Area Editoriale

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. The COlon cancer Laparoscopic or Open Resection Study Group. Lancet Oncol. 2005 Jul;6(7):477-484.

Cancer risks and mortality in heterozygous ATM mutation carriers. Thompson D, Duedal S, Kirner J, McGuffog L, Last J, Reiman A, Byrd P, Taylor M, Easton DF. J Natl Cancer Inst. 2005 Jun 1;97(11):813-22.

Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, Overvad K, Olsen A, Tjonneland A, Clavel F, Boutron-Ruault MC, Kesse E, Boeing H, Bergmann MM, Nieters A, Linseisen J, Trichopoulou A, Trichopoulos D, Tountas Y, Berrino F, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Engeset D, Lund E, Skeie G, Ardanaz E, Gonzalez C, Navarro C, Quiros JR, Sanchez MJ, Berglund G, Mattisson I, Hallmans G, Palmqvist R, Day NE, Khaw KT, Key TJ, San Joaquin M, Hemon B, Saracci R, Kaaks R, Riboli E. Natl Cancer Inst. 2005 Jun 15;97(12):906-16.

Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. JAMA. 2005 Jul 6;294(1):56-65.

Approaching difficult communication tasks in oncology. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. CA Cancer J Clin. 2005 May-Jun;55(3):164-77. Effective communication skills enable physicians to improve patients' understanding of their illnesses, improve patient adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment. Common communication pitfalls include blocking, lecturing, depending on a routine, collusion, and premature reassurance. Fundamental communication skills include "ask-tell-ask," "tell me more," and responding empathetically. Key communication tasks that are linked to the illness trajectory include: the first visit, giving bad news, making anticancer treatment decisions, offering clinical trials, completing anticancer therapy, and discontinuing palliative chemotherapy. While enhancing or acquiring new skills ultimately requires practice and feedback over time, this article provides a cognitive map for important communication skills that physicians need over the course of caring for a person with cancer. Leggi l’articolo: è FULL-TEXT!!!!!

V.Annese Scrive"Screening for the Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)CHAR(13) + CHAR(10)Hampel H, Frankel WL, Martin E, Arnold M, Khanduja K, Kuebler P, Nakagawa H, Sotamaa K, Prior TW, Westman J, Panescu J, Fix D, Lockman J, Comeras I, de la Chapelle A.New Engl J Med 2005;352:1851-1860

m.koch Scrive"Prognostic Scoring in Colorectal Cancer Liver MetastasesDevelopment and ValidationCHAR(13) + CHAR(10)Martin Schindl, Stephen J. Wigmore, Elspeth J. Currie, Friedrich Laengle,O. James Garden.CHAR(13) + CHAR(10)CHAR(13) + CHAR(10)CHAR(13) + CHAR(10)Arch Surg. 2005;140:183-189.CHAR(13) + CHAR(10)CHAR(13) + CHAR(10)

Genetic Variants in the UGT1A6 Enzyme, Aspirin Use, and the Risk of Colorectal Adenoma Andrew T. Chan, Gregory J. Tranah, Edward L. Giovannucci, David J. Hunter, and Charles S. Fuchs J Natl Cancer Inst 2005; 97: 457-460 Genetic variation in the uridine diphosphate glucuronosyltransferase 1A6 (UGT1A6) enzyme is associated with impaired metabolism of aspirin. To determine whether polymorphisms in the UGT1A6 enzyme modulate the protective benefit of regular aspirin use on colorectal adenoma, we conducted a prospective, nested case-control study of 1062 women who provided blood specimens and detailed data on aspirin use before undergoing lower endoscopy. All statistical tests were two sided. Although UGT1A6 genotype was not associated with overall adenoma risk (multivariable odds ratio [OR] = 1.10, 95% confidence interval [CI] = 0.85 to 1.41), functional variant genotypes statistically significantly modified the effect of aspirin on adenoma (Pinteraction = .02). Among the 616 women with variant genotypes, regular use of aspirin (two or more standard tablets per week) was associated with a decreased risk of adenoma (multivariable OR for adenoma = 0.66 [95% CI = 0.45 to 0.95], OR = 0.63 [95% CI = 0.43 to 0.91] for 0.5–7 standard tablets per week and OR = 0.41 [95% CI = 0.24 to 0.71] for more than 7 tablets per week; Ptrend = .001). In contrast, among women with wild-type genotypes, regular aspirin use was not associated with a reduced risk nor did they obtain any additional benefit with higher doses (Ptrend = .50). These results were consistent among women with advanced adenomas (Pinteraction = .003). Thus, functional polymorphisms in the UGT1A6 enzyme statistically significantly modify the effect of aspirin on colorectal neoplasia, and certain subsets of the population, defined by genotype, may obtain differential benefit from aspirin chemoprevention.

Dietary Counseling Improves Patient Outcomes: A Prospective, Randomized, Controlled Trial in Colorectal Cancer Patients Undergoing Radiotherapy . Paula Ravasco, Isabel Monteiro-Grillo, Pedro Marques Vidal, and Maria Ermelinda Camilo . JCO Mar 1 2005: 1431–1438. PURPOSE: To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients: nutritional, morbidity, and quality of life (QoL) during and 3 months after radiotherapy. PATIENTS AND METHODS: A total of 111 colorectal cancer outpatients referred for radiotherapy, stratified by staging, were randomly assigned: group 1 (G1; n = 37), dietary counseling (regular foods); group 2 (G2; n = 37), protein supplements; and group 3 (G3; n = 37), ad libitum intake. Nutritional intake (diet history), status (Ottery's Subjective Global Assessment), and QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were evaluated at baseline, at the end, and 3 months after radiotherapy. RESULTS: At radiotherapy completion, energy intake increased in G1/G2 (P Leggi l’articolo

Predictors of Survival After Radiofrequency Thermal Ablation of Colorectal Cancer Metastases to the Liver: A Prospective Study . Eren Berber, Robert Pelley, and Allan E. Siperstein . JCO Mar 1 2005: 1358–1364. PURPOSE: The aim of this study was to determine the predictors of survival at the time of radiofrequency thermal ablation (RFA) in patients with colorectal liver metastasis. PATIENTS AND METHODS: One hundred thirty-five patients with colorectal liver metastases who were not candidates for resection underwent laparoscopic RFA. RESULTS: The median Kaplan-Meier survival for all patients was 28.9 months after RFA treatment. Patients with a carcinoembryonic antigen (CEA) less than 200 ng/mL had improved survival compared with those with a CEA more than 200 (34 v 16 months; P = .01). Patients with the dominant lesion less than 3 cm in diameter had a median survival of 38 v 34 months for lesions 3 to 5 cm, and 21 months for lesions greater than 5 cm (P = .03). Survival approached significance for patients with one to three tumors versus more than three tumors (29 v 22 months; P = .09). The presence of extrahepatic disease did not affect survival. Only the largest liver tumor size more than 5 cm was found to be a significant predictor of mortality by Cox proportional hazards model, with a 2.5-fold increased risk of death versus the largest liver tumor size less than 3 cm (P = .05). CONCLUSION: This study determines which patients do best after RFA. Historical survival with chemotherapy alone is 11 to 14 months, suggesting RFA has a positive impact on overall survival. Limited amounts of extrahepatic disease do not appear to affect survival adversely. RFA is a useful adjunct to chemotherapy in those patients with liver-predominant disease. Leggi l’articolo

Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention. Solomon SD, McMurray JJ, Pfeffer MA, Wittes J, Fowler R, Finn P, Anderson WF, Zauber A, Hawk E, Bertagnolli M.

Phase I Trial of Capecitabine and Weekly Irinotecan in Combination With Radiotherapy for Neoadjuvant Therapy of Rectal Cancer . Ralf-Dieter Hofheinz, Bolko von Gerstenberg-Helldorf, Frederik Wenz, Ulrike Gnad, Uta Kraus-Tiefenbacher, Albrecht Müldner, Rüdiger Hehlmann, Stefan Post, Andreas Hochhaus, and Frank Willeke. JCO Mar 1 2005: 1350–1357. PURPOSE: To establish the feasibility and efficacy of capecitabine in combination with weekly irinotecan (CAPIRI) with concurrent pelvic radiotherapy (RT) in patients with locally advanced rectal cancer. PATIENTS AND METHODS: Nineteen patients with rectal cancer clinical stage T3-4, Nx received weekly irinotecan 50 mg/m2 (days 1, 8, 15, 22, 29) and two doses of capecitabine (days 1 through 38; dose level [DL] I, 500 mg/m2 bid; DL II, 625 mg/m2 bid) according to phase I methodology. Three-dimensional conformal RT was given to a dose of 50.4 Gy (45 Gy + 5.4 Gy). RESULTS: On DL I, no dose-limiting toxicities occurred, whereas diarrhea grade 3 affected three of seven patients on DL II. Twelve patients were treated on DL I and received a median relative dose-intensity of 100% for both drugs. Grade 3 or 4 adverse events were observed in only one of these patients (asthenia grade 3). All patients underwent surgery and R0 resection was achieved in all patients. Pathologic complete remission was observed in four patients and another five patients had only microfoci of residual tumor. CONCLUSION: Preoperative chemoradiotherapy with CAPIRI is feasible and well tolerated. The preliminary efficacy is good, and the tolerability is at least comparable with data for fluorouracil plus irinotecan chemoradiotherapy. Larger phase II trials of the CAPIRI-RT schedule clearly are warranted. Leggi l’articolo

The TP53 colorectal cancer international collaborative study on the prognostic and predictive significance of p53 mutation: influence of tumor site, type of mutation, and adjuvant treatment. Russo A, Bazan V, Iacopetta B, Kerr D, Soussi T, Gebbia N; TP53-CRC Collaborative Study Group. J Clin Oncol. 2005 Oct 20;23(30):7518-28.

Depressive symptoms and prospective incidence of colorectal cancer in women. Kroenke CH, Bennett GG, Fuchs C, Giovannucci E, Kawachi I, Schernhammer E, Holmes MD, Kubzansky LD. Am J Epidemiol. 2005 Nov 1;162(9):839-48.

Cancer Statistics, 2005. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ. CA Cancer J Clin. 2005 January-February;55(1):10-30. Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,372,910 new cancer cases and 570,280 deaths are expected in the United States in 2005. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for persons younger than 85 since 1999. When adjusted to delayed reporting, cancer incidence rates stabilized in men from 1995 through 2001 but continued to increase by 0.3% per year from 1987 through 2001 in women. The death rate from all cancers combined has decreased by 1.5% per year since 1993 among men and by 0.8% per year since 1992 among women. The mortality rate has also continued to decrease from the three most common cancer sites in men (lung and bronchus, colon and rectum, and prostate) and from breast and colorectal cancers in women. Lung cancer mortality among women has leveled off after increasing for many decades. In analyses by race and ethnicity, African American men and women have 40% and 20% higher death rates from all cancers combined than White men and women, respectively. Cancer incidence and death rates are lower in other racial and ethnic groups than in Whites and African Americans for all sites combined and for the four major cancer sites. However, these groups generally have higher rates for stomach, liver, and cervical cancers than Whites. Furthermore, minority populations are more likely to be diagnosed with advanced stage disease than are Whites. Progress in reducing the burden of suffering and death from cancer can be accelerated by applying existing cancer control knowledge across all segments of the population.

A national survey of primary care physicians' methods for screening for fecal occult blood. Nadel MR, Shapiro JA, Klabunde CN, Seeff LC, Uhler R, Smith RA, Ransohoff DF. Ann Intern Med. 2005 Jan 18;142(2):86-94. BACKGROUND: Screening with the fecal occult blood test (FOBT) has been shown to reduce colorectal cancer incidence and mortality in randomized, controlled trials. Although the test is simple, implementation requires adherence to specific techniques of testing and follow-up of abnormal results. OBJECTIVE: To examine how FOBT and follow-up are conducted in community practice across the United States. DESIGN: Cross-sectional national surveys of primary care physicians and the public. SETTING: The Survey of Colorectal Cancer Screening Practices in Health Care Organizations and the 2000 National Health Interview Survey. PARTICIPANTS: 1147 primary care physicians who ordered or performed FOBT and 11 365 adults 50 years of age or older who responded to questions about FOBT use. MEASUREMENTS: Self-reported data on details of FOBT implementation and follow-up of positive results. RESULTS: Although screening guidelines recommend home tests, 32.5% (95% CI, 29.8% to 35.3%) of physicians used only the less accurate method of single-sample in-office testing; another 41.2% (CI, 38.3% to 44.0%) used both types of test. Follow-up of positive test results showed considerable nonadherence to guidelines, with 29.7% (CI, 27.1% to 32.4%) of physicians recommending repeating FOBT. Furthermore, sigmoidoscopy, rather than total colon examination, was commonly recommended to work up abnormal findings. Nearly one third of adults who reported having FOBT said they had only an in-office test, and nearly one third of those who reported abnormal FOBT results reported no follow-up diagnostic procedures. Limitations: The study was based on self-reports. Data from the National Health Interview Survey may underestimate the prevalence of in-office testing and inadequate follow-up. CONCLUSIONS: Mortality reductions demonstrated with FOBT in clinical trials may not be realized in community practice because of the common use of in-office tests and inappropriate follow-up of positive results. Education of providers and system-level interventions are needed to improve the quality of screening implementation.

Connective tissue growth factor inhibits metastasis and acts as an independent prognostic marker in colorectal cancer. Been-Ren Lin, Cheng-Chi Chang, Ting-Fang Che, Szu-Ta Chen, Robert Jeen-Chen Chen, Ching-Yao Yang, Yung-Ming Jeng, Jin-Tung Liang, Po-Huang Lee, King-Jen Chang, Yat-Pang Chau, Min-Liang Kuo. Gastroenterology 2005;128:9-23.

Localizing colorectal cancer by colonoscopy. Piscatelli N, Hyman N, Osler T. Arch Surg. 2005 Oct;140(10):932-5.

Use of nonsteroidal antiinflammatory drugs and risk of colon cancer in a population-based, case-control study of African Americans and Whites. Sansbury LB, Millikan RC, Schroeder JC, Moorman PG, North KE, Sandler RS. Am J Epidemiol. 2005 Sep 15;162(6):548-58. Epub 2005 Aug 10.

Fever of unknown origin and cancer: a population-based study. Henrik Toft Sørensen, Lene Mellemkjær, Mette Vinther Skriver, Søren P Johnsen, Bente Nørgård, Jørgen H Olsen and John A Baron The Lancet Oncology, In Press, Corrected Proof, Available online 28 September 2005.