Prevalence of diabetes mellitus among 80,193 gastrointestinal cancer patients in five European and three Asian countries

Background Diabetes mellitus (DM) has recently been associated with an increased incidence of such digestive tract malignancies as gastric or colorectal cancer. However, systematic data on the prevalence of DM among digestive tract cancer entities, especially in terms of geographic distributions, are lacking. Methods We used the Oncology Dynamics database (IQVIA) to identify a total of 80,193 patients with gastrointestinal (GI) cancer (5845 esophagus, 20,806 stomach, 38,138 colon, and 15,414 rectum cancer patients) from eight European and Asian countries. Results The overall prevalence of DM among all digestive tract cancer patients was 14.8% (11,866/80,193). In terms of cancer site, DM prevalence was highest in patients with colon (15.5%) or rectal (15.3%) cancer and lowest in patients with esophageal cancer (12.0%). Interestingly, we observed significant differences in DM prevalence between countries. Spain (27.8%, 31.3%) and South Korea (21.0%, 27.9%) had the highest prevalence of DM among gastric and colon cancer patients, while DM prevalence in esophageal (18.8%) and rectal (38.0%) cancer patients was highest in Germany. Conclusion Our data revealed a high prevalence of DM among digestive tract cancer patients in Europe and Asia, and showed that DM prevalence varies among digestive tract cancer sites as well as countries.

Assessment of Quality of Life Following Radiotherapy in Patients With Rectum Cancer

PurposeThe aim of the present study is to investigate the effects of radiotherapy (RT) on quality of life (QoL) and influencing factors.MethodsData of 106 patients who completely filled out the three questionnaires were evaluated in this prospective study. Quality of life was evaluated with cancer-specific QLQ-C30 and colorectal cancer module QLQ-CR29 created by European Organization for Research and Treatment of Cancer (EORTC). All statistical analyses were done with SPSS version 22 software. A p level of <0.05 was accepted as statistically significant.ResultsMedian age was 61 (27-86). Of the patients, 77 (72.6%) were male and 29 (27.4%) were female. When QLQ-C30 questionnaires were evaluated, it was observed that physical, role, cognitive and emotional function scores were impaired following RT however returned to pre-RT levels on control. According to the results of QLQ-CR29 questionnaire, after RT, impairment was observed in urination frequency, urinary incontinence, stool frequency, dysuria, fecal incontinence, embarrassment, sexual interest in males scales however they returned to pre-RT values on control. When evaluated with regard to age, financial difficulty, global health score, mucus in stool, dysuria, dyspareunia and abdominal pain were observed to be poorer in the young; urination frequency and urinary incontinence were observed to be poorer in the elderly. ConclusionAlthough both functional and symptom scales were shown to impair, most of them were detected to be temporal and patients could well tolerate radiotherapy. Additional assessment is required for evaluating the late effects of treatments on QoL.

Maggots Around Colostomy Site: A Case Report

Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.

Prevalence of colorectal cancer and its precursor lesions in symptomatic patients under 55 years of age undergoing total colonoscopy: results of a large retrospective, multicenter, controlled endoscopy study

Purpose Colorectal cancer (CRC) is the second most common cancer in Germany. Around 60,000 people were diagnosed CRC in 2016 in Germany. Since 2019, screening colonoscopies are offered in Germany for men by the age of 50 and for women by the age of 55. It is recently discussed if women should also undergo a screening colonoscopy by the age of 50 and if there are any predictors for getting CRC. Methods Colonoscopies of 1553 symptomatic patients younger than 55 years were compared with colonoscopies of 1075 symptomatic patients older than 55 years. We analyzed if there are any significant differences between those two groups in the prevalence of CRC and its precursor lesions or between symptomatic men and women. We evaluated if there is a correlation between abdominal symptoms and the prevalence of CRC. Results In 164/1553 symptomatic patients, 194 (12.5%) polyps were detected. In total, six colorectal carcinomas (0.4%) were detected. There were no significant differences between men and women. In symptomatic patients ≥ 55 years, significantly more polyps were found (p<0.0001; 26.6% vs. 12.5%). Totally, 286 polyps (26.6%) were removed in 1075 symptomatic patients older than 55 years. Anorectal bleeding was the only abdominal symptom being a significant indicator for the prevalence of the occurrence of colon and rectum cancer in both groups (p=0.03, OR=2.73 95%-CI [1.11;6.70]), but with only low sensitivity (44%). Conclusion Due to no significant differences in men and women, we recommend screening colonoscopies also for women by the age of 50.

DOSIMETRIC COMPARISON OF VMAT AND 3D CONFORMAL RADIOTHERAPY IN PREOPERATIVE RECTAL CANCER

The standard procedure in treating rectum cancer is surgical intervention, but presurgical chemotherapy and radiotherapy lead to a lower rate of localized recidives. Our study compared the results obtained by two techniques of radiation treatment planning (RTP) in radiotherapy, which patients received in the preoperative course of rectum cancer treatment, Volumetric Modulated Arc Therapy (VMAT) and field-in-field three-dimensional conformal radiotherapy (FIF 3D-CRT). We analyzed better coverage of the planning target volume (PTV) and better protection of organs from risk (OAR): bladder, bowel, left femoral head, and right femoral head results and monitor unit (MU). Also, we analyzed the target volume coverage indicators included homogeneity index (HI), and conformity index (CI). Selected five patients were treated in University Clinical Center Kragujevac during 2020. The two types of techniques for making radiotherapy plans, mentioned above, were designed for each patient using the same CT scans. All plans were done on the treatment planning system ECLIPSE- Version 15.6 (Varian). The prescribed dose for all patients was 50 Gy in 25 fractions. The first arc was planned in the clockwise direction and the second in the counter clockwise direction. FIF 3D-CRT plans were obtained by using fields from four different directions with the same isocenter. It was obtained that VMAT plans, compared to the FIF 3D-CRT, achieved better coverage of the PTV (D95%), better heterogeneity, and conformity. Protection for OAR such as the bladder, femoral heads, and small bowel is much better than that given by FIF 3D-CRT plans. However, the number of MU calculated by FIF 3D-CRT is almost twice lower compared to VMAT.

The Role of Diffusion MRI in Rectum Cancer Staging and Evaluation of Neoadjuvan Treatment Efficiency

The correct staging of rectal cancer is very important for treatment. This study aims to show the contribution of diffusion-weighted imaging (DWI) to staging, to predict tumor differentiation and neoadjuvant chemoradiotherapy response using DWI. The study con- sisted of 36 patients and 22 control groups. 12 patients who received neoadjuvant therapy were evaluated before and after treatment. Magnetic Resonance Imaging (MRI) and DWI were performed to all patients and apparent diffusion coefficient (ADC) maps were obtained. The findings were compared with histopathological results. T staging accuracy was 72.2% on MRI. N staging accuracy rate was 75% on the T2 sequence and 72.2% on DWI. Tumoral rectal ADC values were significantly decreased compared to the normal rectal wall (p< 0.001). Mean T3 and T4 (extramural) ADC values were significantly decreased compared to the T2 stage (intramural) ADC values (p< 0.001). ADC and relative ADC (lymph node / primary tumor ADC) values of the metastatic lymph nodes were signifi- cantly decreased compared to benign lymph nodes (p< 0.001). According to the ADC cut point, N staging accuracy was found to be 83%. The ADC values of the low differentiated group were significantly decreased compared to the moderately and well-differentiated group (p< 0.011). In the control MRI of patients receiving neoadjuvant therapy, the ADC increase in the group that responded well to the treatment was significantly higher than the group with partial response (p <0.004). As a result, DWI and ADC are useful for preoperative rectum cancer evaluation. Keywords: Rectum cancer, Staging, Diffusion MRI

Cost-effectiveness indicator for colorectal cancer therapy

Contemporary data on different therapy schemes for colorectal cancer are presented from the point of view of “costeffectiveness” indicator. There is an information about Federal programs aimed at increasing annual healthcare financing connected with preventing and curing malignancies. The statistics of the annual growth in colon and rectum cancer rates is discussed. An actual problem of increasing number of resource-intensive medicines for oncology treatment is stated. This is the reason to analyze cost-effectiveness.

The management of the colorectal cancer: Perspectives

Background: The progress of scientific research gives new tracks to be exploited for the management of the colorectal cancers whose the molecular profile study became fundamental. Aim: the aim of this study was to compare the management of the colorectal cancer in our patients to the current international recommendations. Subjects and methods: In a retrospective study, we analysed 256 files between January, 2015 and September 2019. All the adenocarcinoma of colon and rectum were included. Our patients were divided into two groups: 161 patients with colorectal cancer (63%) and 95 patients with rectum cancer (37%). We studied if the management of the disease was actually compliant to the international recommendations. Results: Our study showed that the colorectal cancer occured most frequently in young population, with 45,5% in patients aged more than 60 years, 44% between 40 -60 years and 10 were under 40 years. The tumor was in T3 or more stage in 40,3% for colon cancer and 68,4% for rectum cancer. Elsewhere, none of the patients benefited from a molecular profile study of his tumor. Discussion:The colorectal cancer is diagnosed in relatively young population with 54,5% of patients aged less than 60 years among whom 10% are less than 40, which explains the diagnostic delay. This delay is also due to the lack of a screening in general population and high risk subjects. Moreover, the absence of a molecular examination has a negative impact on the treatment and on the screening in the apparented, especially in case of tumor with micro satellite instability. Conclusion: In order to improve the prognosis of the colorectal cancers in our patients, a screening adapted to the groups at risk has to be implemented and a molecular profil examination achived so that evolution and therapeutics perspectives could be set.