Can a novel MRI staging system for low rectal cancer aid surgical planning?

Background: Low rectal cancers are associated with worse outcomes in comparison with mid and upper rectal tumors.

Objective: This study aimed to assess the predictive accuracy of MRI in identifying the correct surgical approach based on the mesorectal and extralevator planes.

Design: This study involved the retrospective analysis of MRI and histopathology data of 33 patients with low rectal cancer, with the use of an anatomically based staging system.

Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience.

Purpose: To assess magnetic resonance imaging (MRI) and pathologic staging after neoadjuvant therapy for rectal cancer in a prospectively enrolled, multicenter study.

Methods: In a prospective cohort study, 111 patients who had rectal cancer treated by neoadjuvant therapy were assessed for response by MRI and pathology staging by T, N and circumferential resection margin (CRM) status. Tumor regression grade (TRG) was also assessed by MRI.

American College of Radiology Appropriateness Criteria(®)--locally advanced (high-risk) prostate cancer.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Alchemy and the history of science. Introduction.

Alchemy is part of the cultural experience of early modern Europe and yet has had to overcome problems of demarcation to be considered relevant to the history of science. This essay considers historiographical and methodological issues that have affected the gradual demarginalization of alchemy among attempts to explain, and find things out about, nature. As an area of historical study, alchemy relates to the history of science as part of an ensemble of practices that explored the natural world through natural philosophy and speculative traditions and by functioning as a nexus of social and intellectual life.

Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer.

Background: Extralevator abdominoperineal excision results in superior oncologic outcome for advanced low rectal cancer. The exact definition of surgical resection planes is pivotal to achieving negative circumferential resection margins.

Objective: This study aims to describe the surrounding anatomical structures that are at risk for inadvertent damage during extralevator abdominoperineal excision.

Complete skin examination is essential in the assessment of dermatology patients: findings from 483 patients.

Background: Dermatological teaching has traditionally stressed that complete skin examination is essential in the assessment of patients with potential skin disease.

Objectives: To determine whether complete skin examination results in increased diagnoses of skin malignancies that would not have been discovered otherwise.

Methods: New patients (n = 483) attending a dermatology clinic in a university teaching hospital and private dermatology practice had a complete skin examination, as is our normal practice.

Influence of androgen deprivation therapy on all-cause mortality in men with high-risk prostate cancer and a history of congestive heart failure or myocardial infarction.

Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease.

Methods And Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort.

Outcomes following a limited approach to radiotherapy in rectal cancer.

Background: Variation in the use of neoadjuvant and adjuvant radiotherapy for rectal cancer suggests an opportunity to avoid it in all but patients at highest risk of local recurrence.

Methods: Between 1 July 1999 and 1 February 2006, patients with primary rectal cancer were treated by a single surgeon operating at McMaster University, Hamilton, Ontario, Canada. Digital rectal examination and pelvic computed tomography were used to determine whether the mesorectal margin was threatened by tumour and thus whether preoperative radiotherapy would be needed.

A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era.

Purpose: It is a widely held view that anterior resection (AR) for rectal cancer is an oncologically superior operation to abdominoperineal excision (APE). However, some centres have demonstrated better outcomes with APE. We conducted a systematic review of high-quality studies within the total mesorectal excision (TME) era comparing outcomes of AR and APE.

MRI predictive factors for long-term outcomes of low rectal tumours.

Background: Low rectal cancers have poor outcomes. It has been suggested that low tumours are biologically more aggressive and tend to be more locally advanced at presentation. Pre-operative identification of prognostic factors will enable use of selective neoadjuvant therapies and possibly increase sphincter-sparing rates where oncologically safe.

Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low or intermediate risk disease.

Purpose: Radical prostatectomy and brachytherapy are widely used treatments for favorable risk prostate cancer. We estimated the risk of prostate cancer specific mortality following radical prostatectomy or brachytherapy in men with low or intermediate risk prostate cancer using prospectively collected data.

Materials And Methods: The study cohort comprised 5,760 men with low risk prostate cancer (prostate specific antigen 10 ng/ml or less, clinical category T1c or 2a and Gleason score 6 or less), and 3,079 with intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, clinical category T2b or T2c, or Gleason score 7).

A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*.

Background: Currently, no tumor-node-metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters.

Methods: Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry.

A new standard of care for the management of peritoneal surface malignancy.

Cancer dissemination to peritoneal surfaces was, in the past, a lethal condition with a limited survival. Clinical and pharmacologic research have shown that options for both treatment and prevention are now reality. The diseases most commonly treated include peritoneal dissemination from appendiceal malignancy, colorectal malignancy, and peritoneal mesothelioma.

American College of Radiology Appropriateness Criteria permanent source brachytherapy for prostate cancer.

Purpose: Permanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy.

Methods: Panel members with expertise on prostate cancer were assembled and provided several clinical scenarios for consensus treatment and management guidelines.

One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer.

Background: A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM).

Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study.

Objective: To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone.

Background: The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy.

[Optimising surgery for rectal cancer].

The crucial aspect of open as well as laparoscopic rectal cancer surgery is to find the correct dissection plane to avoid damage of the nerves and to create a perfect specimen. By doing so, a "specimen oriented" resection will be achieved and the risk of a positive circumferential resection margin minimized. Currently, and for the foreseeable future, open surgery remains optimal for complex cases and in cases where a low difficult restorative resection is needed.

Predictors of the use of supplemental androgen suppression therapy and external beam radiation in men with high-risk prostate cancer undergoing brachytherapy in community practice.

Purpose: We assessed clinical- and practice-related variables associated with the use of trimodality treatment (androgen suppression therapy, external beam radiation therapy, and brachytherapy) in a community-based cohort of men with high-risk prostate cancer.

Methods And Materials: The study cohort was composed of 1342 men with a prostate-specific antigen level >20ng/mL, clinical tumor stage T3 or T4, and/or Gleason score 8-10 disease at two community radiation facilities, Chicago Prostate Cancer Center (Chicago PCC) and 21st Century Oncology (21C). Logistic regression multivariable analysis was performed to identify factors associated with trimodality treatment.

Postgraduate multidisciplinary development program: impact on the interpretation of pelvic MRI in patients with rectal cancer: a clinical audit in West Denmark.

Background: Pelvic MRI in patients with rectal cancer is an accepted tool for the identification of patients with poor prognostic tumors who may benefit from neoadjuvant therapy. In Denmark, this examination has been mandatory in the workup on rectal cancer since 2002.

Objective: This study aimed to assess the impact of a multidisciplinary team course for doctors in West Denmark on the technical quality, reporting, and interpretation of pelvic MRI in rectal cancer.

Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin.

Background: Pseudomyxoma peritonei syndrome is a clinical entity characterized by mucinous ascites usually originating from a perforated mucinous appendiceal tumor. Currently optimal therapy is considered complete macroscopic tumor removal (complete cytoreduction) combined with heated intraperitoneal chemotherapy. When complete cytoreduction is not achievable, major tumor debulking is undertaken.

ACR appropriateness criteria postradical prostatectomy irradiation in prostate cancer.

The role of postradical prostatectomy radiation therapy continues to evolve under the influence of new clinical data. In particular, 2 recently published or updated randomized trials have prompted a reevaluation of its utility in the adjuvant and salvage setting. The Southwest Oncology Group 8794 trial randomized 473 patients with stage T3a-T3b disease to adjuvant radiotherapy versus observation.

On or in the liver? Two cases with diffuse pseudomyxoma peritonei and synchronous hepatic pathology.

Pseudomyxoma peritonei (PMP) is a borderline malignancy, simulating carcinomatosis and generally arising from perforation of an appendiceal mucinous tumour. Some patients have coincidental dual pathology. Liver abnormalities in particular may be overlooked and/or misclassified.

Pseudomyxoma peritonei.

Pseudomyxoma peritonei (PMP) is an uncommon "borderline malignancy" generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Controversy persists regarding the pathological classification and its prognostic value.