You are here
Interviews from ECCO 2017
Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial
Interview with Dr. Sheraz MarkarSheraz Markar, Clinical Lecturer working at Department of Surgery and Cancer at Imperial College, London, shared some insights on analysis of the breath volatile organic compounds for the diagnosis of oesophago-gastric cancer. Oesophageal cancer is typically diagnosed with a diagnostic endoscopy which is an expensive and invasive investigation. The primary care physician has to identify the right patient for an endoscopy. Hence it was imperative to evaluate whether or not oesophageal cancer can be non-invasively diagnosed or at least evaluate the patients at risk for oesophageal cancer who can then benefit from further endoscopy later. A study was conducted on 210 patients of which 83 had cancer and the investigators were able to diagnose cancer with a good accuracy of over 90%. They then further reduced the number of volatile organic compound based signatures in the breath analysis from thirteen and evaluated it in a multi-centre trial whose results were presented during the conference.
Interview with Prof. Serge EvrardProf. Serge Evrard, Surgical Oncologist from Bordeaux, France spoke about his team’s current focus on the metastases and to protect the normal liver. His was amongst the first teams who launched the concept of combining resection and intra-operative ablation which is now an accepted evidence-based practice. They proposed to make a small resection focused on the lesions and intra-operative ablation, for example when there are deep lesions, especially in the parenchyma, in spite of removing a lot of liver, they just inserted the needle with ultrasound control and destroyed the lesions. RAF23000 study has also demonstrated on a prospective basis that this approach is equivalent in terms of recurrences, local recurrences and the expectation of survival.
Interview with Dr. Maxime van der Valk and Prof Cornelis van der VeldeDr Maxime van der Valk and Professor Cornelis van de Velde, mentioned that there are some differences internationally but in most cases for locally advanced rectal cancer a combination of chemotherapy and radiotherapy (chemo-radiotherapy), is used as an induction treatment followed by TME surgery. About 0-25% patients have a complete pathological response, which is established after surgery. However the watch and wait approach is about identifying complete response before surgery, mostly based on imaging modalities such as endoscopy, MRI or CT scans. The International Watch and Wait database has evaluated whether it is oncologically safe to omit surgery in patients who have a complete clinical response.
Interview with Prof. Maarten HulshofIn the last 15 years there has been a big change in radiation oncology. The combination of chemotherapy plus radiation has increased the effect of radiation significantly which is clinically relevant. This means that for inoperable cases the combination of radiation plus chemotherapy has changed the intention from palliative to curative. Additionally, preoperative chemoradiation has improved the outcome of surgery significantly and is clinically relevant by about 15%, so compared to about 15 years ago where only few patients were referred to a radiation oncologist, now every patient is referred to a radiation oncologist either preoperative or curative.
Randomised phase 3 study of S-1 versus capecitabine, with bevacizumab optional in both arms, in the first-line treatment of metastatic colorectal cancer (mCRC), the SALTO study of the Dutch Colorectal Cancer Group
Interview with Prof. Cornelis (Kees) PuntProf. Kees Punt, Chairman of Department of Medical Oncology of the Academic Medical Centre, Amsterdam, Netherlands shared his interest in patients with colorectal cancer. The treatment for metastatic colorectal cancer (mCRC) has two objectives, first is to downsize the metastases in order to allow secondary resections and combination chemotherapy with a targeted agent is initiated to achieve this. Second, is if there are permanently non-resectable metastases then the option is to start with mono-chemotherapy with targeted agents (such as mono-treatment with fluoropyrimidine and oral agent capecitabine is used). The SALTO study with the Dutch colorectal cancer group compared treatment with capecitabine with the other oral agent, S-1 or oral fluoropyrimidine.
Interview with Dr. Marianne G. GurenThe presentation was ‘Two Countries (Norway and Sweden), Two Different Treatment Strategies for Rectal Cancer’. The teams in both countries chose different treatment strategies for localised rectal cancer and also maintained population-based registries with good quality data. In Sweden, the treatment was based mainly on giving short course radiotherapy and then surgery. They started using preoperative chemo-radiotherapy in an increasing rate and especially since around 2004. They had compared groups in the rectal cancer registries where they looked at all patients, around 45,000 patients and then they looked at all that were Stage 1-3 rectal cancer and also for those that had major surgery but the most important group was the ones that had major radical surgery.