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Latest & greatest articles for colorectal cancer
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, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Chemotherapy in advanced gastrointestinalcancer. Type of intervention Treatment/palliative care. Economic study type Cost-effectiveness analysis. Study population Patients below the age of 76 years with surgically non-curablegastric, pancreatic-biliary or colorectalcancer. Setting Hospital. The study was carried out in Uppsala, Sweden. Dates to which data (...) gastrointestinalcancer. Annals of Oncology 1995; 6(3): 267-274 PubMedID Other publications of related interest Comment in: Annals of Oncology 1995;6(3):205-7. Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Antineoplastic Combined Chemotherapy Protocols /economics /therapeutic use; Cost-Benefit Analysis; Female; GastrointestinalNeoplasms /drug therapy /mortality; Humans; Male; Middle Aged; Palliative Care /economics; Quality of Life; Retrospective Studies; Sensitivity and Specificity
transfusions in survival, disease-free survival, cancer recurrence rates, or overall infection rates after an average follow-up of 36 months. Patients who had a curative resection and who received blood of any sort had a lower 3-year survival than non-transfused patients (69% vs 81%, p = 0.001) and a higher infection rate (39% vs 24%, p < 0.001). Colorectalcancer recurrence rates, however, were not influenced by blood transfusion (30% vs 26%, p = 0.22). These combined observations confirm the association (...) Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectalcancer. In retrospective studies, perioperative blood transfusions were associated with poor prognosis after surgery for cancer and were a major independent risk factor for postoperative bacterial infection. Leucocyte-depleted, in contrast to buffy-coat-depleted, blood has no immunosuppressive effects in transplantation and so might lack detrimental effects on cancer
Randomised trial of monoclonal antibody for adjuvant therapy of resected Dukes' C colorectalcarcinoma. German Cancer Aid 17-1A Study Group. Over the past decade various clinical trials have used monoclonal antibodies as therapeutic agents against solid tumours. No consistent pattern of response or improved survival has yet emerged although antigenic heterogeneity and insufficient accessibility of cells in advanced tumours have been offered as explanations for these failures. We designed (...) a study in which a monoclonal antibody was used to target minimal residual disease in an early stage of tumour cell dissemination in patients with colorectalcancer. Only patients in Dukes' stage C who had undergone curative surgery and were free of manifest residual tumour were admitted. 189 patients with colorectalcancer of stage Dukes' C were randomly assigned to an observation regimen or to postoperative treatment with 500 mg of 17-1A antibody, followed by four 100 mg infusions each month
, Delfino C, Abad A, Petrelli N Authors' objectives To assess the benefit of 5-fluorouracil (5FU) with methotrexate (MTX) over 5FU alone for tumour response rate and overall survival in metastatic colorectalcancer. Searching MEDLINE and the proceedings of major congresses were searched over the 5 years preceding 1991. Other trials were identified in the Proceedings of the American Society of Clinical Oncology and through personal contact with the investigators. Study selection Study designs (...) Cooperative Oncology Group (ECOG) scale in 83% of all patients; primary tumour site was colon in 58% of patients; metastasis were limited to the liver in 34% and to the lung in 7% of patients. Outcomes assessed in the review The main outcomes assessed were: complete response, defined as the disappearance of all detectable tumour; partial response, defined as a 50% reduction in the sum of the product of the largest perpendicular diameters of all measurable disease without new lesions; and duration
for following up patients after curative surgery for coloncancer. The results of randomised controlled trials should be used to inform policy. Bibliographic details Bruinvels D J, Stiggelbout A M, Kievit J, van Houwelingen H C, Habbema J D, van de Velde C J. Follow-up of patients with colorectalcancer: a meta-analysis. Annals of Surgery 1994; 219(2): 174-182 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Actuarial Analysis; ColorectalNeoplasms /diagnosis /mortality /surgery; Follow-Up (...) , laboratory test, sigmoidoscopy, colonoscopy, barium enema, chest x-ray and liver ultrasonography. Participants included in the review Patients with colorectalcancer who have had curative surgery. Outcomes assessed in the review Recurrences, deaths, symptomatic recurrences, operated recurrences, surgically resected recurrences, metachronous tumours and curatively resected metachronous tumours. How were decisions on the relevance of primary studies made? The authors do not state how the papers were
for colorecteral cancer in a high risk population. Annals of Internal Medicine 1990;13:373-84. Okubo I, Glick HA, Frumkin H, et al. Cost-effectiveness analysis of mass screening for breast cancer in Japan. Cancer 1991;67:2021-9. Indexing Status Subject indexing assigned by NLM MeSH Adult; ColorectalNeoplasms /diagnosis /economics; Cost-Benefit Analysis; Female; Humans; Japan; Male; Mass Screening /economics; Sensitivity and Specificity AccessionNumber 22005008034 Date bibliographic record published 28/02/2005 (...) Cost-effectiveness analysis of strategies for colorectalcancer screening in Japan Cost-effectiveness analysis of strategies for colorectalcancer screening in Japan Cost-effectiveness analysis of strategies for colorectalcancer screening in Japan Shimbo T, Glick H A, Eisenberg J M Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed
there are no studies that document decreased overall mortality from CRC in first-degree relatives as a result of screening, the decision as to whether to screen this population needs to be based on future prospective controlled trials and these must be standardised. Bibliographic details Brewer D A, Fung C L, Chapuis P H, Bokey E L. Should relatives of patients with colorectalcancer be screened: a critical review of the literature. Diseases of the Colon and Rectum 1994; 37(12): 1328-1338 PubMedID Indexing Status (...) Should relatives of patients with colorectalcancer be screened: a critical review of the literature Should relatives of patients with colorectalcancer be screened: a critical review of the literature Should relatives of patients with colorectalcancer be screened: a critical review of the literature Brewer D A, Fung C L, Chapuis P H, Bokey E L Authors' objectives To assess whether there should be index screening and surveillance of relatives of patients with colorectalcancer (CRC). Searching
Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectalcancer. To compare the length of survival and quality of life in patients given combination chemotherapy in addition to supportive care and in patients given only supportive care.Randomised study.Gastrointestinal oncology departments.40 previously untreated patients with histologically confirmed, measurable colorectalcancer that was locally recurrent (...) functional living index-cancer scale.Overall survival was significantly longer for patients given chemotherapy (11.0 months) than for those receiving supportive care alone (5.0 months; p = 0.006). Despite common association of chemotherapy with mild to moderate gastrointestinal symptoms, there was no significant difference between the two groups in global or subgroup quality of life scores. In patients with abnormal scores before treatment, quality of life seemed better in the chemotherapy arm.In
Beneficial effect of autologous blood transfusion on infectious complications after colorectalcancer surgery. Homologous blood transfusion has been associated with an increased risk of postoperative infectious complications. To test the clinical consequences of this apparently immunosuppressive effect of homologous blood in a controlled trial, we designed a study in which the control group deposited autologous blood before their operations for use should transfusion be needed. We enrolled 120 (...) patients with apparently curable colorectalcancer who were able to predeposit autologous blood (haemoglobin > 12.5 g/dL). 62 patients were assigned to receive homologous blood if blood transfusions were needed during operation, and the other 58 to receive their own predeposited blood followed, if necessary, by homologous blood [corrected]. Despite the similarity between the groups in factors known to affect the risk of postoperative infections, there was a significant difference in postoperative
Reducing mortality from colorectalcancer by screening for fecal occult blood. Minnesota ColonCancer Control Study. Although tests for occult blood in the feces are widely used to screen for colorectalcancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness.We randomly assigned 46,551 participants 50 to 80 years of age to screening for colorectalcancer once a year (...) specimen. Differences in mortality from colorectalcancer, the primary study end point, were monitored with the sequential log-rank statistic.The 13-year cumulative mortality per 1000 from colorectalcancer was 5.88 in the annually screened group (95 percent confidence interval, 4.61 to 7.15), 8.33 in the biennially screened group (95 percent confidence interval, 6.82 to 9.84), and 8.83 in the control group (95 percent confidence interval, 7.26 to 10.40). The rate in the annually screened group
Blood transfusions and prognosis in colorectalcancer. Blood transfusions may adversely affect the prognosis of patients treated surgically for cancer, although definite proof of this adverse effect has not been reported.We carried out a randomized trial to investigate whether the prognosis in patients with colorectalcancer would be improved by a program of autologous blood transfusion as compared with the current practice of allogeneic transfusion. Patients in the autologous-transfusion group (...) were required to donate two units of blood before surgery.A total of 475 patients were evaluated. We found no significant difference in prognosis between the allogeneic-transfusion group (236 patients) and the autologous-transfusion group (239 patients); colorectalcancer-specific survival rates at four years were 67 percent and 62 percent, respectively (P = 0.39). Among the 423 patients who underwent curative surgery, 66 percent of those in the allogeneic-transfusion group and 63 percent of those
Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectaladenocarcinoma. About half the patients treated with curative resection for colorectalcancer do not survive long-term. Adjuvant chemotherapy given during and after surgery may prevent hepatic metastases and improve patient survival. In patients with colorectalcancer, we have done a multicentre, randomised controlled trial comparing five-year survival after intraportal infusion (...) % compared with surgery-only controls. Further study of intraportal infusion of chemotherapeutic agent as adjuvant treatment to surgery in patients with colorectalcancer appears worthwhile.
of related interest Hardcastle JD, Thomase WM, Chamberlain J, et al. Randomised controlled trial of faecal occult blood screening for colorectalcancer: results for the first 107,344 patients. Lancet 1989;i:119-23. Indexing Status Subject indexing assigned by NLM MeSH ColorectalNeoplasms /epidemiology /prevention & Cost-Benefit Analysis; Costs and Cost Analysis; Humans; Mass Screening /economics /methods /standards; Models, Econometric; Occult Blood; Patient Compliance; Prevalence; Sensitivity (...) Filtering strategies in mass population screening for colorectalcancer: an economic evaluation Filtering strategies in mass population screening for colorectalcancer: an economic evaluation Filtering strategies in mass population screening for colorectalcancer: an economic evaluation Walker A, Whynes D K Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results
Levamisole and fluorouracil for adjuvant therapy of resected coloncarcinoma. Twelve hundred ninety-six patients with resected coloncancer that either was locally invasive (Stage B2) or had regional nodal involvement (Stage C) were randomly assigned to observation or to treatment for one year with levamisole combined with fluorouracil. Patients with Stage C disease could also be randomly assigned to treatment with levamisole alone. The median follow-up time at this writing is 3 years (range, 2 (...) to 5 1/2). Among the patients with Stage C disease, therapy with levamisole plus fluorouracil reduced the risk of cancer recurrence by 41 percent (P less than 0.0001). The overall death rate was reduced by 33 percent (P approximately 0.006). Treatment with levamisole alone had no detectable effect. The results in the patients with Stage B2 disease were equivocal and too preliminary to allow firm conclusions. Toxic effects of levamisole alone were infrequent, usually consisting of mild nausea
Randomised, controlled trial of faecal occult blood screening for colorectalcancer. Results for first 107,349 subjects. To assess the effectiveness of screening by faecal occult blood tests, 107,349 people without symptoms of colorectaldisease identified from general practitioner records have been randomly allocated to test and control groups. 53,464 test subjects were invited to carry out the screening test; 27,651 (53%) of the 52,258 who received the tests did so. Further investigation (...) A) was 0.72 per 1000 person-years. Cancers detected by screening were at a less advanced pathological stage, but it is too early to show any effect of screening on mortality from colorectalcancer.
Prolongation of the disease-free interval in surgically treated rectal carcinoma. GastrointestinalTumor Study Group. To assess the effects of postoperative radiation therapy and chemotherapy on tumor recurrence and patient survival, 227 patients (data on 202 of whom were analyzed) who had undergone "curative" surgical resection for rectal adenocarcinoma were prospectively and randomly assigned to one of four treatments: no adjuvant therapy (concurrent controls, 58 patients), postoperative (...) radiotherapy with 4000 or 4800 rad (50 patients), postoperative chemotherapy (fluorouracil and semustine [methyl-CCNU], 48 patients), or a combination of radiation therapy and chemotherapy (46 patients). Five years after the entry of the last patient and with a median follow-up of all survivors for 80 months, the recurrence rate was highest among the control patients (55 per cent) and lowest among the patients receiving a combination of adjuvant radiation and chemotherapy (33 per cent). Time to tumor
screening for colorectalcarcinoma. DigestiveDiseases and Sciences 1985; 30(9): 860-865 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Aged; ColonicNeoplasms /epidemiology; Cost-Benefit Analysis; Humans; Mass Screening /economics; Middle Aged; Occult Blood; Reagent Kits, Diagnostic /economics; Rectal Neoplasms /epidemiology AccessionNumber 21995005293 Date bibliographic record published 25/06/1996 Date abstract record published 25/06/1996 NHS Economic Evaluation Database (NHS EED (...) Cost benefits of hemoccult screening for colorectalcarcinoma Cost benefits of hemoccult screening for colorectalcarcinoma Cost benefits of hemoccult screening for colorectalcarcinoma Allison J E, Feldman R Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study
Adjuvant therapy of coloncancer--results of a prospectively randomized trial. GastrointestinalTumor Study Group. After curative surgical resection, 621 patients with modified Dukes' stage B2, C1, or C2 coloncarcinoma were randomly assigned to one of four treatment programs. These included chemotherapy with fluorouracil and semustine, immunotherapy with methanol extraction residue of bacillus Calmette-Guérin (BCG), combination therapy with fluorouracil, semustine, and immunotherapy, or close (...) as an adjuvant treatment program for patients at high risk for recurrent coloncarcinoma. The data do, however, demonstrate the necessity for an untreated control group in a trial of adjuvant therapy for coloncancer.
. 77 people (2 . 1%) had a positive test result, and 50% of these on investigation had neoplasticdisease--12 had invasive carcinomas (9 Dukes' stage A, 2 stage B, 1 stage C) and 27 had 40 adenomas (12 over 2 cm, 2 of which contained areas of severe dysplasia). In the year following the screening test 1 carcinoma (stage C) has presented in the group which accepted the test, and 10 carcinomas (4 stage B, 4 stage C, 2 stage D) have presented in the control group. This respresents a 3 . 6 times (...) Controlled trial of faecal occult blood testing in the detection of colorectalcancer. 20 525 patients from general practitioners' lists were randomly allocated into test and control groups. The 10 253 test subjects were invited to perform haemoccult faecal occult blood testing over 3 days. 3613 (36 . 8%) of the 9807 who received their invitations completed the test. Compliance was improved by direct invitation from the general practitioner and by prior health education by letter or interview
Leukemia and preleukemia after adjuvant treatment of gastrointestinalcancer with semustine (methyl-CCNU). We evaluated the risk of acute nonlymphocytic leukemia, acute myelodysplastic syndrome, and preleukemia in 3633 patients with gastrointestinalcancer who were treated in nine randomized clinical trials. Among 2067 patients given semustine (methyl-CCNU) as adjuvant therapy, leukemic disorders developed in 14, whereas only one leukemic disorder (acute nonlymphocytic leukemia) occurred among (...) radiotherapy or immunotherapy. In addition, no excess of acute nonlymphocytic leukemia was seen in 44,370 patients treated for gastrointestinalcancer in Connecticut during the period 1935 to 1974, before the advent of nitrosourea chemotherapy. This study provides quantitative evidence that nitrosoureas are leukemogenic in human beings and confirms previous observations that adjuvant chemotherapy with alkylating agents may increase the risk of leukemia.