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Ascorbic acid PEG-2L is superior for early morning colonoscopies in colorectal cancer screening programs: a prospective non-randomized controlled trial.
Rodríguez de Miguel, C, Serradesanferm, A, López-Cerón, M, Carballal, S, Pozo, A, Balaguer, F, Cárdenas, A, Fernández-Esparrach, G, Ginés, A, González-Suárez, B, et al
Gastroenterologia y hepatologia. 2015;(2):62-70
Abstract
BACKGROUND The quality of colon cleansing and the tolerability of anterograde preparation are essential to the success of colorectal cancer screening. AIM: To compare the tolerability and efficacy of low-volume preparations vs the standard regimen in individuals scheduled for an early morning colonoscopy. STUDY Participants in a population-based colorectal cancer screening program using the fecal immunochemical test who were scheduled for a colonoscopy from 09:00 a.m. to 10:20 a.m. were prospectively included and assigned to: (1) control group (PEG-ELS 4L): PEG 4L and electrolytes; (2) group AscPEG-2L: a combination of PEG and ascorbic acid 2L; and (3) group PiMg: sodium picosulfate and magnesium citrate 500 mL plus 2L of clear fluids. Tolerability was evaluated with a questionnaire and the quality of bowel preparation with the Boston Bowel Preparation Scale. RESULTS A total of 292 participants were included: 98 in the PEG-ELS 4L control group, 96 in the AscPEG-2L study group and 98 in the PiMg study group. Low-volume treatments were better tolerated than the standard solution (AscPEG-2L 94.8% and PiMg 93.9% vs PEG-ELS 4L 75.5%; p < 0.0001). The effectiveness of AscPEG-2L was superior to that of PEG-ELS 4L and PiMg (p = 0.011 and p = 0.032, respectively). Patient acceptance was higher for single-dose than for split-dose administration but efficacy was higher with the split dose than with other doses. CONCLUSIONS In early morning colonoscopies, ascPEG-2L appears to be the best option, especially when administered in a split-dose.
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[Chemotherapy in patients with non-resectable colorectal cancer metastases to the liver: systemic or regional?].
Nasyrov, AR, Pirtskhalava, TL, Korovina, IaV
Voprosy onkologii. 2011;(2):192-8
Abstract
Efficacy of the-state-of-the-art modalities of systemic and regional chemo-infusion with oxalyplatin (FOLFOX) and irinotecan (FOLFIRI) (162) was compared. Objective response to the former was 40.8%, to the latter--11.9% (p = 0.0002); survival before intrasplenic relapse--9 and 5 months, respectively, (p = 0.0005); overall survival before relapse (median 7 and 4 months, respectively, (p = 0.01). The rate of survival before intrasplenic relapse in the systemic chemo-infusion group was significantly higher (median 10.5 vs. 8.1 months, respectively, (p = 0.03). No significant differences in overall survival were reported (median 15 vs. 13 months, respectively, in the latter group (p = 0.72).
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Effect of preoperative chemotherapy on liver resection for colorectal liver metastases.
Mehta, NN, Ravikumar, R, Coldham, CA, Buckels, JA, Hubscher, SG, Bramhall, SR, Wigmore, SJ, Mayer, AD, Mirza, DF
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2008;(7):782-6
Abstract
AIM: To compare the effects of preoperative chemotherapy on liver parenchyma morphology, as well as morbidity and mortality after liver resection for colorectal liver metastases. METHODS Prospectively collected data on 173 patients undergoing liver resection for CLM between 1/2003 and 9/2005 was analysed in three groups: A: preoperative oxaliplatin (Ox, n=70); B: other chemotherapeutic agents (OC, n=60); and C: surgery alone without chemotherapy (SA, n=43). Blood transfusion, hospital stay, operative procedure, peak postoperative bilirubin levels, complications and histopathology of the resected liver were compared. RESULTS Intra-operative blood transfusion requirement (34%) and biliary complications (16%) was higher in patients receiving oxaliplatin-based chemotherapy (p=0.01 and p=0.06, respectively). Oxaliplatin-based chemotherapy was also associated with sinusoidal dilatation of mild grade in 52.8% vs. 26.6% and 23.3% patients (p=0.007 and p=0.004) in other groups, respectively. Steatosis was similarly distributed across the study group. Postoperative mortality was 2, 1 and 4 patients, respectively (p=ns). CONCLUSION Oxaliplatin-based preoperative chemotherapy is associated with vascular alterations in the liver parenchyma without significantly increasing the risk of steatosis, or postoperative morbidity and mortality.
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The effect of the herbal medicines dai-kenchu-to and keishi-bukuryo-gan on bowel movement after colorectal surgery.
Suehiro, T, Matsumata, T, Shikada, Y, Sugimachi, K
Hepato-gastroenterology. 2005;(61):97-100
Abstract
BACKGROUND/AIMS: To evaluate the safety and efficacy of the herbal medicines Dai-ken-chu-to and Keish-bukuryo-gan in the patients undergoing colorectal resection. METHODOLOGY Sixty-six patients undergoing colorectal resection were studied. Patients in the Study group began on 7.5g of Dai-ken-chu-to and 6.0g of Keish-bukuryo-gan on the first postoperative day. Control group did not take herbal medicine at all. All of the patients were monitored for vomiting, abdominal distention, length of ileus, tolerance of regular diet, duration of intravenous fluid administration, length of hospitalization, and complications. RESULTS The time to flatus was 63.1 +/- 22.8 hours and 95.4 +/- 33.0 hours in the Study and Control group, respectively (p<0.05). And the time to tolerance of regular diet was 2.53 +/- 1.93 days and 6.25 +/- 1.50 days in the Study and Control group, respectively (p<0.05). In addition, length of postoperative hospitalization in the patients within the Study group was significantly shorter than those within the Control group (15.7 +/- 4.8 days vs. 20.8 +/- 4.8 days, p<0.05). The incidence of complications including nausea, vomiting, anastomotic leak and wound infection occurred equally in both groups. CONCLUSIONS Administration of Dai-ken-chu-to and Keish-bukuryo-gan is safe, with no evidence of increased morbidity, and is also highly effective in improving postoperative bowel motility and in reducing hospital stay.
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Folic acid reduces nuclear translocation of beta-catenin in rectal mucosal crypts of patients with colorectal adenomas.
Jaszewski, R, Millar, B, Hatfield, JS, Nogothu, K, Finkenauer, R, Rishi, AK, Naumoff, JA, Kucuk, O, Axelrod, BN, Majumdar, AP
Cancer letters. 2004;(1):27-33
Abstract
We have demonstrated that folic acid inhibits cell proliferation and epidermal growth factor receptor (EGFR) activation in colon cancer cell lines. We examined the effect of one year supplemental folic acid (5 mg/day) on the rectal mucosal expression of beta-catenin and pGSK3beta, known to be affected by EGF-R, in patients with colorectal adenomas. Folic acid treatment significantly reduced nuclear expression of beta-catenin (P < 0.05) and cellular expression of pGSK3beta (P < 0.01) when compared to placebo. Folic acid may exert its chemopreventive effect, at least in part, through inhibition of nuclear translocation of beta-catenin.
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[Cytoreductive surgery of liver metastasis from colorectal cancer: principles of intra-arterial regional chemotherapy].
Malinovskiĭ, NN, Severtsev, AN, Smirnova, NB
Khirurgiia. 2003;(3):14-21
Abstract
A significant number of patients with colorectal cancer have metastases (MTS) to the liver. Cytoreductive surgery (CRS) and new antitumor drugs provide promising results. The aim of the study was to evaluate clinical results of CRS in combination with modern antitumor drug irinotekan (kampto). Forty-seven patients suffering from colorectal cancer with MTS to the liver were treated. Primary focus was resected. All the patients were divided into 4 groups depending on combination of surgical treatment and chemotherapy: with liver resection and complete removal (or devitalization) of metastatic lesions in combination with postoperative intravenous (group 1) or intraarterial regional (group 2) injection of Irinotekan and without resection of the liver with implantation of a catheter to the hepatic artery with postoperative intraarterial (group 3) or systemic intravenous (group 4) therapy with Irinotekan. Mean dose of kampto was 350 mg per 1 m2 of body surface. It was demonstrated that intraarterial infusion was highly effective. The follow-up in group 1 was 9.5 +/- 3.75 months, in group 2--11.3 +/- 4.2, in group 3--6.5 +/- 5.3, in group 4--4.6 +/- 2.3 months. It is concluded that cytoreduction of the the liver with intraarterial intrahepatic regional chemotherapy is an effective method of treatment of patients with metastatic colorectal cancer of the liver.
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Clinical and economic benefits of irinotecan in combination with 5-fluorouracil and folinic acid as first line treatment of metastatic colorectal cancer.
Cunningham, D, Falk, S, Jackson, D
British journal of cancer. 2002;(11):1677-83
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Abstract
The combination of irinotecan plus 5-fluorouracil and folinic acid has clinical and survival benefits over 5-fluorouracil and folinic acid alone in the setting of first line treatment of metastatic colorectal cancer. The aim of this cost-effectiveness analysis was to compare the economic implications, from a UK health commissioner perspective, of the two treatment arms (de Gramont regimen) in this setting. Resource utilisation data collected prospectively during the study were used as a basis for estimating cumulative drug dosage, chemotherapy administration, and treatment of complications during first line therapy. Resource utilisation associated with further chemotherapy in patients who had progressed during the study was derived from a retrospective case note review. Drug acquisition costs were derived from the British National Formulary (September, 2001) and unit costs for clinical consultation and services were taken from the latest relevant cost database. Cumulative costs per patient associated with further chemotherapy were lower in the irinotecan plus 5-fluorouracil and folinic acid treatment arm. Based on incremental costs per life-year gained of 14 794 pounds sterling, the combination of irinotecan plus 5-fluorouracil and folinic acid can be considered cost-effective by commonly accepted criteria compared with 5-fluorouracil and folinic acid alone. Thus, clinical and economic data demonstrate that irinotecan, either in combination with irinotecan plus 5-fluorouracil and folinic acid in the first line setting or as monotherapy in the second line setting, has a major role in the management of metastatic colorectal cancer.