Loading...

Follow Surg Onc Files on Feedspot

Continue with Google
Continue with Facebook
or

Valid

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2019/01/Absite-Part-2-2019.mp3

Welcome back to the SO Files! Here you’ll find the part two of our ABSITE-themed surgical oncology tour de force. On this 2nd part of our review we cover GI, HPB and GU cancers, as well as Melanoma. Our goal is to hit the high points on the major cancer topics throughout the body with the hopes of getting you an extra few points this weekend. Best wishes from the SurgOnc Files, good luck and happy studying!

Outline:

  • Gynecology (Vaginal, Ovarian, Endometrial, Cervical)
  • Stomach
  • Liver
  • HPB
  • Urology (Renal/Bladder/Prostate)
  • Adrenal
  • Small Intestine
  • Colorectal
  • Melanoma/Sarcoma

As much as possible, our goal was to stay high yield and not get too bogged down in the details. Please refer to the NCCN guidelines for any additional information or questions and good luck this weekend!

https://www.nccn.org/professionals/physician_gls/default.aspx

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2019/01/ABSITE_HeadtoDiaphragm.mp3

Welcome back to the SO Files! With the ABSITE right around the corner we thought we’d go for a marathon session and build up our stamina for test day – here we present a head to toe review of all things surgical oncology that you might be asked this weekend. Although initially intended to be released en bloc, I think you’ll understand why we broke this bad boy up. So sit back and enjoy a brief review (~ 30 minutes) of high yield surgical oncology – and be sure to come back for part 2!

Outline:

  • Neurosurgery
  • HEENT (including salivary gland and thyroid disease)
  • Thoracic/Cardiac (including esophageal and lung cancers)
  • Mediastinum
  • Breast

As much as possible, our goal was to stay high yield and not get too bogged down in the details. Please refer to the NCCN guidelines for any additional information or questions and good luck this weekend!

https://www.nccn.org/professionals/physician_gls/default.aspx

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/11/Mel_Faries_FINAL.mp3

Welcome back to the SO Files! On today’s show we focus on melanoma and welcome Dr. Mark Faries onto the podcast. We discuss his role in the MSLT-I and MSLT-II trials as well as how their results have influenced the most recent editions of the NCCN and AJCC clinical practice guidelines. Before jumping into our interview with Dr. Faries, we take some time to introduce the basic staging principles for melanoma and the highlights of the MSLT-I and MSLT-II trials.

Dr. Faries is the head of the division of surgical oncology and co-director of the melanoma program at the Angeles Clinic and Research Institute, as well as a Professor of Surgery and Surgical Director of Experimental Therapeutics at Cedars Sinai Medical Center. He is a member of the AJCC Melanoma Staging Committee and the American Society of Clinical Oncology / Society of Surgical Oncology Melanoma guidelines panel. He has also published numerous chapters and articles on melanoma research and therapy, and was the lead investigator on the recently published, and practice changing, MSLT-II trial.

0-12:00 – Brad and Alston give overview of melanoma workup and 8th edition AJCC staging. Brief intro to MSLTI and MSLTII.

12:00- Interview with Dr. Faries

Background:

AJCC 8th Edition (2018) Melanoma Staging

An updated, evidence based overview of melanoma staging.

NCCN Clinical Practice Guidelines (v3.2018)

Clinical practice guidelines for the treatment of melanoma from the national comprehensive cancer network, version 3.2018. 

Relevant Reading:

1. MSLT-I Trial;  MSLT-I Trial – 10 year followup

Sentinel-Node Biopsy or Nodal Observation in Melanoma; Morton et al. NEJM, Sept 2006

Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma; Morton et al. NEJM Feb 2014

Patients (n = 2001) with primary cutaneous melanoma were randomly assigned to either wide excision (WE) and postoperative observation of regional lymph nodes with lymphadenectomy if nodal relapse occurred [observation group], or to wide excision (WE) and sentinel-node biopsy (SLNBx) with immediate lymphadenectomy if nodal micrometastases were detected on biopsy [biopsy group]. No difference in 10-yr melanoma-specific survival seen in overall treatment group. But significantly improved disease-free survival rates were seen in biopsy group compared to observation group among patients with intermediate-thickness melanoma, defined as 1.2 to 3.5mm depth, 71% vs 64%, p=0.01; as well as thick melanoma, defined as > 3.5mm – 50% vs 40%, p=0.03. In addition, among patients with nodal mets and intermediate thickness melanoma, 10 year melanoma specific survival was 62.1% for those who got upfront SLN biopsy followed by dissection, versus 41.5% in the observation group (HR 0.56, p=0.006).

Takeaway – Biopsy-based staging of intermediate or thick primary melanomas provides important prognostic information. In addition SLN biopsy followed by lymphadenectomy appears to increase melanoma specific survival for patients who have involved lymph nodes and intermediate thickness disease.

2. MSLT-II Trial

Completion Dissection of Observation for Sentinel-Node Metastasis in Melanoma; Faries et al, NEJM, June 2017.

After MSLT-I, SLNBx was associated with increased melanoma-specific survival among patients with node-positive, intermediate-thickness melanomas (1.2 to 3.5mm). This trial set out to determine the value of completion lymph-node dissection at the time of surgery. Randomly assigned patients (n = 1934) with sentinel-node metastases to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Mean 3-yr melanoma-specific survival was similar between groups (86% in both) at a median follow-up of 43 months. However, rate of disease-free survival was higher in the dissection group (68% vs 63%, p=0.05)) which was primarily attributed to better regional nodal disease control at 3 years (92% vs 77%, p<0.001)

Takeaway – Immediate completion LN dissection increased the rate of regional disease control and provided prognostic information, but didn’t increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. 

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/03/DTC-Compiled-Final-.mp3

We were so lucky to catch up with Dr. Julie Ann Sosa, who is the new Chair of Surgery at UCSF starting April 1st, 2018, and also world renowned endocrine surgeon on the newly updated staging guidelines for differentiated thyroid cancer and some common controversies in management in the US. We also chat about mentorship and her advice to learners at all stages! Check it out!

Background Reading:

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Bryan R. Haugen, Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini, Gregory W. Randolph, Anna M. Sawka, Martin Schlumberger, Kathryn G. Schuff, Steven I. Sherman, Julie Ann Sosa, David L. Steward,
R. Michael Tuttle, and Leonard Wartofsky

American Thyroid Association guidelines for both differentiated thyroid cancer and thyroid nodules. Differentiated thyroid cancer= papillary thyroid cancer, follicular thyroid cancer or Hurthle cell cancer.

Differentiated and Anaplastic Thyroid Carcinoma: Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual

Nancy D. Perrier, James D. Brierley, and R. Michael Tuttle

Overview of the changes made from the 7th to 8th editions of the AJCC staging system for thyroid cancer. One major change is that cut point age for staging is now 55 years of age, rather than 45. 

NCCN Guidelines for Thyroid Carcinoma

Updated guidelines from the NCCN outlining the management strategy for patients diagnosed with thyroid cancer.

Papers we discussed:

Controversies in the Management of Low-Risk Differentiated Thyroid Cancer

Megan R. Haymart, Nazanene H. Esfandiari, Michael T. Stang, and Julia Ann Sosa

Great overview and discussion of the controversies in the management of low-risk differentiated thyroid cancer. Controversies discussed include: surgical management, radioactive iodine ablation therapy, thyroid hormone supplementation, and long-term surveillance.

An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid.

Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma S, Kuma K, Miyauchi A.

2003 article in Thyroid that demonstrated in a Japanese population with 10mm or less papillary thyroid micro carcinoma, active surveillance appears to be safe. In this observation trial patients with papillary micro carcinoma either elected to undergo thyroidectomy or active surveillance. Over 5 years of surveillance 27.5% of patients had an increased size of the lesion. 1.2% of patients developed lymph node disease. In total 35% of patients in the observation group went on to have surgery either due to progression or preference. No patients in the observation group had a thyroid cancer related death.

Extent of surgery affects survival for papillary thyroid cancer.

Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C.

Annals of Surgery article from 2007, that utilized NCDB data to demonstrate that total thyroidectomy leads to improved survival over thyroid lobectomy for patients 1cm+ papillary thyroid carcinoma.

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.

Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, Scheri R, Roman SA, Sosa JA.

Annals of Surgery article from 2014, that used NCDB data from 1998-2006 to look at outcomes after lobectomy or total thyroidectomy for papillary thyroid cancer 1cm+. The authors found equivalent survival for total thyroidectomy and thyroid lobectomy groups, unlike the Bilimoria study from 2007. Of note, the NCDB began more accurately tracking comorbidities in 2003, and it is likely that the addition of this data allowed for more accurate modeling–and thus the change in study outcome.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 
Surg Onc Files by Surgoncfiles - 4M ago

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/10/gastric_TCGA_COMPILED_EDITS.mp3

Welcome back to the SO Files! We’re happy to present part 2 of our gastric cancer series. Here we briefly review the historical gastric cancer classifications (Lauren and WHO) and then explain how this has drastically changed over the past 5-10 years with the advent of next-generation sequencing capabilities. We go in depth to evaluate how this applies to the budding surgical oncologist, and what discoveries may lie on the horizon. We also welcome back Dr. Ryan Fields, MD, FACS who is an Associate Professor in the Department of Surgery at Washington University in St. Louis and was recently appointed co-leader of the Solid Tumor Therapeutics Program (STTP) at Siteman Cancer Center.  Dr. Fields talks about the outcomes of several recent trials and how they are helping us to treat gastric cancer patients in the clinic today. As always, all references from the podcast are linked below, enjoy!

Background:

NCCN Guidelines – Gastric Cancer 

An updated, evidence based overview of gastric cancer management. Workup, and    surgical/ medical treatment algorithms discussed.

Relevant Reading:

1. Comprehensive molecular characterization of gastric adenocarcinoma

The Cancer Genome Atlas, Nature 2014

Comprehensive molecular evaluation of 295 primary gastric adenocarcinoma specimens reveals four distinct subtypes of gastric cancer: Epstein – Barr virus (EBV) positive (~10% of tumors), microsatellite unstable tumors (MSI-Hi, ~20% of tumors), genomically stable tumors (~20% of tumors), and chromosome instability tumors (~50% of tumors). 

2. ToGA (Trastuzumab for Gastric Cancer) Trial

Bang et al. The Lancet 2010

International (122 centers in 24 countries), phase 3, RCT comparing chemotherapy versus chemotherapy PLUS trastuzumab in patients with gastric cancer that over-expresses HER2 protein. 594 patients, primary endpoint was overall survival. Median overall survival was 13.8 months in the chemo PLUS trastuzumab group, compared to 11.1 months in the chemo alone group.

Takeaway – Chemo + Trastuzumab > chemo alone for gastric cancer

3. Adjuvant Options for Advanced Melanoma

Melanoma episode with Dr. Andtbacka where we discussed the role of PD-1/PDL1-2 in cancer.

4. PD-1 and Mismatch Repair Deficiency Trial

Le et al., NEJM 2015

Treated 41 patients with progressive metastatic carcinoma with or without mismatch-repair deficiency with Pembrolizumab (anti-PD 1 immune checkpoint inhibitor). Coprimary end points were immune-related objective response rate and 20-week immune-related progression-free survival rate. Mismatch repair-deficient colorectal carcinomas had 40% and 78% objective response rate and progression free survival respectively. Compared to mismatch repair-proficient tumors, which saw 0% and 11% immune-related objective response rate and immune-related progression-free survival rates respectively. Patients with mismatch repair-deficient noncolorectal cancers had responses similar to those of patients with mismatch repair -deficient colorectal cancer.

Takeaway – MMR status can predict clinical benefit of immune checkpoint blockade with pembrolizumab. 

5. KEYNOTE – 059 Trial

Fuchs et al., JAMA Oncology 2018

International, Phase 2 trial designed to evaluate safety and efficacy of pembrolizumab in patients with previously treated advanced Gastric and GE junction cancer. 259 patients, 16 countries were treated with IV pembrolizumab until disease progression. Primary end points were objective response rate (ORR) and safety. Demonstrated promising activity for all patients (11.6%) which was more prominent in PD-L1+ tumors (15.5% ORR) compared to PD-L1- tumors (6.4%). 

Takeaway – Pembrolizumab demonstrated objective response for all-comers with progressive (failed 2 or more previous chemo regimens) advanced gastric cancer, with especially pronounced response in PD-L1+ tumors.

6. PD-1 Inhibition in Metastatic Gastric Cancer Trial

Kim et al., Nature Medicine 2018

Phase 2 trial that performed molecular characterization of tissues and circulating tumor DNA (ctDNA) from 61 patients with metastatic gastric cancer (mGC); tried to identify determinants of response to salvage pembrolizumab therapy. Saw very high overall response rates in patients with EBV+ tumors (100%) and MSI-high tumors (85.7%). Overall response rate was also higher in patients with PD-L1+ tumors compared to PD-L1 negative tumors, 50% vs 0% respectively

Takeaway – EBV positivity, MSI-high status, and PD-L1 positivity in gastric cancer all predict likely response to pembrolizumab.

 

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/02/Pancreas-Adjuvant-Compiled.mp3

On this episode of the SO files, we interview Dr. Andrea Wang-Gillam MD/PhD, associate professor in the division of oncology at Wash U School of medicine and clinical director of the GI oncology, about systemic options for treating pancreatic adenocarcinoma. As much as we all love a good Whipple, this really is a systemic disease, and unlike other cancers 100% of patients regardless of stage will need some form of systemic treatment. Good thing we have great options to choose from! …Right?

Resources

NCCN guidelines

RCTs in the metastatic setting 

Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine

NEJM 2013

Daniel D. Von Hoff, M.D., Thomas Ervin, M.D., Francis P. Arena, M.D., E. Gabriela Chiorean, M.D., Jeffrey Infante, M.D., Malcolm Moore, M.D., Thomas Seay, M.D., Sergei A. Tjulandin, M.D., Wen Wee Ma, M.D., Mansoor N. Saleh, M.D., Marion Harris, M.D., Michele Reni, M.D., Scot Dowden, M.D., Daniel Laheru, M.D., Nathan Bahary, M.D., Ramesh K. Ramanathan, M.D., Josep Tabernero, M.D., Manuel Hidalgo, M.D., Ph.D., David Goldstein, M.D., Eric Van Cutsem, M.D., Xinyu Wei, Ph.D., Jose Iglesias, M.D., and Markus F. Renschler, M.D.

Take away: nab-Paclitaxel (Abraxane) added to gemcitabine improved survival when compared to gemcitabine alone (median OS 8.5 pos vs 6.7 mos, ORR 23% vs 7%). 

FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer

NEJM 2011

Thierry Conroy, M.D., Françoise Desseigne, M.D., Marc Ychou, M.D., Ph.D., Olivier Bouché, M.D., Ph.D., Rosine Guimbaud, M.D., Ph.D., Yves Bécouarn, M.D., Antoine Adenis, M.D., Ph.D., Jean-Luc Raoul, M.D., Ph.D., Sophie Gourgou-Bourgade, M.Sc., Christelle de la Fouchardière, M.D., Jaafar Bennouna, M.D., Ph.D., Jean-Baptiste Bachet, M.D., Faiza Khemissa-Akouz, M.D., Denis Péré-Vergé, M.D., Catherine Delbaldo, M.D., Eric Assenat, M.D., Ph.D., Bruno Chauffert, M.D., Ph.D., Pierre Michel, M.D., Ph.D., Christine Montoto-Grillot, M.Chem., and Michel Ducreux, M.D., Ph.D. for the Groupe Tumeurs Digestives of Unicancer and the PRODIGE Intergroup

FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, fluorouracil) is a much more effective regimen than gemcitabine alone (median OS 11.1 mos vs 6.8 mos; ORR 32% vs 9%), but is a more toxic regimen with higher rate of adverse events. 

RCTS in the Adjuvant Setting 

Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial.

JAMA 2013.

Helmut Oettle, MD, PhD; Peter Neuhaus, MD, PhD; Andreas Hochhaus, MD, PhD; Jörg Thomas Hartmann, MD, PhD; Klaus Gellert, MD, PhD; Karsten Ridwelski, MD, PhD; Marco Niedergethmann, MD, PhD; Carl Zülke, MD, PhD; Jörg Fahlke, MD, PhD; Michael B. Arning, MD, PhD; Marianne Sinn, MD; Axel Hinke, PhD; Hanno Riess, MD, PhD

Take away: 6 months of gemcitabine treatment after complete resection was better for OS than no treatment (13.4 mos vs 6.7 mos). 

Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.

Lancet 2017

Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O’Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW; European Study Group for Pancreatic Cancer.

Take away: Combination gemcitabine and capecitabine (Xeloda) did better than gemcitabine alone in patients with completely resected disease (OS 28 mos v 25.5 pos). 

New and exciting things coming down the pipeline… 1. Targeting desmoplastic reaction

HALO 202: Randomized Phase II Study of PEGPH20 Plus Nab-Paclitaxel/Gemcitabine Versus Nab-Paclitaxel/Gemcitabine in Patients With Untreated, Metastatic Pancreatic Ductal Adenocarcinoma.

JCO 2018

Hingorani SR, Zheng L, Bullock AJ, Seery TE, Harris WP, Sigal DS, Braiteh F, Ritch PS, Zalupski MM, Bahary N, Oberstein PE, Wang-Gillam A, Wu W, Chondros D, Jiang P, Khelifa S, Pu J, Aldrich C, Hendifar AE.

Take away: The addition of PEGPH20 (pegvorhyaluronidase alfa) to gem/abraxane improved PFS and OS compared to gem/abraxane alone in patients with untreated metastatic disease, especially in patients with hyaluron high tumors. Phase III study ongoing!!

2. Targeting cancer stem cells 

A Study of BBI608 in Combination With Standard Chemotherapies in Adult Patients With Pancreatic Cancer

Ongoing phase Ib dose escalation study of BBI608 (Napabucasin), STAT3/cancer stem cell inhibitor, in combination with other standard chemotherapy regimens (gem/abraxane, FOLFIRINOX, FOLFIRI). Accrual slated to complete June 2018. 

3. Targeting innate immunity 

Targeting tumour-associated macrophages with CCR2 inhibition in combination with FOLFIRINOX in patients with borderline resectable and locally advanced pancreatic cancer: a single-centre, open-label, dose-finding, non-randomised, phase 1b trial.

Lancet Onc. 2016

Nywening TM, Wang-Gillam A, Sanford DE, Belt BA, Panni RZ, Cusworth BM, Toriola AT, Nieman RK, Worley LA, Yano M, Fowler KJ, Lockhart AC, Suresh R, Tan BR, Lim KH, Fields RC, Strasberg SM, Hawkins WG, DeNardo DG, Goedegebuure SP, Linehan DC.

Blockade of CCR2, as a means to suppress tumor infiltration of immunosuppressive tumor associated macrophages, in combination with FOLFIRINOX chemotherapy for borderline resectable or locally advanced PDAC resulted in a 49% objective tumor response rate.

Phase 1b Study of CCX872-B in Patients With Pancreatic Adenocarcinoma

CCR2 inhibition decreases tumor-associated macrophages and Treg cells, and increases CD8+ and CD4+ T cells in pancreatic tumors. In preliminary data presented at ASCO, CX872-B plus FOLFIRINOX resulted in a TCR of 78% and an ORR of 30 to 37% with no safety issues ascribed to CCX872-B use. Estimated study completion date December 2018. 

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/08/TailorX_Episode_original-edits.mp3

On this episode of SO Files, Alston, Brad and Linda take a closer look at the recently published TAILORx Clinical Trial Published in NEJM by Sparano and colleagues. The study expands the existing clinical application of the Oncotype DX score. If that score sounds familiar its because it has been quickly making its way into clinical practice over the past few years (see our last episode on the new AJCC guidelines!). We explain the origin of the score, how it has been incorporated into clinical practice thus far, and how this trial addresses a large gap in the existing literature.

Relevant Reading:

TAILORx Trial

Sparano et. al., NEJM 2018

A randomized controlled trial, designed to assess the utility of the Oncotype DX Score in predicting the need for chemotherapy, in addition to anti endocrine therapy, for hormone receptor +, Her2 -, node negative breast cancer. Bottom Line: Patients with an intermediate Oncotype DX Score of 11-25 can forgo chemotherapy, especially those patients >50 y/o.

NSABP B14 Study

Fisher et al. NEJM 1989

Overview of study layout in 1980’s – establishes adjuvant tamoxifen > no adjuvant therapy in ER+/Node negative patients.

NSABP B20 Study

Fisher et al. JNCI 1997

Overview of study layout in 1990’s – establishes chemo + endocrine for ER+/Node negative patients = decreased recurrence. 

Oncotype Dx Study

Paik et al. NEJM 2004

First description of OncotypeDx use and correlation with outcomes. Patients can now be stratified into low, intermediate, high risk of recurrence.

Oncotype DX applied study

Paik et al. J Clin Onc 2006

Same group shows that the score can be used to predict benefit from chemotherapy in individual patients.

ASCO 2007 Update

Harris et al. JCO 2007

ASCO first updates their guidelines to recommend use of gene assays in clinical care.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/07/Breast-Staging-Compiled-1-1.mp3

On this episode of SO Files, Brad and Linda cover the updated staging guidelines for breast cancer that have been in practice (theoretically) since Jan 1, 2018. The possibilities for stage groups now cover a full six pages in the AJCC manual and you can hear Brad and Linda read through each one right here…. just kidding. We will however cover the major changes, the reasoning behind them, and talk about how they are fitting into practice with podcast favorite Dr. Cyr.

BONUS: listen to Brad, Alston and Linda survive a tornado during the live taping of this show!

Show Breakdown:

0-14 minutes: Background information with Brad, Linda and Alston

14 minutes- end: Brad and Linda interview Dr. Cyr

Relevant Reading:

NCCN Guidelines

Updated NCCN breast cancer guidelines, which includes the new AJCC 8th edition staging system.

AJCC 8th Edition Staging Chapter

Gabriel N. Hortobagyi, James L. Connolly, Carl J. D’Orsi, Stephen B. Edge, Elizabeth A. Mittendorf, Hope S. Rugo, Lawrence J. Solin, Donald L. Weaver, David J. Winchester, and Armando Giuliano

Detailed chapter outlining the new AJCC staging system. 

Oncotype DX Score Background

Background info on Oncotype DX Score from the company, Genomic Health, with links to relevant articles.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2017/12/MIS_POD_DRHAMMILL__FINAL_EDITS.mp3

On this episode of the SO Files, Brad and Linda discuss minimally invasive hepatobiliary surgical oncology, focusing specifically on MIS pancreatic and liver surgery. The SO Files welcome special guest, Dr. Chet Hammill, Associate Professor of Surgery in the Hepatobiliary and GI Surgical Section at Wash U, Barnes Jewish Hospital.

Papers Discussed Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-Matched Study From a National Cohort of Patients.
Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, Choti MA, Mansour JC, Xie XJ, Polanco PM, Minter RM.
A propensity matched analysis of MIS vs. open pancreaticoduodenectomy, using the pancreas-targeted ACS NSQIP database. Minimally invasive whipples had a similar morbidity/mortality to open whipples. A decreased length of stay in the MIS group was partially offset by an increased readmission rate, and SSI was only decreased when removing those MIS whipples without conversion to open or open assist.
 

Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial.

Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Røsok BI, Bjørnbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B; Oslo-CoMet study group.

A randomized controlled trial of lap vs open surgery for colorectal liver mets that could be resected with a parenchyma sparing resection. Lap liver resection had equivalent R0 rate to open, was cost effective, and had fewer postoperative complications.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

https://media.blubrry.com/surgoncfiles/www.surgoncfiles.com/wp-content/uploads/2018/04/CRLM-BK-Compiled.mp3

Today we will be discussing the modern management of colorectal liver metastases. For today’s episode, we are excited to be welcoming on Dr. Yuman Fong, Sangiacomo Family Chair in Surgical Oncology and Surgical chair at City of Hope Cancer Center in California. Dr. Fong previously held the Murray F. Brennan Chair of Surgery at Memorial Sloan Kettering Cancer center, and is an international expert in both liver and pancreatic surgery.

Background Reading:

NCCN Guidelines: Colon Cancer

NCCN guidelines for colon cancer, which includes the management strategy for patients with liver metastases.

Sabiston Textbook of Surgery, Twentieth Edition

Overview of the surgical management of the liver and hepatic neoplasms, including metastatic colorectal cancer.

Articles Discussed:

Patient selection for the surgical treatment of resectable colorectal liver metastases.

Araujo RL, Riechelmann RP, Fong Y

2017 review article in The Journal of Surgical Oncology, outlining the surgical and medical management of colorectal liver metastases. Figure depicting the utilization of the colorectal liver metastasis clinical risk score in order to guide chemotherapy and surgical strategy.

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH

Classic article depicting a clinical risk score that predicts survival in patients with resected colorectal liver metastasis. 5 preoperative factors, with each factor contributing to 1 point on the score, with more points = worse prognosis. At time of initial publication in 1998: 5 pts led to 14% 5 year survival vs. 60% for someone with 0 points. The 5 factors are: >1 liver metastasis, node positive primary, <12 months between primary colorectal tumor and liver met, >5cm liver tumor, preop CEA >200. 

Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution.

House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, Brennan MF, Blumgart LH, Jarnagin WR, D’Angelica MI

Data from Memorial Sloan Kettering that compared survival after resection for colorectal liver metastases for patients during 2 different eras: 1985-1998, and 1999-2004. Many of the patients in the more modern era were offered therapy with oxaliplatin or irinotecan, which likely led to the improved survival in these patients. Recurrence free survival in both generations were similar, suggesting that chemotherapy regimens and possibly patient selection differences led to differences in overall survival. 

Read Full Article

Read for later

Articles marked as Favorite are saved for later viewing.
close
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Separate tags by commas
To access this feature, please upgrade your account.
Start your free month
Free Preview