Biomedical subjects

Leonard B Saltz

Publications and source records attributed to Leonard B Saltz.

23 records · Page 2Linked to original sources

PubMed2002

Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease.

BACKGROUND: The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. METHODS: Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. RESULTS: Radical resection was accomplished by low anterior resection (n = 65), abdominoperineal resection (n = 11), and Hartmann's resection (n = 4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n = 5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. CONCLUSIONS: For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.

Adenocarcinoma↗

PubMed2002

Adjuvant therapy of cancers of the colon and rectum.

Important advances have been made in our understanding of the role of adjuvant therapy for colorectal cancer. Current standard 5FU-based regimens have been convincingly shown to reduce the incidence of recurrences and to prolong overall survival in patients with resected stage III colon cancer. Colon cancer patients with stage II disease have a better-overall prognosis than those with stage III; however, the relative merits of adjuvant treatment in these patients remains controversial. Combined chemotherapy plus radiation therapy is currently the standard adjuvant approach for stage II and III rectal cancer patients. Despite the advances that have been made, far too many patients with resectable colorectal cancer ultimately relapse and die of their disease. There remains a pressing need for continued development of improved adjuvant treatments. Participation of eligible patients in clinical trials must continue to be actively encouraged. Only in this way will we be able to continue to build and expand on the progress that has been made thus far.

Antineoplastic Agents↗

PubMed2002

Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients.

BACKGROUND: Patients with transmural or node-positive rectal cancer benefit from the addition of chemoradiation to surgical resection. Administration of the chemoradiation (combined modality therapy) preoperatively has gained popularity in recent years. Some patients undergo apparent complete tumor regression after preoperative combined modality therapy, and controversy exists about the proper management of these patients. Some investigators have proposed that such patients should simply be observed and not undergo resection. STUDY DESIGN: The purpose of this study was to determine the significance of clinical complete response to preoperative combined modality therapy. Specifically, we have attempted to determine the frequency with which a clinical complete response (based on the absence of detectable tumor on preoperative digital rectal examination and proctoscopy) correlates with a pathologic complete response (based on the absence of cancer cells in the resected specimen). A retrospective review of the clinical and pathologic characteristics of 488 patients from the Memorial Sloan-Kettering prospective colorectal database who received preoperative chemoradiation followed by resection for primary rectal cancer was performed. The indications for preoperative therapy included clinical or ultrasound T3 or T4 tumors or node-positive disease. RESULTS: The clinical complete response rate to preoperative therapy was 19%. All patients underwent resection subsequent to preoperative therapy regardless of response. The pathologic complete response rate among all patients was 10%. The pathologic complete response rate among clinical complete responders was 25%. Clinical complete response was a significant predictive factor for pathologic complete response, but the majority (75%) of clinical complete responders had persistent foci of tumor that were not detectable on preoperative examination or proctoscopy. CONCLUSIONS: Clinical complete response to preoperative therapy as determined by preoperative digital rectal examination and proctoscopy or EUA is not an accurate predictor of pathologic complete response. A significant percentage of clinical complete responders have persistent deep tumors or nodal involvement. We do not recommend making treatment decisions based solely on the absence of clinically palpable or visible tumor after chemoradiation. Our data suggest that all acceptable-risk patients with a diagnosis of primary rectal cancer should undergo resection, regardless of their response to preoperative therapy.

Adult↗

PubMedDate not supplied

Palliative management of rectal cancer: the roles of chemotherapy and radiation therapy.

One of the first maxims of oncologic care is that we must never miss an opportunity to cure a patient. Perhaps an equally important corollary is that to provide the best possible care for each individual, it is necessary to accurately recognize when a curative option does not exist and to adjust our treatment recommendations accordingly. A discussion of palliative care in a patient with rectal cancer must therefore be based on the assumption that the patient does not have a realistic chance of undergoing a curative intervention.

Antineoplastic Agents↗

PubMedDate not supplied

Understanding and managing chemotherapy-induced diarrhea.

Diarrhea is particularly problematic in patients receiving fluoropyrimidines and/or irinotecan. Careful patient monitoring, patient education, and good patient-provider communication are the primary tools of prevention. The patient must be carefully evaluated on a regular basis early in treatment, so that mid-course corrections, dose adjustments, or dose delays can be instituted early on if indicated. Diet need not be modified as a preventive measure, but once diarrhea occurs, a number of modifications must be made. Maintenance of fluid intake is critical and inability to maintain adequate hydration would be a primary indication for parenteral fluid support. Oral intake of fluids should not be limited to plain water only, since electrolytes need to be replenished. Early recognition of diarrhea and early pharmacologic intervention can greatly facilitate successful resolution of this treatment complication.

Antidiarrheals↗