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A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (15 July 2022) | Viewed by 26304

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Special Issue Editors

Prof. Dr. Torben Frøstrup Hansen

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Head of Oncological Research Unit, Department of Oncology, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
Interests: translational and clinical cancer research; angiogenesis; circulating tumor DNA; immunotherapy
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Lars Henrik Jensen

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Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
Interests: colorectal cancer; clinical and translational research; mismatch repair genes; ctDNA; radiotherapy; immunotherapy

Special Issue Information

Dear Colleagues,

Colorectal cancer is one of the most common solid malignancies in the world, and the mortality rate is high. The prognosis of the patients, however, has improved over the last decade due to enhanced diagnostics, surgery, oncology treatment, and not least the overall multidisciplinary approach that characterizes the handling of these patients at most cancer centers.

Danish Colorectal Cancer Center South is a dedicated research group with more than 20 years of experience. Five years ago, our center obtained status as a Center of Clinical Excellence based on an international review and recommendation. A close multidisciplinary approach to all research aspects and treatment recommendations defines our strategy. We have a long tradition of patient-oriented care, and the concept of shared decision making is an integrated part.

The aim of this Special Issue is to summarize five years of colorectal cancer research, presenting a model for improved patient care by means of original research and reviews.

Prof. Dr. Torben Hansen
Prof. Dr. Lars Henrik Jensen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

ctDNA
minimal residual disease (MRD)
shared decision making
angiogenesis
radiotherapy
imaging
clinical pathology
surgery
genetics
immunology
clinical trials

Published Papers (13 papers)

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12 pages, 730 KiB

Open AccessArticle

NPY Gene Methylation in Circulating Tumor DNA as an Early Biomarker for Treatment Effect in Metastatic Colorectal Cancer

by Louise Raunkilde, Torben Frøstrup Hansen, Rikke Fredslund Andersen, Birgitte Mayland Havelund, Caroline Brenner Thomsen and Lars Henrik Jensen

Cancers 2022, 14(18), 4459; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14184459 - 14 Sep 2022

Cited by 5 | Viewed by 1440

Abstract

Despite several limitations, the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) are still the gold standard in response evaluation of metastatic colorectal cancer (mCRC). The aim of the present study was to investigate hypermethylated neuropeptide Y circulating tumor DNA (meth-NPY) as an early biomarker for treatment effect and monitoring in 70 mCRC patients receiving first-line treatment in the FOLFOXIRI-Toco trial. Meth-NPY was analyzed using droplet digital PCR, and the response rate was defined as the fraction of patients converting from a baseline detectable level to an undetectable level after the first treatment cycle (responders). A significant increase in meth-NPY was defined as a value with no overlap between the 95% CI of the current and preceding measurement. Progression-free survival (PFS) was significantly longer in meth-NPY responders compared to non-responders, 10.1 and 7.6 months, respectively (p = 0.02, HR = 0.43). Patients with response according to RECIST 1.1 had a PFS of 10.1 compared to 7.3 months for non-responders (p = 0.17, HR = 0.65). A significant increase in meth-NPY was found with a median of 49 days before radiological progression. In conclusion, early meth-NPY response proved superior to response according to RECIST 1.1 with respect to predicting improved PFS. Meth-NPY is an early indicator of progression, allowing treatment reorientation at an earlier timepoint. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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13 pages, 490 KiB

Open AccessArticle

The Impact of Surgical Techniques in Patients with Rectal Cancer on Spine Mobility and Abdominal Muscle Strength—A Prospective Study

by Iwona Głowacka-Mrotek, Michał Jankowski, Bartosz Skonieczny, Magdalena Tarkowska, Tomasz Nowikiewicz, Łukasz Leksowski, Mariusz Dubiel, Wojciech Zegarski and Magdalena Mackiewicz-Milewska

Cancers 2022, 14(17), 4148; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14174148 - 27 Aug 2022

Viewed by 1108

Abstract

The aim of this non-randomized study was to evaluate the impact of spine joint mobility and chest mobility on inhalation and exhalation, and to assess the abdominal muscle strength in patients undergoing surgery for colorectal cancer with one of the following methods: anterior resection, laparoscopic anterior resection or abdominoperineal resection. In patients who were successively admitted to the Department of Surgical Oncology at the Oncology Center in Bydgoszcz, the impact of spine joint mobility, muscle strength and chest mobility on inhalation and exhalation wasassessed three times, i.e., at their admission and three and six months after surgery. The analysis included 72 patients (18 undergoing abdominoperineal resection, the APR group; 23 undergoing laparoscopic anterior resection, the LAR group; and 31 undergoing anterior resection, the AR group). The study groups did not differ in terms of age, weight, height, BMIor hospitalization time (p > 0.05). Three months after surgery, reductions in spine joint mobility regarding flexion, extension and lateral flexion, as well asreductions in the strength of the rectus abdominis and oblique muscles, were noted in all study groups (p < 0.05). In comparison between the groups, the lowest values suggesting the greatest reduction in the range of mobility were recorded in the APR group. Surgical treatment and postoperative management in colorectal cancer patients caused a reduction in spine mobility, abdominal muscle strength and chest mobility. The patients who experienced those changes most rapidly and intensively werethose undergoing abdominoperineal resection. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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7 pages, 815 KiB

Open AccessArticle

Interobserver Reliability and the Sigmoid Takeoff—An Interobserver Study

by Malene Roland Vils Pedersen, Peter Obel Otto, Chris Vagn-Hansen, Torben Sørensen and Søren Rafael Rafaelsen

Cancers 2022, 14(11), 2802; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14112802 - 04 Jun 2022

Cited by 1 | Viewed by 1763

Abstract

Background: Colorectal cancer is the second most common cancer worldwide. The sigmoid takeoff is the landmark where the colon sigmoid curves toward the sacrum viewed from sagittal magnetic resonance imaging (MRI). The purpose of this study was to assess interobserver variability in the assessment of the anal verge and anorectal junction in patients diagnosed with rectal cancer on magnetic resonance imaging (MRI). Materials and Methods: The rectal MRI examinations were performed using a 1.5- or 3.0-tesla unit using an anterior coil and a standard scan protocol. Two senior radiologists assessed MRI scans from patients under investigation for rectal cancer. The two observers assessed the anal verge and takeoff in cm independently. Difference in agreement between the observers were evaluated using intraclass correlation (ICC) and graphically by Bland–Altman plots. Results: The study population (n = 122) included 68 (55.7%) female and 54 (44.3%) male subjects. The overall median age was 69.5 years (range 39–95 years). There was perfect agreement between the two observers when defining rectal tumor above or below the takeoff landmark. The reliability of measuring the distance from the anal verge to the sigmoid takeoff was 0.712. Conclusion: Overall, the study found a moderate reliability in assessing the location of the sigmoid takeoff, with a low difference in the distance measuring, as well as a good consensus concerning the determination of tumors in relation to the sigmoid takeoff. Routine implementation of this information within the report seems reasonable. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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8 pages, 983 KiB

Open AccessArticle

Intra- and Interobserver Variability of Shear Wave Elastography in Rectal Cancer

by Martina Kastrup Loft, Malene Roland Vils Pedersen, Peter Grimm, Andreas Hoffmann Lauritzen, Claus Dam and Søren Rafael Rafaelsen

Cancers 2022, 14(11), 2633; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14112633 - 26 May 2022

Cited by 1 | Viewed by 1360

Abstract

Background: Endorectal ultrasound (ERUS) is an important tool when evaluating complex rectal adenomas and rectal cancer, and the accuracy is improved by adding elastography measurements. A high interobserver agreement is imperative in clinical practice. Therefore, the aim of this study was to evaluate interobserver agreement assessed on real-time images. Additionally, we investigated the intra- and interobserver agreement between experienced and inexperienced observers. Materials and methods: We prospectively included patients referred to an ERUS at the Department of Radiology with a complex rectal polyp or suspected rectal malignancy. Two operators independently scanned each patient in turn. Furthermore, four observers assessed previously obtained images using three different methods for placing the region of interest (ROI). Three months later, the four observers reassessed the images to assess intraobserver variability. Results: A total of 19 patients were included for live assessment. Agreement of tumor classification was substantial for T stage (kappa: 0.86) and fair for N stage (kappa: 0.73), with an absolute agreement for T and N stages of 84% and 89%, respectively. Agreement of SWE was good for Emean (ICC 0.94, 95% CI 0.86–0.98) and fair for Emax (ICC 0.85, 95% CI 0.66–0.94). Intra- and interobserver agreement between inexperienced and experienced observers showed good to excellent agreement with all ROI methods. Conclusion: Interobserver agreement is high in SWE when performed in a clinical setting. We found the best agreement using the mean value of several ROIs. Intra- and interobserver agreement was high regardless of operator experience. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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17 pages, 1347 KiB

Open AccessArticle

Impact of Open Dialogue about Complementary Alternative Medicine—A Phase II Randomized Controlled Trial

by Mette Stie, Charlotte Delmar, Birgitte Nørgaard and Lars Henrik Jensen

Cancers 2022, 14(4), 952; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14040952 - 14 Feb 2022

Cited by 4 | Viewed by 1746

Abstract

Complementary alternative medicine (CAM) may reduce the symptom burden of side effects to antineoplastic treatment but also cause new side effects and non-adherence to conventional treatment. The aim of this RCT was to investigate the impact of open dialogue about complementary alternative medicine (OD-CAM) on cancer patients’ safety, health and quality of life (QoL). Patients undergoing antineoplastic treatment were randomly assigned to standard care (SC) plus OD-CAM or SC alone. The primary endpoint was frequency of grade 3–4 adverse events (AE) eight weeks after enrollment. Secondary endpoints were frequency of grade 1–4 AE, QoL, psychological distress, perceived information, attitude towards and use of CAM 12 and 24 weeks after enrollment. Survival was analyzed post hoc. Fifty-seven patients were randomized to the OD-CAM group and fifty-five to the SC group. No significant difference in frequency of grade 3–4 AEs was shown. The same applied to grade 1–4 AEs and QoL, psychological distress and perceived information. A tendency towards better QoL, improved survival and a lower level of anxiety was found in the OD-CAM group. OD-CAM is not superior to SC in reducing the frequency of AEs in patients undergoing antineoplastic treatment. OD-CAM does not compromise patient safety; it may reduce psychological stress and improve QoL and overall survival. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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10 pages, 1521 KiB

Open AccessArticle

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

by Peter Grimm, Martina Kastrup Loft, Claus Dam, Malene Roland Vils Pedersen, Signe Timm and Søren Rafael Rafaelsen

Cancers 2021, 13(20), 5120; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205120 - 13 Oct 2021

Cited by 8 | Viewed by 1725

Abstract

Colorectal cancer is the second most common cancer in Europe, and accurate lymph node staging in rectal cancer patients is essential for the selection of their treatment. MRI lymph node staging is complex, and few studies have been published regarding its reproducibility. This study assesses the inter- and intraobserver variability in lymph node size, apparent diffusion coefficient (ADC) measurements, and morphological characterization among inexperienced and experienced radiologists. Four radiologists with different levels of experience in MRI rectal cancer staging analyzed 36 MRI scans of 36 patients with rectal adenocarcinoma. Inter- and intraobserver variation was calculated using interclass correlation coefficients and Cohens-kappa statistics, respectively. Inter- and intraobserver agreement for the length and width measurements was good to excellent, and for that of ADC it was fair to good. Interobserver agreement for the assessment of irregular border was moderate, heterogeneous signal was fair, round shape was fair to moderate, and extramesorectal lymph node location was moderate to almost perfect. Intraobserver agreement for the assessment of irregular border was fair to substantial, heterogeneous signal was fair to moderate, round shape was fair to moderate, and extramesorectal lymph node location was substantial to almost perfect. Our data indicate that subjective variables such as morphological characteristics are less reproducible than numerical variables, regardless of the level of experience of the observers. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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11 pages, 1056 KiB

Open AccessArticle

The Soluble Urokinase-Type Plasminogen Activator Receptor as a Biomarker for Survival and Early Treatment Effect in Metastatic Colorectal Cancer

by Kristian Blomberg, Torben F. Hansen, Claus L. Brasen, Jeppe B. Madsen, Lars H. Jensen and Caroline B. Thomsen

Cancers 2021, 13(20), 5100; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205100 - 12 Oct 2021

Cited by 4 | Viewed by 1409

Abstract

The soluble urokinase-type plasminogen activator receptor (suPAR) is prognostic for overall survival (OS) in colorectal cancer (CRC). Our study explored the association between baseline suPAR and OS and progression-free survival (PFS) in metastatic CRC (mCRC). It is also the first study to explore the association between the initial change in suPAR level and OS, PFS and the first CT response evaluation. The study included 132 patients with mCRC treated with chemotherapy (FOLFIRI) with or without an EGFR-inhibitor. Blood samples were drawn before the first treatment cycle and in between the first and second treatment cycle. suPAR levels were determined using an ELISA assay. Using the Kaplan-Meyer method, we demonstrated a significantly shorter OS for patients with suPAR levels above the median (HR = 1.79, 95%CI = 1.10–2.92, p = 0.01). We also showed association between plasma suPAR level, gender and performance status (PS). However, we could not show any association with PFS, and analysis on the change in suPAR level provided no significant results. The results showing association between baseline suPAR and OS are in line with previous findings. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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12 pages, 414 KiB

Open AccessArticle

The Prevalence of Pathogenic or Likely Pathogenic Germline Variants in a Nationwide Cohort of Young Colorectal Cancer Patients Using a Panel of 18 Genes Associated with Colorectal Cancer

by Erik Frostberg, Annabeth Høgh Petersen, Anders Bojesen, Hans Bjarke Rahr, Jan Lindebjerg and Karina Rønlund

Cancers 2021, 13(20), 5094; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205094 - 12 Oct 2021

Cited by 4 | Viewed by 1713

Abstract

Introduction: The prevalence of pathogenic or likely pathogenic germline variants (PGV) in colorectal cancer (CRC) in young patients is seen in approximately one in five patients, with the majority of cases having gene variants associated with Lynch syndrome (LS). The primary aim was to describe the prevalence of 18 genes, all associated with hereditary polyposis and CRC, in a nationwide population of young CRC (yCRC) patients, and outline disease characteristics in patients with or without germline variants. Methods: We screened 98 patients aged 18–40 with CRC diagnosed in 2010–2013 for variants in MSH2, MSH6, MLH1, PMS2, EPCAM, APC, MUTYH, SMAD4, BMPR1A, STK11, PTEN, POLE, POLD1, NTHL1, AXIN2, MSH3, GREM1 and RNF43 using Next Generation Sequencing. Comparisons between patients’ characteristics in patients with PGV, and patients without germline variants (NPGV) were analyzed. Results: PGV were detected in twenty-four patients (24.5%), and twenty-one patients (21.1%) had variants in the mismatch repair (MMR) genes associated with LS. Variants in the APC and MUTYH genes were detected in 1% and 4%, respectively. Patients with NPGV had more advanced disease with adverse histopathological features. Conclusion: PGV was detected in one in four yCRC patients, and one in five yCRC patients had disease causing variants in the mismatch repair genes associated with LS. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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10 pages, 808 KiB

Open AccessArticle

Glycemic Control for Colorectal Cancer Survivors Compared to Those without Cancer in the Dutch Primary Care for Type 2 Diabetes: A Prospective Cohort Study

by Jing de Haan-Du, Gijs W. D. Landman, Nanne Kleefstra, Dennis Schrijnders, Marjolijn Manders, Amanda C. R. K. Bos, Cathrien Tromp-van Driel, Petra Denig, Klaas H. Groenier and Geertruida H. de Bock

Cancers 2021, 13(11), 2767; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13112767 - 02 Jun 2021

Cited by 3 | Viewed by 2311

Abstract

Cancer survivors with diabetes tend to have worse glycemic control after their cancer diagnosis, which may increase the risk of cardiovascular diseases. We aimed to investigate whether glycemic control differs between colorectal cancer (CRC) survivors and those without cancer, among patients with type 2 diabetes being treated in the Dutch primary care. The Zwolle Outpatient Diabetes project Integrating Available Care database was linked with the Dutch Cancer Registry (n = 71,648, 1998–2014). The cases were those with stage 0–III CRC, and the controls were those without cancer history. The primary and secondary outcomes were the probability of reaching the glycated hemoglobin (HbA1c) target and the mean of HbA1c during follow-up, respectively. Mixed linear modeling was applied, where the status of CRC was a time-varying variable. Among the 57,330 patients included, 705 developed CRC during follow-up. The mean probability of reaching the HbA1c target during follow-up was 73% versus 74% (p = 0.157) for CRC survivors versus those without cancer, respectively. The mean HbA1c was 51.1 versus 50.8 mmol/mol (p = 0.045) among CRC survivors versus those without cancer, respectively. We observed a clinically comparable glycemic control among the CRC survivors without cancer, indicating that glycemic control for CRC survivors can be delegated to primary care professionals. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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18 pages, 2162 KiB

Open AccessArticle

Circulating let-7e-5p, miR-106a-5p, miR-28-3p, and miR-542-5p as a Promising microRNA Signature for the Detection of Colorectal Cancer

by Camila Meirelles S. Silva, Mateus C. Barros-Filho, Deysi Viviana T. Wong, Julia Bette H. Mello, Livia Maria S. Nobre, Carlos Wagner S. Wanderley, Larisse T. Lucetti, Heitor A. Muniz, Igor Kenned D. Paiva, Hellen Kuasne, Daniel Paula P. Ferreira, Maria Perpétuo S. S. Cunha, Carlos G. Hirth, Paulo Goberlânio B. Silva, Rosane O. Sant’Ana, Marcellus Henrique L. P. Souza, Josiane S. Quetz, Silvia R. Rogatto and Roberto César P. Lima-Junior

Cancers 2021, 13(7), 1493; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13071493 - 24 Mar 2021

Cited by 29 | Viewed by 3544

Abstract

Colorectal cancer (CRC) is a disease with high incidence and mortality. Colonoscopy is a gold standard among tests used for CRC traceability. However, serious complications, such as colon perforation, may occur. Non-invasive diagnostic procedures are an unmet need. We aimed to identify a plasma microRNA (miRNA) signature for CRC detection. Plasma samples were obtained from subjects (n = 109) at different stages of colorectal carcinogenesis. The patients were stratified into a non-cancer (27 healthy volunteers, 17 patients with hyperplastic polyps, 24 with adenomas), and a cancer group (20 CRC and 21 metastatic CRC). miRNAs (381) were screened by TaqMan Low-Density Array. A classifier based on four differentially expressed miRNAs (miR-28-3p, let-7e-5p, miR-106a-5p, and miR-542-5p) was able to discriminate cancer versus non-cancer cases. The overexpression of these miRNAs was confirmed by RT-qPCR, and a cross-study validation step was implemented using eight data series retrieved from Gene Expression Omnibus (GEO). In addition, another external data validation using CRC surgical specimens from The Cancer Genome Atlas (TCGA) was carried out. The predictive model’s performance in the validation set was 76.5% accuracy, 59.4% sensitivity, and 86.8% specificity (area under the curve, AUC = 0.716). The employment of our model in the independent publicly available datasets confirmed a good discrimination performance in five of eight datasets (median AUC = 0.823). Applying this algorithm to the TCGA cohort, we found 99.5% accuracy, 99.7% sensitivity, and 90.9% specificity (AUC = 0.998) when the model was applied to solid colorectal tissues. Overall, we suggest a novel signature of four circulating miRNAs, i.e., miR-28-3p, let-7e-5p, miR-106a-5p, and miR-542-5p, as a predictive tool for the detection of CRC. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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13 pages, 583 KiB

Open AccessReview

The Prognostic Importance of ctDNA in Rectal Cancer: A Critical Reappraisal

by Edina Dizdarevic, Torben Frøstrup Hansen and Anders Jakobsen

Cancers 2022, 14(9), 2252; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14092252 - 30 Apr 2022

Cited by 8 | Viewed by 2044

Abstract

The treatment of locally advanced rectal cancer (LARC) has evolved during the last decades, but recurrence remains a problem. Circulating tumor DNA (ctDNA) may result in an individualized treatment approach with improved survival and quality of life, but diverging results impede further development. In this systematic review, we addressed the quality of reporting and its impact on the interpretation of ctDNA results. We performed a systematic literature search using subject headings and search terms related to ctDNA and rectal cancer. The Quality of Prognostic Studies (QUIPS) tool was used to assess bias. Nine studies, with substantial heterogeneity, were included in the analysis. Three out of nine articles had moderate or high risk of bias. No association was found between treatment response and ctDNA status at baseline. There was a negative association between ctDNA positivity at baseline, before and after surgery and survival. The ctDNA status may be of importance to the long-term prognosis, but the area of research is new and is short of dedicated studies. There is an obvious need for standardization in ctDNA research, and the issue should be addressed in future research. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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19 pages, 490 KiB

Open AccessReview

Angiogenesis Inhibitors for Colorectal Cancer. A Review of the Clinical Data

by Torben Frøstrup Hansen, Camilla Qvortrup and Per Pfeiffer

Cancers 2021, 13(5), 1031; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13051031 - 01 Mar 2021

Cited by 23 | Viewed by 2698

Abstract

Since the late 1990s, therapy for metastatic colorectal cancer (mCRC) has changed considerably, and the combination of doublet or triplet chemotherapy and a targeted agent are now routinely used. The targeting of angiogenesis, the development of new blood vessels, represents a key element in the overall treatment strategy. Since the approval in 2004 of the first anti-angiogenetic drug, multiple agents have been approved and others are currently under investigation. We present an overview of the recent literature on approved systemic treatment of mCRC, with a focus on anti-angiogenic drugs, and current treatment approaches, and elaborate on the future role of angiogenesis in colorectal cancer as seen from a clinical perspective. The treatment of mCRC, in general, has changed from “one strategy fits all” to a more personalized approach. This is, however, not entirely the case for anti-angiogenetic treatments, partly due to a lack of validated biomarkers. The anti-angiogenetic standard treatment at the present primarily includes monoclonal antibodies. The therapeutic field of angiogenesis, however, has received increased interest after the introduction of newer combinations. These approaches will likely change the current treatment strategy, once again, to the overall benefit of patients. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

Other

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12 pages, 3551 KiB

Open AccessSystematic Review

Can Ultrasound Elastography Discriminate between Rectal Adenoma and Cancer? A Systematic Review

by Martina Kastrup Loft, Malene Roland Vils Pedersen, Hans Bjarke Rahr and Søren Rafael Rafaelsen

Cancers 2021, 13(16), 4158; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13164158 - 18 Aug 2021

Cited by 7 | Viewed by 2259

Abstract

Background: Rectal cancer is a common malignancy. Since the introduction of bowel-screening programs, the number of patients with advanced adenomas and early rectal cancer has increased. Despite improved diagnostics, the discrimination between rectal adenomas and early rectal cancer (i.e., pT1–T2) remains challenging. The purpose of this systematic review was to evaluate the diagnostic performance of endorectal ultrasound (ERUS) elastography in discriminating rectal adenomas from cancer. Method: Using PRISMA guidelines, a systematic search was performed on PubMed, Embase, and MEDLINE databases. Studies evaluating the primary staging of rectal adenomas and cancer using ERUS elastography were included. Results: Six studies were identified; three evaluated the discrimination between adenomas and cancer; two evaluated adenomas and early rectal cancer (i.e., pT1–T2); one evaluated performance on different T categories. All studies reported increased diagnostic accuracy of ERUS elastography compared to ERUS. Sensitivity, specificity and accuracy ranged 0.93–1.00, 0.83–1.00 and 0.91–1.00, respectively, when discriminating adenomas from cancer. In the differentiation between adenomas and early rectal cancer, the sensitivity, specificity and accuracy were 0.82–1.00, 0.86–1.00 and 0.84–1.00, respectively. Conclusion: Elastography increases the accuracy of ERUS and may provide valuable information on malignant transformation of rectal lesions. Full article

(This article belongs to the Special Issue A Model for Improved Care of Patients with Colorectal Cancer – Experience from a Center of Clinical Excellence)

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