[News in management of colorectal cancer at JFHOD 2012 meeting].
All aspects of the management of colorectal cancer were presented during the 2012 edition of JFHOD meeting, from screening to new drugs tested in metastatic situation. It was confirmed that an average number of more than 0.8 detected polyps was a quality criteria of screening colonoscopies performed for positive Hemoccult(®). The superiority of brush-sampling fecal immunological test compared to guaiac fecal occult blood test has been demonstrated in two studies, with doubled and tripled detection rates of invasive cancers and advanced adenomas, respectively. Reproducibility is a major quality factor of the histopathological analysis of malignant colorectal polyps treated by endoscopic polypectomy. The inter-observer concordance was satisfying for the invasion depth and the resection margins, but inadequate for the degree of differentiation, the budding, the degree of submucosal infiltration and vascular embol. Reliability was enhanced by the importance of the endoscopic activity in center and by the orientation of the polyps. Ultrasonographic evidence of downsizing after neoadjuvant radiochemotherapy in rectal cancer was predictive of better survival. In a randomized trial, neoadjuvant radiochemotherapy was more toxic in patients older than 70 years, inducing a decreased frequency of surgery and more frequent permanent colostomy. After retrospective analysis of individual data from patients with synchronous metastases included in four clinical trials, the resection of the primary tumor was an independent predictive factor of overall and progression free survival. A prospective randomized trial must confirm this result. A study confirmed the important contribution of diffusion-weighted MRI in the preoperative evaluation of liver metastases. Promising data were presented concerning the intensification of chemotherapy, hepatic intra-arterial chemotherapy and integration of targeted therapies to increase the resectability rate of metastases. In palliative setting, the promising action of two tyrosine kinase inhibitors (sorafenib and nintedanib) in phase I-II studies will warrant further clinical development.
CHU de Reims, hôpital Robert-Debré, service d'hépato-gastroentérologie et de cancérologie digestive, avenue du Général-Koenig, 51092 Reims Cedex, France, CHU de Reims, unité de médecine ambulatoire-cancérologie-hématologie (UMA-CH), 51092 Reims, France.
Julien
J
Volet
Louis
L
de Mestier
Florent
F
Ehrhard
Olivier
O
Bouché
D018256:Adenomatous Polyps / Q000175:diagnosis / Q000628:therapy; D000367:Age Factors; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy; D005602:France; D006801:Humans; D007159:Immunologic Tests / Q000379:methods; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D015588:Observer Variation; D009780:Occult Blood; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy