Surgery May Not Be Needed With Locally Advanced Rectal Cancer

A short course of radiation therapy followed by neoadjuvant chemotherapy resulted in a clinical complete response (CR) in almost half of 90 patients with locally advanced rectal cancer, allowing the majority of responders to skip surgical resection, a retrospective study indicates.

Specifically, at a median follow-up of 16.6 months for living patients, the initial clinical CR was 48% overall.

“While we do not have enough follow-up yet to know the late side-effect profile of this regimen, our preliminary results are promising,” Re-I. Chin, MD, Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News in an email.

The study was presented at the virtual 2020 meeting of the American Society of Radiation Oncology (ASTRO).

“Certainly longer follow-up will be needed in this study but none of the observed patients to date has experienced an unsalvageable failure,” said meeting discussant Amol Narang, MD, of Johns Hopkins University, Baltimore, Maryland.

He reminded conference attendees that despite good evidence supporting equivalency in oncologic outcomes between short-course radiation and long-course chemoradiation, the former is “highly underutilized in the US” with a mere 1% usage rate between 2004 and 2014.

The current study’s short-course treatment approach was compared in this setting to long-course chemoradiation and adjuvant chemotherapy in the  RAPIDO trial reported at the 2020 annual meeting of the American Society of Clinical Oncology (ASCO), Narang pointed out.

Short-course patients had a higher rate of pathological complete response (pCR) and a lower rate of treatment failure compared with patients who received long course chemoradiation and adjuvant chemotherapy; both patient groups underwent total mesorectal excision — which is different from the current analysis. The RAPIDO investigators concluded that the approach featuring the short-course “can be considered as a new standard of care.”

Narang said the data collectively “begs the question as to whether the superiority of long course chemoradiation should really have to be demonstrated to justify its use.”

But Chin highlighted toxicity issues. “Historically, there have been concerns regarding toxicity with short-course radiation therapy since it requires larger doses of radiation given over a shorter period of time,” Chin explained. “But [the short course] is particularly convenient for patients since it saves them more than a month of daily trips to the radiation oncology department.”

Seven Local Failures

The single-center study involved patients with newly diagnosed, nonmetastatic rectal adenocarcinoma treated with short course radiation therapy followed by chemotherapy in 2018 and 2019. Nearly all (96%) had locally advanced disease, with either a T3/T4 tumor or node-positive disease.  Median tumor size was 4.6 cm.

“Many of the patients in the study had low lying tumors,” Chin reported, with a median distance from the anal verge of 7 cm.

Radiation therapy was delivered in 25 Gy given in five fractions over 5 consecutive days, with the option to boost the dose to 30 Gy or 35 Gy in five fractions if extra-mesorectal lymph nodes were involved. Conventional 3D or intensity-modulated radiation was used and all patients completed treatment.

The median interval between diagnosis of rectal

Read more

Canada says stronger response needed to fight coronavirus, PM hopes to avoid major shutdown

OTTAWA (Reuters) – Canadians need to do more to tackle a second wave of the coronavirus by slashing the number of personal contacts they have with others, health authorities said on Friday.

FILE PHOTO: People walk in the Eaton Centre shopping mall, as the provincial phase 2 of reopening from the coronavirus disease (COVID-19) restrictions begins in Toronto, Ontario, Canada June 24, 2020. REUTERS/Carlos Osorio/File Photo

Prime Minister Justin Trudeau said more targeted measures could help avert another major national shutdown of the kind that hammered the economy earlier in the year.

Released modeling updates show the cumulative death toll in the country could range between 10,285 and 10,400 by Nov 8. Cumulative cases could be between 251,800 and 262,200 by the same date.

“(The) long-range forecast indicates that a stronger response is needed now to slow the spread of COVID-19,” chief public health officer Theresa Tam told a briefing.

“If we decrease our current rate of contacts by 25% the epidemic is forecast to come under control in most locations,” she said.

Canada has recorded 10,074 deaths and 228,542 cases so far and is breaking daily records for the number of new cases.

Suncor Energy SU.TO, Canada’s second-biggest oil producer, confirmed 19 infections among workers at its Firebag oil sands site in Alberta, dating back to Oct. 18. All of those affected are in isolation at home or other locations, spokeswoman Erin Rees said.

Suncor shut down part of the site where 17 of the employees worked, but the outbreak has not affected oil production, she said.

Some provinces are reintroducing bans on indoor dining and limiting the size of gatherings.

Manitoba, which has the highest rate of active cases per capita among provinces, said it would tighten restrictions starting on Monday. In Winnipeg, where most cases are located, all restaurants and bars will close to in-person dining.

Trudeau said authorities know more now about the pandemic than they did six months ago.

“There are things we can do to help to control the pandemic, the second wave, without – we hope – having to impose a nationwide shutdown,” he told the briefing.

Additional reporting by Rod Nickel in Winnipeg and Moira Warburton in Toronto; Editing by Kirsten Donovan, Aurora Ellis and Sonya Hepinstall

Source Article

Read more

New, Equitable NYC Health Care Needed After Coronavirus: Study

NEW YORK CITY — The coronavirus crisis showed equitable health care in New York City is a matter of life and death, a new study argues.

The study — “Toward a Resilient System of Health” — found Black and Hispanic city dwellers accounted for 62 percent of all COVID-19 fatalities. Together, the two groups are just 51 percent of the city’s population.

The outcomes showed the city’s primary focus should be to predict and proactively treat illness at a community level rather than provide reactive care when an individual gets sick, the study states.

“COVID-19 vividly demonstrated how social determinants of health— factors beyond direct medical services that influence overall health—are linked to disparate outcomes for Black and Hispanic populations,” the study states.

The Partnership for New York City released the study in collaboration with Deloitte. The group has garnered attention throughout the pandemic — first for warning a third of the city’s small businesses may go under, then by sending an open letter to Mayor Bill de Blasio signed by 167 business leaders.

The new study outlines a broad vision for the city’s health care system.

New York leaders should focus on not only rebuilding short-term trust in the health care system, but laying the groundwork for other city systems to support health and well-being, the study states.

It proposes the near-term support of science-based public health guidelines, a medium-term focus on community-based care and long-term reforms in Medicaid reimbursement, among many other proposals.

Read the full study here.

This article originally appeared on the New York City Patch

Source Article

Read more