(s):  
Dna Methylation ◽  
African Americans ◽  
Racial Differences ◽  
Age Of Onset ◽  
Left Colon ◽  
Right Colon ◽  
Normal Colon ◽  
Epigenetic Aging ◽  
Epigenetic Age Acceleration ◽  
The Right

Abstract There are well-documented racial differences in age-of-onset and laterality of colorectal cancer. Epigenetic age acceleration is postulated to be an underlying factor. However, comparative studies of side-specific colonic tissue epigenetic aging are lacking. Here, we performed DNA methylation analysis of matched right and left biopsies of normal colon from 128 individuals. Among African Americans (n = 88), the right colon showed accelerated epigenetic aging as compared to individual-matched left colon (1.51 years; 95% CI = 0.62 to 2.40 years; two-sided P = .001). In contrast, among European Americans (n = 40), the right colon shows remarkable age deceleration (1.93 years; 95% CI = 0.65 to 3.21 years; two-sided P = .004). Further, epigenome-wide analysis of DNA methylation identifies a unique pattern of hypermethylation in African American right colon. Our study is the first to report such race and side-specific differences in epigenetic aging of normal colon, providing novel insight into the observed younger age-of-onset and relative preponderance of right-side colon neoplasia in African Americans.

Change from triple negative type to triple positive type: A case report of discordance of re-biopsy from primary breast cancer

2020 ◽  
pp. 1-5
Keyword(s):  
Primary Tumor ◽  
Triple Negative ◽  
Lobular Carcinoma ◽  
Rare Event ◽  
Metastatic Tumor ◽  
Complete Response ◽  
Current Treatment ◽  
Positive Type ◽  
Impact On Treatment ◽  
The Right

The patient was a 60-year-old woman who had visited a clinic with the chief complaint of a mass in the right breast prior to being referred to our hospital. Breast examination revealed the presence of a 3-cm hard elastic mass in the C region of the right breast. Computed tomography (CT) further indicated metastases to the liver and lungs. Upon needle biopsy of the primary tumor, the patient was diagnosed with triple-negative (ER (-), PgR (-), HER2 (-)) invasive lobular carcinoma. Chemotherapy was successful in achieving a transient partial response (PR); however, the tumor later advanced to a progressive disease (PD) after five cycles of oral fluoropyrimidine derivative therapy (S-1). Re-biopsy of the primary tumor revealed that the tumor was triple-positive (ER (+), PgR (+), HER2 (+)). The patient was subsequently treated with anti-HER2 therapy and has since achieved complete response (CR). Although biological changes sometimes occur from the primary to the metastatic tumor, changes in the primary tumor itself during the course of treatment is a rare event. Furthermore, the transition from triple-negative to triple-positive status is very uncommon. Re-biopsy rarely changes the biological characteristics of a tumor; however, biological changes can have a significant impact on treatment if they do occur. Thus, it is important to perform a re-biopsy if the current treatment results in PD.

scholarly journals MALIGNANCY IN LARGE COLORECTAL LESIONS

2014 ◽  
Vol 51 (3) ◽  
pp. 235-239
Author(s):  
Carlos Eduardo Oliveira dos SANTOS ◽  
Daniele MALAMAN ◽  
Tiago dos Santos CARVALHO ◽  
César Vivian LOPES ◽  
Júlio Carlos PEREIRA-LIMA
Keyword(s):  
Invasive Carcinoma ◽  
Lesion Size ◽  
Primary Treatment ◽  
Left Colon ◽  
Right Colon ◽  
High Prevalence ◽  
Early Adenocarcinoma ◽  
The Mean ◽  
The Right ◽  
Low Rate

Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion Objectives To evaluate the malignancy of colorectal lesions ≥20 mm. Methods Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed Results The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm). Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3%) lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5%) and IV (53.9%) pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma), with no difference in morphology and site. Only one lesion (1.3%) invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001). The primary treatment was endoscopic resection, and invasive carcinoma was referred to surgery. Recurrence rate was 10.6%. Conclusions Large colorectal neoplasms showed a low rate of malignancy. Endoscopic treatment is an effective therapy for these lesions.

Differential radiographic appearance of BRAF V600E mutant metastatic colorectal cancer (mCRC) in patients matched by primary tumor location.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 554-554 ◽  
Author(s):  
Claire Greene ◽  
Chloe Evelyn Atreya ◽  
Ryan McWhirter ◽  
Nabia Ikram ◽  
Katherine Van Loon ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Braf Mutation ◽  
Tumor Location ◽  
Peritoneal Metastases ◽  
Left Colon ◽  
Braf V600e ◽  
Right Colon ◽  
Mutation Status ◽  
Primary Tumor Location ◽  
Braf Mutant

554 Background: BRAF mutation status and location of CRC primary each correlate with pattern of metastatic spread. We sought to determine whether presence of a BRAF V600E (BRAF) mutation is differentially associated with sites and appearance of metastatic disease in patients matched by primary tumor location. Methods: 40 patients with BRAF mutant mCRC were matched to 80 patients with BRAF wild-type CRC by location of primary tumor (right colon, left colon or rectum), sex, and age ( < 50; 50+). CT scans were reviewed for disease characterization. BRAF mutation status, clinicopathological characteristics, and sites of metastatic disease were associated using proportion tests. Results: Of the 120 matched patients,60% were female. The distribution of primary tumor locations was: 60% right colon, 30% left colon, and 10% rectum. Median age at diagnosis was 57, range 20-88 yrs. Significantly higher frequencies of peritoneal metastases (p = 0.045) and ascites (p = 0.0038) occurred in patients with BRAF mutant tumors. Among patients with right colon primaries, no significant difference in sites of disease by BRAF mutation status was observed. In patients with left colon primaries, BRAF mutations associated with less frequent liver metastases (42% vs. 79%, p = 0.024) and more frequent ascites (58% vs. 12%, p = 0.0038). Disease was not measurable by RECIST version 1.1 criteria in 20% of patients with BRAF mutations, most often with peritoneal metastases and ascites. Conclusions: Presence of a BRAF V600E mutation associated with a greater proportion of peritoneal metastases and ascites, even among patients matched for primary tumor location. Of 20 patients with BRAF mutant mCRC and peritoneal metastases plus ascites, 6 patients (30%) had disease that was not measurable by RECIST version 1.1. Radiographic characterization provides a window on BRAF mutant mCRC biology and also reveals a challenge for response evaluation on clinical trials. [Table: see text]

scholarly journals Experimental Study of the Quantification of Indocyanine Green Fluorescence in Ischemic and Non-Ischemic Anastomoses, Using the Sergreen Software Program

2021 ◽  
Author(s):  
Xavier Serra-Aracil ◽  
Albert García-Nalda ◽  
Borja Serra-Gomez ◽  
Alvaro Serra-Gomez ◽  
Laura Mora-Lopez ◽  
...  
Keyword(s):  
Experimental Study ◽  
Indocyanine Green ◽  
Left Colon ◽  
Right Colon ◽  
Indocyanine Green Fluorescence ◽  
Tissue Ischemia ◽  
Control Stage ◽  
Initial Control ◽  
The Right ◽  
Sequential Images

Abstract Background: Tissue ischemia is a key risk factor for anastomotic leakage (AL). Indocyanine green (ICG) is widely used in colorectal surgery to define the segments with the best vascularization. In an experimental model, we present a new system for quantifying ICG saturation, SERGREEN software.Methods: This was a controlled experimental study with eight pigs. In the initial control stage, ICG saturation was analyzed at the level of two anastomoses in the right and left colon. Control images of the two segments were taken after ICG administration. The images were processed with the SERGREEN program. Then, in the experimental ischemia stage, the inferior mesenteric artery was sectioned at the level of the anastomosis of the left colon. Fifteen minutes after the section, sequential images of the two anastomoses were taken every 30’ for the following 2 h.Results: At the control stage, the mean scores were 134.2 (95% CI: 116.3-152.2) for the right colon and 147 (95% CI: 134.7-159.3) for the left colon (p = 0.174). The right colon remained stable throughout the experiment. In the left colon, saturation fell by 47.9 points with respect to the preischemia value (p <0.01). After the first postischemia determination, the values of the ischemic left colon remained stable throughout the experiment. The relative decrease in ICG saturation of the ischemic left colon was 32.6%.Conclusions: The SERGREEN program quantifies ICG saturation in normal and ischemic situations and detects differences between them. A reduction in ICG saturation of 32.6% or more was correlated with complete tissue ischemia.

Distribution of neuroendocrine marker-positive cells in colorectal cancer tissue and adjacent mucosa.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 617-617
Author(s):  
Takashi Ogimi ◽  
Sotaro Sadahiro ◽  
Hiroshi Miyakita ◽  
Gota Saito ◽  
Lin Fung Chan ◽  
...  
Keyword(s):  
Chromogranin A ◽  
Normal Mucosa ◽  
Tumor Location ◽  
Left Colon ◽  
Cancer Tissue ◽  
Positive Staining ◽  
Right Colon ◽  
Neuroendocrine Marker ◽  
Adjacent Mucosa ◽  
The Right

617 Background: Neuroendocrine carcinoma (NEC) is a rare disease and has been reported to most frequently arise in the right side of the colon. In the 2010 WHO classification, mixed adenoneuroendocrine carcinoma (MANEC) was defined as a neoplasm consisting of NEC and adenocarcinoma components. To clarify the histogenesis of NEC, we attempted to detect neuroendocrine marker-positive cells in cancer tissue and in the adjacent mucosa in patients with adenocarcinoma. Methods: The study group comprised 390 patients with Stage II or III colorectal adenocarcinoma between 2007 and 2012. Immunostaining was performed with anti chromogranin A, synaptophysin, and CD56 antibodies. Cases with positively stained cells in cancer tissue were defined as positive. In the adjacent mucosa, at least 5 cm from the tumor, the numbers of positive cells per 15 HPF were measured. Results: Tumor location was right side in 181 patients, left side in 173, and the rectum in 36 patients. Positive rates of Chromogranin A in cancer tissues were 23.7% in the right colon, 13.2% in the left colon, and 19.4% in the rectum. Those of synaptopysin were 35.3%, 21.9%, and 30.6%, respectively. Those of CD56 were 22.6%, 8.0%, and 16.7%, respectively. Positive rates of these three markers in right colon were significantly higher than those in left colon and rectum. (p = 0.0115, p = 0.0054, p = 0.0062). In the adjacent mucosa, the mean numbers of positive cells for chromogranin A were 62.2 ± 20.5 in the right colon, 131.9 ± 44.7 in the left colon, and 243.7 ± 60.2 in the rectum (p < 0.001). Those for synaptophysin were 47.7 ± 23.5, 95.3 ± 35.1, and 156.9 ± 56.8, respectively. (p < 0.001). There were no significant differences in the number of positive cells for CD56 among the sites (p = 0.295). Conclusions: In cancer tissue, the rate of positive staining for neuroendocrine marker-positive cells was higher in the right side of the colon, whereas in normal mucosa the rates of positive staining for these cells were higher in the sigmoid colon and the rectum. These results suggest that neuroendocrine marker-positive cells are an acquired characteristic of cancer tissue.

Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?

2009 ◽  
Vol 44 (4) ◽  
pp. 783-787 ◽  
Author(s):  
Hyun-Young Kim ◽  
Sung-Eun Jung ◽  
Seong-Cheol Lee ◽  
Kwi-Won Park ◽  
Woo-Ki Kim
Keyword(s):  
Left Colon ◽  
Right Colon ◽  
Antegrade Continence Enema ◽  
The Right ◽  
Better Than

scholarly journals Correlation of Cleanliness among Different Bowel Segments during Colonoscopy: A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Zhou Haibin ◽  
Zhang Xiaofeng ◽  
Yang Jianfeng
Keyword(s):  
Retrospective Study ◽  
Transverse Colon ◽  
Intestinal Tract ◽  
Left Colon ◽  
Right Colon ◽  
School Of Medicine ◽  
The Difference ◽  
The Right ◽  
Bowel Segments ◽  
Intestinal Preparation

Objective. To analyze the correlation of intestinal cleanliness in each segment of the Boston Intestinal Preparation Scale. Methods. From February 2017 to October 2019, the data of patients who underwent colonoscopy in the Department of Gastroenterology, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, were collected. Statistical analysis was performed according to the Boston Intestinal Preparation Scale score, and the correlation of intestinal cleanliness in each region was obtained. Results. A total of 1739 patients were included. The overall score of BBPS was 6.77±1.88. The scores of each region were 2.04±0.84 (right lateral colon), 2.25±0.68 (transverse colon), and 2.48±0.64 (left colon). The difference between the regions was statistically significant (P<0.05). The bowel cleanliness showed a gradual deterioration trend, and there was a positive correlation between colon cleanliness in each region. The accuracy of the transverse colon in predicting the right colon (AUC=0.809) is higher than that of the left colon (AUC=0.735), and the accuracy of predicting the cleanliness of the right colon intestinal tract by the cleanliness of the left colon intestinal tract is relatively low. Conclusion. Intestinal cleanliness gradually deteriorates from the direction of the insert. It is not reliable to predict the right side of poor cleanliness by using the left colon intestinal cleanliness (BBPS 0-1 score). It should continue to further endoscopy. When the cleanliness of the transverse colon is poor, then stopping further endoscopy is considered.

scholarly journals Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex

2020 ◽  
Vol 189 (6) ◽  
pp. 543-553 ◽  
Author(s):  
Inger T Gram ◽  
Song-Yi Park ◽  
Lynne R Wilkens ◽  
Christopher A Haiman ◽  
Loïc Le Marchand
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Cox Regression ◽  
Left Colon ◽  
Right Colon ◽  
Right Colon Cancer ◽  
Increased Risk ◽  
The Right ◽  
Incident Cases

Abstract The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45–75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993–1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.

scholarly journals Colon cancer survival differs from right side to left side and lymph node harvest number matter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucia Mangone ◽  
Carmine Pinto ◽  
Pamela Mancuso ◽  
Marta Ottone ◽  
Isabella Bisceglia ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Cancer Survival ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Left Colon ◽  
Cancer Site ◽  
Right Colon ◽  
Emilia Romagna Region ◽  
The Right ◽  
The Impact

Abstract Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

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