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    <recommendedItem id="20100101_19_307"
                     title="Good Results in Poor-Risk Rectal Cancer (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18169?impressionId=1265732871473"
                     
      &lt;p&gt;Patients with high-risk rectal cancer had high response and three-year survival rates on a regimen of preoperative chemotherapy, followed by standard chemoradiation and then surgical resection, according to results of a multicenter study.&lt;/p&gt;
&lt;p&gt;Three-fourths of patients had objective responses to neoadjuvant chemotherapy, increasing to 89% after chemoradiation, researchers reported online in &lt;em&gt;The Lancet Oncology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Additionally, 97% of patients who underwent surgery had microscopically clear surgical margins. At three years, 83% of patients remained alive, including almost 70% who were progression free.&lt;/p&gt;
&lt;p&gt;&quot;Intensification of systemic therapy with neoadjuvant combination chemotherapy before standard treatment is feasible in poor-risk, potentially operable rectal cancer, with acceptable safety and promising long-term outcomes,&quot; David Cunningham, MD, of the Royal Marsden Hospital in Sutton, England, and co-authors concluded.&lt;/p&gt;
&lt;p&gt;&quot;Future development of this multidisciplinary treatment strategy in randomized trials is warranted.&quot;&lt;/p&gt;
&lt;p&gt;Although surgery remains the primary and potentially curative therapy for localized rectal cancer, local recurrence rates as high as 40% have been reported with conventional resection.&lt;/p&gt;
&lt;p&gt;The introduction of standardized surgery and total mesorectal excision reduced local recurrence rates to less than 10%, which has been associated with improved survival, the authors noted.&lt;/p&gt;
&lt;p&gt;Preoperative radiotherapy and then chemoradiation further reduced the risk of local recurrence, but did not improve overall survival compared with surgery alone.&lt;/p&gt;
&lt;p&gt;Combination chemotherapy has led to higher response rates and progression-free survival compared with monotherapy for patients with advanced rectal cancer, the authors continued. Adjuvant chemotherapy containing oxaliplatin (Eloxatin) also has improved outcomes in resected colon cancer.&lt;/p&gt;
&lt;p&gt;Given that oxaliplatin-fluoropyrimidine combinations have become a preferred standard, investigators designed a clinical trial of high-risk rectal cancer to investigate preoperative treatment with oxaliplatin and capecitabine (Xeloda).&lt;/p&gt;
&lt;p&gt;A previous report involving the first 77 patients enrolled in the trial showed substantial tumor regression, rapid improvement in symptoms, and a high rate of clear surgical margins (&lt;em&gt;J Clin Oncol&lt;/em&gt; 2006; 24: 668-74).&lt;/p&gt;
&lt;p&gt;Nine treatment-related cardiac events occurred in eight of the 77 patients, prompting a protocol amendment to exclude patients with a recent history of clinically significant cardiac problems.&lt;/p&gt;
&lt;p&gt;The updated results comprised 105 patients, and only one cardiac event occurred after the change in eligibility criteria, the authors wrote.&lt;/p&gt;
&lt;p&gt;All of the patients had MRI-defined, poor-risk but nonmetastatic rectal cancer. Patients received four cycles of neoadjuvant chemotherapy over 12 weeks, followed by chemoradiotherapy consisting of a total radiation dose of 54 Gy administered over six weeks, plus daily capecitabine.&lt;/p&gt;
&lt;p&gt;After total mesorectal excision, patients received 12 weeks of adjuvant capecitabine.&lt;/p&gt;
&lt;p&gt;The primary endpoint was pathologic complete response, and median follow-up was 55 months.&lt;/p&gt;
&lt;p&gt;Radiologically confirmed response rates were 74% after neoadjuvant chemotherapy and 89% after chemoradiation. Of 97 patients who had surgery, 93 had microscopically clear margins, and 21 of 105 patients had pathologic complete responses.&lt;/p&gt;
&lt;p&gt;Three-year progression-free and overall survival were 68% and 83%, respectively. Among patients who had surgery, three-year, relapse-free survival was 74%.&lt;/p&gt;
&lt;p&gt;&quot;Our findings show the feasibility of neoadjuvant chemotherapy with capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision, which accord with the initial results of this study,&quot; the authors declared.&lt;/p&gt;
&lt;p&gt;&quot;High radiological response rates to preoperative treatment were recorded, and the number of pathological complete responses surpassed the prespecified number needed to meet the primary objective of this trial.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by England&apos;s National Health Service and sanofi-aventis.&lt;/p&gt;&lt;p&gt;Cunningham and co-author Niall Tebbutt disclosed relationships with Roche and sanofi-aventis.&lt;/p&gt;&lt;p&gt;Co-author Ian Chau disclosed relationships with Roche and sanofi-aventis.&lt;/p&gt;&lt;p&gt;Co-author Yu Jo Chua disclosed relationships with Roche and sanofi-aventis.&lt;/p&gt;&lt;p&gt;Co-author Gina Brown disclosed a relationship with sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_100"
                     title="PET-CT Finds More Cancers than Standard Neurologic Screens (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/17905?impressionId=1265732871473"
                     
      In patients who have neurologic symptoms indicative of cancer, whole-body positron emission tomography-computed tomography (PET-CT) may improve the detection rates when other screening test results are negative, researchers say.&lt;br&gt;
&lt;br&gt;The use of PET-CT increased the diagnostic yield for cancer by 18% in patients with suspected paraneoplastic neurologic disorders for whom results of standard oncologic tests were negative, Andrew McKeon, MB, MRCPI, of the Mayo Clinic in Rochester, Minn., and colleagues reported online in &lt;em&gt;Archives of Neurology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;This is important in that firstly, cancer is detected,&quot; McKeon said in an interview with &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;The cancers were treated in all patients and seven of 10 patients went into remission. In addition, five of 10 had improvements in neurologic problems through cancer treatment or treatment with immunotherapies.&quot;&lt;br&gt;
&lt;br&gt;Paraneoplastic neurologic disorders occur in some people with cancer  --  including lung, breast, or ovarian cancer  --  and develop when cancer-fighting antibodies mistakenly attack cells in the nervous system.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Routine screening for cancer in patients with such symptoms  --  including physical examination, CT of the chest, abdomen and pelvis, and mammography or testicular ultrasound  --  may be unrevealing. That&apos;s often because cancers detected in a paraneoplastic context are frequently small and restricted to one site.&lt;/p&gt;
&lt;p&gt;Detecting autoantibodies via serologic testing refines the search and detects cancer in about 70% of seropositive patients, the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;Once [a paraneoplastic antibody] is detected and the suspicion is raised for underlying cancer, the challenge is to try and find it,&quot; McKeon said. &quot;So we wanted to try and see what sort of patients we would find cancers in with PET-CT and try and predict what type of patients the cancers would be found in.&quot;&lt;/p&gt;
&lt;p&gt;PET-CT allows the detection of radiolabeled fludeoxyglucose preferentially taken up by highly metabolically active cancers.&lt;/p&gt;
&lt;p&gt;To evaluate its ability to detect cancer, the researchers conducted a literature review for studies that evaluated the utility of PET for cancer diagnosis in patients with paraneoplastic neurologic disorders. Then they did a retrospective review of medical records of 56 patients with clinically suspected paraneoplastic neurologic disorders who&apos;d had PET-CT scans after standard evaluations that turned out to be negative.&lt;/p&gt;
&lt;p&gt;Median age of the patients at symptom onset was 61.&lt;/p&gt;
&lt;p&gt;Before their PET-CT, patients had had a median of three other screening tests; the most common was CT of the chest, abdomen, and pelvis.&lt;/p&gt;
&lt;p&gt;Using PET-CT, the researchers detected abnormalities suggestive of cancer in 22 patients, or 39% of the total population.&lt;/p&gt;
&lt;p&gt;Among these, cancer was confirmed histologically in 10 patients as follows: &lt;ul&gt; &lt;li&gt;Thyroid papillary cell carcinomas: 2&lt;/li&gt; &lt;li&gt;Solitary lymph nodes: 2 adenocarcinomas, 1 small cell carcinoma&lt;/li&gt; &lt;li&gt;Tonsil squamous cell carcinoma: 1&lt;/li&gt; &lt;li&gt;Lung carcinomas: 1 adenocarcinoma, 1 small cell, 1 squamous cell&lt;/li&gt; &lt;li&gt;Colon adenocarcinoma: 1&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;All 10 patients were seropositive for paraneoplastic autoantibodies.&lt;/p&gt;
&lt;p&gt;Four of the 10 cancers detected using PET-CT were outside the anatomical scope of CT of the chest, abdomen, and pelvis. The six other cancers were too small to be detected by an appropriate regional CT, the researchers wrote.&lt;/p&gt;
&lt;p&gt;Among the other 12 patients who had abnormalities on PET-CT, two had premalignant lesions, one had a noncaseating granuloma, five had negative biopsy results, and other PET-directed evaluations without biopsy were negative in two. There were no further evaluations in the remaining patients.&lt;/p&gt;
&lt;p&gt;The researchers found that detection of a well-characterized neuronal nuclear or cytoplasmic paraneoplastic autoantibody was associated with a successful PET-CT-directed cancer search (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Since the majority of cancers were detected in a limited-stage, 70% of treated patients went into remission. Five patients had sustained improvements in neurologic symptoms after a median follow-up of 11 months.&lt;/p&gt;
&lt;p&gt;Based on their literature review, the present study had a higher detection rate of cancer for PET-CT (12% versus 18%), which may be explained by a larger number of patients available for follow-up in the present study or the enhanced sensitivity of PET-CT over PET alone.&lt;/p&gt;
&lt;p&gt;Still, a caveat is the screen&apos;s high false-positive rate.&lt;/p&gt;
&lt;p&gt;&quot;PET-CT is very sensitive, since it can pick up hypermetabolic tissue,&quot; McKeon said. &quot;But tissue can be hypermetabolic for different reasons.&quot;&lt;/p&gt;
&lt;p&gt;He added that PET-CT &quot;is by no means the be-all and end-all of this. It&apos;s just a helpful screening tool in patients where a cancer is suspected.&quot;&lt;/p&gt;
&lt;p&gt;They acknowledged that their study was limited by its retrospective design and small sample size, but the researchers concluded that &quot;recognizing the limitations of PET-CT, we favor this modality for initial oncologic evaluation of patients in whom a paraneoplastic neurologic disorder is strongly suspected.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;A co-author stands to receive royalties for commercial assays to detect aquaporin-4-specific autoantibodies.&lt;/p&gt;&lt;p&gt;The other researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_5_137"
                     title="Cancer Survivors No More Active or Less Obese than General Population"
                     score="-0.005"
                     href="