Clinical Trial Launched To Test New Treatment Technique For Bowel Cancer

Cancer Research UK this week launches a new trial for patients with bowel cancer that has spread to the liver to see whether a new radiotherapy treatment technique is more effective than standard chemotherapy.


Researchers at trial centres across the UK and coordinated at Oxford University will test a new treatment called Radio-embolisation, a form of internal radiotherapy that uses the tumour's blood supply to target multiple sites of disease within the liver. They will combine this new treatment with standard chemotherapy in patients recently diagnosed with bowel cancer that has spread to the liver.


The first patient will start the treatment this week at the Royal Surrey County Hospital in Guildford.


Despite major advances in treating advanced bowel cancer, the number of patients who survive beyond five years remains disappointingly low - less than 10 per cent.


The trial - called FOXFIRE and funded by Cancer Research UK and by Sirtex Medical Ltd.- aims to recruit almost 500 patients in the UK with advanced bowel cancer. The results are being combined with an international study called SIRFLOX, meaning that over 800 patients will be studied worldwide.


The patients will be divided into two groups at random. One group will receive chemotherapy plus Radio-embolisation and the other will receive chemotherapy alone.


Dr Ricky Sharma, the chief investigator from the Cancer Research UK and Medical Research Council Gray Institute for Radiation Oncology and Biology at the University of Oxford, said: "Although we now have several new ways of treating bowel cancer which has spread to the liver, we are keen to develop other novel techniques to improve treatment.


"What is exciting about this new technique is that we know that radiotherapy works well in treating bowel cancer and this new way of administering high-dose radiation therapy directly into the blood supply of the cancer appears to be effective when we combine it with chemotherapy.


"We are hoping that this national trial will tell us whether this new form of radiotherapy, when combined with standard chemotherapy, improves the outcome for individual patients."















More than 37,500 cases of bowel cancer are diagnosed each year making it the third most common cancer in the UK.


Kate Law, Cancer Research UK's director of clinical trials, said: "Without clinical trials like FOXFIRE, we wouldn't be able to improve techniques for cancers that are hard to treat. It's a promising trial and we look forward to following its progress and seeing the results."


Reference


- The FOXFIRE trial on Current Controlled Trials



Notes


1. Trial centres are located across the UK and are now recruiting patients - for more information visit the The Oncology Clinical Trials Office website.


2. Radio-embolisation (also known as Selective Internal Radiation Therapy, or SIRT) takes advantage of the leaky and immature blood vessels in cancers to deliver a high dose of radiotherapy to primary liver cancer or other cancers that have spread to the liver. The radioactive particles (called SIR-spheres microspheres) are tiny polymer beads that are delivered directly into and around each tumour via a catheter tube inserted into the patient's groin and then passed up, under X-ray guidance, into the blood supply of the liver.


The radiotherapy delivered is a very high dose which travels only about 2-3 mm within liver tissues. No other types of radiation are emitted by the microspheres, so there is minimal risk to other organs of the patient's body. Since radiotherapy works very differently from chemotherapy, this treatment often works even when cancers have become resistant to chemotherapy.


The FOXFIRE clinical trial aims to see if giving chemotherapy and radio-embolisation together when cancer is first detected in the liver is better than the current standard therapy, i.e. using chemotherapy alone.


3. Supported by the Bobby Moore Fund for Cancer Research UK.


4. More information about bowel cancer on our patient information website, CancerHelp UK

Source
Cancer Research UK

A Promising Endoscopic Technique For Rectal Carcinoids

Conventional snare polypectomy or endoscopic mucosal resection often presents an unsatisfactory result in complete resection of rectal carcinoids. It was perfomed EMR-L with 3D-EUS for rectal carcinoids and compared between EMR-L with 3D-EUS and EMR-L alone. The rate of complete resection and the vertical resection margin has been reported.



A research article was published in the World Journal of Gastroenterology. This reseach team was led by Prof. Maetani from Division of Gastroenterology, Toho University Ohashi medical center. Conventional snare polypectomy or endoscopic mucosal resection often presents an unsatisfactory result in complete resection of rectal carcinoids. Various endoscopic treatments were demonstrated.reported. Authors perfomed EMR-L with 3D-EUS for rectal carcinoids and compared between EMR-L with 3D-EUS and EMR-L alone.



The rate of complete resection for EMR-L with 3D-EUS and EMR-L alone was 100% and 71%. The vertical resection margin of EMR-L with 3D-EUS was longer than that of EMR-L alone.



EMR-L is effective as an endoscopic treatment for rectal carcinoids. In combination with 3D-EUS, a safe and complete resection is further assured.



Successful outcomes of EMR-L with 3D-EUS in this study demonstrate a new view of good endoscopic technique for rectal carcinoids.







Reference: Abe T, Kakemura T, Fujinuma S, Maetani I. Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids in comparison with our historical controls. World J Gastroenterol 2008;14(25): 4054-4058wjgnet/1007-9327/14/4054.asp



Correspondence to: Tsuyoshi Abe, MD, Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi Meguro-ku, Tokyo 153-8515, Japan.



About World Journal of Gastroenterology



World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.



About The WJG Press



The WJG Press mainly publishes World Journal of Gastroenterology.



Source: Lai-Fu Li


World Journal of Gastroenterology

Noise Is Distressing For People With Colostomies

Results from a new survey show that those with colostomy pouches face a noise issue which can affect their quality of life.


A colostomy may be needed as a result of abdominal surgery for conditions such as Crohn's disease, colitis or more commonly cancer - and can even result from complications of childbirth. It means that instead of going to the loo 'normally' those affected have a `stoma' or opening created in their abdomen and use a pouch to collect bodily waste which is emptied and changed regularly.


Although many people responding to the survey report that they do not notice pouch noise, a large proportion - almost 70 per cent - state they are conscious of the noise their pouch makes including almost 16 per cent who said they notice it 'a lot.'


As many as 40 per cent are embarrassed by the noise of their pouch and 15 per cent avoid going out in public in case people hear the noise. Almost half said 'life would be easier' if the pouch was quieter.


A fifth say pouch noise affects their sex life and 18 per cent say it affects their relationships. More than 80 per cent of responders were either married or in a relationship. Three-quarters were aged 70 or under, including 18 per cent under 50.


Despite this, three-quarters of responders who are embarrassed by their pouch noise have not mentioned this problem to their specialist nurse. Other issues include mood with a third saying that pouch noise affects how they feel and 26 per cent report that it impacts on their social life.


The taboo does appear to be reducing, as the survey shows 64 per cent are happy to discuss their situation with friends and 43 per cent with colleagues.


But almost a fifth are still not comfortable discussing it with a partner. More than half of partners say they, too, notice the noise; 14 per cent are embarrassed by it in public and say it restricts what they do. Almost a third say life would be easier for them without the noise.


The survey, sponsored by the healthcare company Hollister, assessed quality of life factors such as social life, relationships, holidays and work and was completed by 76 users of pouches and their partners, via the Colostomy Association's website and by face-to-face interviews. Overall, responders had been living with a pouch from between six months to 30 years with the majority needing a colostomy as a result of cancer.


The charity believes there are 110,000 people in the UK who have a stoma and use bags to collect bodily waste as a result of cancer or other conditions and more than 6,400 permanent colostomy operations are performed each year.


In the survey, the responders describe the noise as a 'ruffling' commenting that it made them feel uncomfortable in close proximity with others - even leading to relationship breakdowns and issues at work in some cases.


It is not just older people who need a colostomy. Yvonne Cole, 21, from Somerset, has been using a colostomy bag for over a year as a result of Crohn's disease and ulcerative colitis. "Noise has been an issue for me in the past", explains Yvonne. "It always sounded as though I was wearing a carrier bag when I moved around and people would stop and stare at me. I was also very conscious of the bulkiness of the pouches as I am quite small. I am now using new noise reducing pouches which are much more discreet and have helped me a lot, and I am incredibly lucky that I have such a supportive family and fianc?©."


Explains Rebecca Davenport, a specialist stoma nurse, "Many of the patients I meet have faced life threatening conditions which have resulted in the need for a colostomy. So not only do they have to come to terms with a serious illness and the impact this has on their life and the lives of their partners and families, but many also have psychological issues associated with their colostomy pouch, one of which is noise. I think many people feel that noise will be viewed as insignificant in the scale of things and are reluctant to discuss it with their nurse, but there are solutions we can offer them. Pouch noise is an issue and people should not be afraid to ask for help."


Source:

Colostomy Association

Studies Find Screening Colonoscopies May Be Done More Frequently Than Recommended, And May Not Be Beneficial To Some Older Adults

Among Medicare beneficiaries, a large portion of colonoscopies for screening purposes are performed more frequently than recommended intervals. But among older patients treated at Veterans Affairs facilities, warranted follow-up colonoscopies for patients with positive fecal blood tests often do not occur, or cause burden when they do. These findings are from two reports posted online today that will appear in the August 8 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals.



Colonoscopy, a screening test used for the detection of colorectal cancer, may be overused as a screening tool, the authors suggest as part of the Less Is More series in the journal, with potential negative consequences including adverse effects without sufficient benefit, unnecessary expense, and use of limited medical resources. At first screening, most patients have no signs of cancer and clinical guidelines recommend that the next screening colonoscopy not take place for another ten years. "Identifying and decreasing overuse of screening colonoscopy should free up resources to increase appropriate colonoscopy in inadequately screened populations," write the authors.



James S. Goodwin, M.D., and colleagues from the University of Texas Medical Branch, Galveston, analyzed a national sample of 5 percent of persons enrolled in Medicare from 2000 through 2008. They identified patients at average risk for colon cancer who received an initial screening colonoscopy between 2001 and 2003. The researchers determined that 24,071 patients in the sample had a negative screening examination result and calculated the time before the procedure was repeated.



Of the group of 24,071, nearly one-fourth (23.5 percent) received a follow-up colonoscopy within seven years with no clear indication for the early repeated examination. Repeat screening rates were relatively high among older patients (45.6 percent in ages 75 to 79 years, and 32.9 percent in patients ages 80 years and older). Researchers also found that men, patients with more health conditions, those screened in high-volume colonoscopy settings, and those in certain geographic areas were more likely to be tested.



The authors recommend that closer attention be paid to colonoscopy screening rates so that this procedure is reserved for those who can really benefit from it. "Early repeated colonoscopies without clear indication compose a substantial proportion of the present endoscopist workload and also represents substantial Medicare expenditures," they state. "Given the increasing public interest in and ownership of cancer screening, public information campaigns that emphasize both the necessity for colorectal cancer screening as well as the dangers of overuse may prove beneficial in reducing overuse."
















In another article, Christine E. Kistler, M.D., M.A.Sc. from the University of North Carolina at Chapel Hill, and colleagues, found that some patients who should receive colonoscopies did not receive the procedure, and some who did experienced a burden from screening. The authors studied 212 patients receiving care through Veterans Affairs facilities, and who were age 70 or older and had a positive result on a fecal occult blood test (FOBT). The study participants were followed-up for seven years to determine what other interventions occurred and what the outcomes for patients were.



More than half of the patients (118 of 212, or 56 percent) received a follow-up colonoscopy, which found 34 significant adenomas and six cases of cancer. Among this group, ten percent developed complications from the procedure or from cancer therapy. Of those (94 of 212, or 44 percent) who did not have a follow-up colonoscopy, three died of colorectal cancer within a five-year period and 43 died from other causes. The authors also estimated the relative benefits and burdens of the procedure against patients' life expectancies.



The findings point to the need to better determine which patients are good candidates for FOBT in the first place. "As with all screening tests, FOBT does not benefit most patients because most do not have cancer or significant adenomas," write the authors. Still, the proportion of those who had cancer or significant adenomas detected by the test and successfully treated (15.6 percent) "suggests that a significant minority received net benefit from current practices." Noting that those with the best life expectancies were the most likely to benefit from the test, the authors conclude, "Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates."


Arch Intern Med.
2011;doi:10.1001/archinternmed/2011.212; doi:10.1001/archinternmed.2011.206.