European Journal of Surgical Oncology

Whether salvage surgery after chemoradiation in recurrent or residual head and neck cancer improves outcomes is an open question. The proponents of salvage surgery point to the multiple small, retrospective, single-center analyses performed across the globe which hint towards the efficacy of salvage surgery. The opponents on the other hand point that diseases with small volumes that are accessible without involving critical structures are usually selected for salvage surgery. This selection gives a biological advantage to patients undergoing salvage surgery over those treated with non-surgical modalities and therefore it is possible that the improved outcomes seen with salvage surgery are a result of selection bias. To answer this question we performed this analysis. This was a post hoc analysis of data from a phase 3 study comparing the efficacy of cisplatin - radiation versus Nimotuzumab-cisplatin-radiation. Patients in this study who had the recurrent or residual disease and who were eligible for salvage surgery were selected for this study. These were divided into 2 cohorts for comparison, willing for salvage surgery (n=91) and unwilling for salvage surgery(n=22). The primary endpoint was overall survival. This we thought was a better method of comparison than who underwent salvage surgery versus did not undergo salvage surgery. As some patients even who are willing for salvage surgery progress before the surgery. This biologically bad subgroup deteriorates the results of patients who did not undergo salvage surgery group. We feel this analysis is close to perfect as performing a randomized study in this setting seems unethical after observing our results. The results are in favor of salvage surgery.

Local Recurrence (LR) rates - LR was defined as any form of pelvic relapse after effective surgery for the primary tumor; Distant Disease (DD) rates - DD was established as any form of distant disease dissemination); and Overall Survival (OS) - was defined as death from any cause)

The use of systemic chemotherapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in appendiceal carcinomatosis is not associated with better clinical outcomes. Traditional agents may not be effective and other regimens are needed.

SEER database

This record contains raw data related to article “Surgical management of BRCA-mutation carriers: A single institution experience" Abstract: Introduction: The optimal surgical management of BRCA-mutation carriers remains a subject of debate. To evaluate the appropriateness of breast cancer (BC) treatment, the oncological outcomes of BRCA-mutation carriers treated either with breast-conserving therapy (BCT) or mastectomy were compared. Additionally, the role of bilateral salpingo-oophorectomy (BSO) and potential independent predictive factors for BC treatment were analyzed. Materials and methods: We retrospectively reviewed all the consecutive patients with a pathogenic germline mutation in the BRCA1/2 genes tested at our Institution between July 2008 and October 2018. Primary end-points were disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS). Results: The characteristics and outcomes of 124 BRCA-associated BC patients were analyzed. Overall, 69 (55.7%) and 55 (44.3%) patients underwent BCT and mastectomy, respectively; 72 (58.1%) patients underwent BSO. After a median interval of 13.3 months, 24 patients underwent mastectomy after primary BCT. There was no significant difference in terms of DFS, DDFS, and OS between patients treated with BCT or mastectomy (p = 0.39,p = 0.27,p = 0.265, respectively). Patients treated with BSO had significantly better DDFS and OS compared to ovarian conservation (p = 0.033,p = 0.040, respectively). Three independent predictive factors for BCT were identified: age ≤41 years, genetic testing performed post-operatively, and breast tumors ≤21 mm. Conclusions: Our data suggest that BRCA-mutation carriers treated with BCT present similar oncological outcomes compared to mastectomy. Ovarian preservation decreases survival. Young BRCA-mutated patients with small BCs may not need up-front mastectomy, and BSO might be performed when ovarian cancer risk epidemiologically rises and potential reproductive desire is fulfilled.

This record contains raw data related to article “Early age of onset is an independent predictor for worse disease-free survival in sporadic rectal cancer patients. A comparative analysis of 980 consecutive patients" Background: while interest on early-onset colorectal cancer (age ≤49) is on the rise, studies on early-onset rectal cancer (EORC) are limited. The aim of this study was to compare predictors for disease progression/recurrence between sporadic EORC and late-onset RC patients (LORC). Methods: 163 EORC and 830 LORC operated between January 1st, 2010 and April 30th, 2021 at a tertiary center were included. Demographics, tumor characteristics, microsatellite status, gene mutations (KRAS, BRAF, NRAS, PI3Kca) and oncologic outcomes were compared. A Cox proportional hazards regression analysis was performed to ascertain the effect of variables on recurrence/progression and death. Recurrence/Progression free survival (R/PFS) and cancer specific survival (CSS) were analyzed by the Kaplan-Meier estimator. Results: Mean age of EORC was 42.16, (46% aged 45-49). A majority of EORC patients had a family history for CRC (p = 0.01) and underwent total neoadjuvant treatment (p = 0.01). EORC patients showed a higher rate of low-grade tumor differentiation (p < 0.0001), stage III-IV (p = 0.001), microsatellite instability (p = 0.02), locoregional nodal (p = 0.001) and distant metastases (p < 0.0001). Accordingly, more EORC patients underwent adjuvant treatment (p < 0.0001). Mutations were mostly reported among LORC cases (p = 0.04), whereas EORC patients showed a worse R/PFS (p = 0.02), even at stage I (p = 0.04). CSS did not differ (p = 0.11) across groups. Multivariate analysis indicated age of onset (p = 0.04) was an independent predictor for progression/recurrence. Conclusions: Age of onset was shown to be an independent unfavorable predictor. Delayed diagnosis could explain this effect in the more advanced stages, while the worse outcomes in stage I may suggest a more aggressive disease behavior.