The RAPIDO trial compared short-course radiotherapy followed by chemotherapy and surgery to standard chemoradiotherapy, surgery, and optional adjuvant chemotherapy for locally advanced rectal cancer. The trial found that short-course radiotherapy and chemotherapy led to fewer disease-related treatment failures at 3 years compared to standard treatment, mainly by reducing distant metastases. Short-course treatment resulted in a higher rate of pathological complete response, which could allow for organ preservation in some patients.
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Highlights in the treatment of Rectal cancer.pptxMona Quenawy
rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
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rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. TOTAL NEOADJUVANT THERAPY
OF RECTAL CANCER
• Journal Club
• Mr.Mekki Hassan
• Post CCT colorectal Fellow
• Bradford Teaching hospitals Foundation trust
2. TOTAL NEOADJUVANT THERAPY
OF RECTAL CANCER
Short-course radiotherapy followed by chemotherapy
before total mesorectal excision (TME) versus
preoperative chemoradiotherapy, TME, and optional
adjuvant chemotherapy in locally advanced rectal cancer
(RAPIDO): A randomised, open-label, phase 3 trial
3. BACKGROUND
• Standard of care for locally advanced rectal cancer consists
of chemoradiotherapy followed by surgery according to total
mesorectal excision principles after 6–8 weeks. In several
countries, adjuvant chemotherapy is also part of the
standard of care. Preoperative chemoradiotherapy aims to
downstage tumours, leading to improved locoregional
control with local recurrence rates of approximately 5–
9%.unfortunately the occurrence of distant metastases has
not decreased accordingly
• Downstaging also occurs after short-course radiotherapy
followed by delayed surgery.
4. SUMMARY OF NEO ADJUVANTRECTAL
CANCER TREATMENT
Threatened CRM,T4 Dx,lateral
l.nodes
yes
TNT
no
T3b/ +ve L.nodes
no
surgery
yes
chemoradiotherapy for
5/52Short course for 1/52
5. SUMMARY OF RECTAL CANCER
SURGICAL APPROACHES
Rectal
cancer
cT1/2 No
M0
Suitable for
local
excision
TEMS/TAMIS
Not suitable
for local
excision
>cT2 orN
+ve
> 5cm
above anal
verge
AR
<5cm of
anal verge
APER/ELAPE
6. AIM
• The main objective of the RAPIDO trial was to reduce disease-
related treatment failure at 3 years with short course
radiotherapy followed by chemotherapy and total mesorectal
excision compared with standard chemoradiotherapy, total
mesorectal excision, and optional adjuvant chemotherapy.
• Disease-related treatment failure, defined as the first occurrence
of locoregional failure, distant metastasis, a new primary
colorectal tumour, or treatment-related death.
• Locoregional failure included locally progressive disease leading
to an unresectable tumour, local R2 resection, or local recurrence
after an R0–R1 resection.
7. METHODOLOGY
• Open label, randomised, controlled, phase 3 trial, done at in 54
hospitals and radiotherapy centres in seven countries (the Netherlands,
Sweden, Spain, Slovenia, Denmark, Norway, and the USA)
• Inclusion if they were aged 18 years or older, with a biopsy-proven,
newly diagnosed, primary, locally advanced rectal adenocarcinoma with
distal extension less than 16 cm from the anal verge. A pelvic MRI with
at least one of the following high-risk criteria was required: clinical
tumour (cT) stage cT4a or cT4b, extramural vascular invasion, clinical
nodal (cN) stage cN2, involved mesorectal fascia (tumour or lymph node
≤1 mm from the mesorectal fascia), or enlarged lateral lymph nodes
considered to be metastatic
8. • Exclusion criteria included extensive growth of the rectal tumour
into the cranial part of the sacrum or the lumbosacral nerve
roots.
• Recruited at the participating hospitals before commencement
of any treatment and randomly assigned (1:1) by use of the
ProMISe data management system.
• Patients in the experimental group were assigned to short-
course radiotherapy (5×5 Gy) administered over a maximum of 8
days. Chemotherapy was preferably started within 11–18 days
after the last radiotherapy fraction
• Chemotherapy: CAPOX(X8 cycles) or FOLFOX4(X12 cycles)
9. RESULTS
• Between June 21, 2011,
and June 2, 2016, 920
patients were randomly
assigned to the
experimental group (468)
or standard of care group
(452), of whom 912 (99%)
were eligible (462 in the
experimental group and
450 in the standard of care
group.
10. RESULTS
• 128 disease-related treatment
failure events in the
experimental group and 152
events in the standard of care
group, the difference between
groups in disease-related
treatment failure at 3 years was
significant, with fewer disease-
related treatment failure events
in the experimental group than
in the standard of care group
(3-year cumulative probability
of 23·7% [95% CI 19·8–27·6] vs
30·4% [26·1–34·6]; HR 0·75 [95%
CI 0·60–0·95]; p=0·019
11. eligible patients, 25
(3%) were followed
up according to the
watch-and-wait
strategy due to a
clinical complete
response (14 in the
experimental group
and 11 in the
standard of care
group).
3-year overall survival
was 89·1% (95% CI
86·3–92·0) in the
experimental group
and 88·8% (85·9–91·7)
in the standard of care
group (HR 0·92 [95% CI
0·67–1·25]
12. CONCLUSION
• Patients with high-risk locally advanced rectal cancer, the
RAPIDO trial shows that short-course radiotherapy followed
by 18 weeks of chemotherapy before surgery decreases the
probability of disease related treatment failure compared
with chemoradiotherapy with or without adjuvant
chemotherapy, mainly by reducing the probability of distant
metastases. Additionally, the high rate of pathological
complete response in the experimental group can potentially
contribute to organ preservation.
13. DISCUSSION
• Large multicentral study , randomised
• Watch and wait !
• Possible MRI downstaging or overstaging
• More chemo related adverse effects.
• Longer duration between treatment and surgery
(chance for dx progression).
14. • Thank You
• Further reading:
1- Locoregional Failure During and After Short-course
Radiotherapy followed by Chemotherapy and Surgery Compared
to Long-course Chemoradiotherapy and Surgery - A Five-year
Follow-up of the RAPIDO Trial
https://pubmed.ncbi.nlm.nih.gov/36661037/
2-Multicenter, Randomized, Phase III Trial of Short-Term
Radiotherapy Plus Chemotherapy Versus Long-Term
Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR)
https://ascopubs.org/doi/full/10.1200/JCO.21.01667