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  1. Article: A narrative review of the evolving role of immunotherapy in the management of esophageal and gastric cancer.

    Madan, Ankit / Uronis, Hope E / Strickler, John H

    Journal of gastrointestinal oncology

    2022  Volume 13, Issue 4, Page(s) 2007–2019

    Abstract: Background and objective: Despite recent advances in the multidisciplinary management of esophagogastric cancer, overall prognosis remains poor. There is a need for improved treatment options, along with predictive biomarkers that improve therapeutic ... ...

    Abstract Background and objective: Despite recent advances in the multidisciplinary management of esophagogastric cancer, overall prognosis remains poor. There is a need for improved treatment options, along with predictive biomarkers that improve therapeutic decision-making.
    Methods: We conducted an extensive review of immunotherapy articles in the PubMed database between December 2013 and October 2021. Articles in English were included. We included phase 1, 2, and 3 clinical trials for immunotherapy review, and prospective, retrospective, and meta-analyses for biomarker review.
    Key content and findings: Initial studies of immunotherapy were performed in patients with relapsed refractory metastatic disease and demonstrated a modest survival benefit. Subsequent studies have evaluated the use of these agents in combination with first line chemotherapy for metastatic disease. Finally, recent data indicates that immunotherapy in the adjuvant setting after concurrent chemoradiation and surgery improves disease free survival. Both microsatellite instability high (MSI-H) status and Epstein-Barr virus (EBV) positivity predict response to immunotherapy, but many patients without these biomarkers still benefit. The predictive impact of programmed cell death-ligand 1 (PD-L1) expression and tumor mutational burden (TMB) have been variable, and the optimal cutoff point for these biomarkers remains poorly defined.
    Conclusions: While immunotherapy agents have demonstrated clinical benefit and are now incorporated into the current standard of care, novel immunotherapy approaches such as dual immunotherapy combinations, chimeric antigen receptor (CAR) T cells, and tumor vaccines need to be further investigated. As the era of precision medicine beckons, refined biomarkers to predict benefit are needed.
    Language English
    Publishing date 2022-09-02
    Publishing country China
    Document type Journal Article ; Review
    ZDB-ID 2594644-4
    ISSN 2219-679X ; 2078-6891
    ISSN (online) 2219-679X
    ISSN 2078-6891
    DOI 10.21037/jgo-22-55
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  2. Article ; Online: Hepatic artery infusion for unresectable colorectal cancer liver metastases: Palliation and conversion.

    Zaidi, Mohammad Y / Nussbaum, Daniel P / Hsu, Shiaowen David / Strickler, John H / Uronis, Hope E / Zani, Sabino / Allen, Peter J / Lidsky, Michael E

    Surgery

    2023  Volume 174, Issue 2, Page(s) 428–430

    Abstract: Patients with unresectable colorectal liver metastases are commonly treated with systemic chemotherapy to convert their disease to an operable state. Unfortunately, many patients remain unresectable after first-line chemotherapy and resort to second- and ...

    Abstract Patients with unresectable colorectal liver metastases are commonly treated with systemic chemotherapy to convert their disease to an operable state. Unfortunately, many patients remain unresectable after first-line chemotherapy and resort to second- and third-line regimens with poor results. Liver-directed strategies have historically been used in this setting. There has been a renewed interest in offering hepatic artery infusion chemotherapy combined with systemic chemotherapy to improve resectability or palliate disease. Prospective studies over the past 2 decades have produced encouraging data, even in chemorefractory patients. This therapy has expanded to multiple centers across North America and worldwide with similar results. This review addresses these data, specifically focusing on conversion to resection and palliation of colorectal liver metastases after patients have received multiple lines of systemic chemotherapy.
    MeSH term(s) Humans ; Hepatic Artery/pathology ; Prospective Studies ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Colorectal Neoplasms/pathology ; Infusions, Intra-Arterial ; Liver Neoplasms/drug therapy ; Liver Neoplasms/surgery ; Liver Neoplasms/secondary ; Fluorouracil/therapeutic use
    Chemical Substances Fluorouracil (U3P01618RT)
    Language English
    Publishing date 2023-05-12
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.04.025
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  3. Article ; Online: mHealth Coping Skills Training for Symptom Management (mCOPE) for colorectal cancer patients in early to mid-adulthood: Study protocol for a randomized controlled trial.

    Hyland, Kelly A / Amaden, Grace H / Diachina, Allison K / Miller, Shannon N / Dorfman, Caroline S / Berchuck, Samuel I / Winger, Joseph G / Somers, Tamara J / Keefe, Francis J / Uronis, Hope E / Kelleher, Sarah A

    Contemporary clinical trials communications

    2023  Volume 33, Page(s) 101126

    Abstract: ... by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family ... accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms ... or standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation ...

    Abstract Background: Colorectal cancer (CRC) patients in early to mid-adulthood (≤50 years) are challenged by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family, work). Cognitive behavioral theory (CBT)-based coping skills training interventions reduce symptoms and improve quality of life in cancer patients. However, traditional CBT-based interventions are not accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms within the context of this stage of life. We developed a mobile health (mHealth) coping skills training program for pain, fatigue and distress (mCOPE) for CRC patients in early to mid-adulthood. We utilize a randomized controlled trial to test the extent to which mCOPE reduces pain, fatigue and distress (multiple primary outcomes) and improves quality of life and symptom self-efficacy (secondary outcomes).
    Methods/design: Patients (N = 160) ≤50 years with CRC endorsing pain, fatigue and/or distress are randomized 1:1 to mCOPE or standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation, activity pacing, cognitive restructuring) that was adapted for CRC patients in early to mid-adulthood. mCOPE utilizes mHealth technology (e.g., videoconference, mobile app) to deliver coping skills training, capture symptom and skills use data, and provide personalized support and feedback. Self-report assessments are completed at baseline, post-treatment (5-8 weeks post-baseline; primary endpoint), and 3- and 6-months later.
    Conclusions: mCOPE is innovative and potentially impactful for CRC patients in early to mid-adulthood. Hypothesis confirmation would demonstrate initial efficacy of a mHealth cognitive behavioral intervention to reduce symptom burden in younger CRC patients.
    Language English
    Publishing date 2023-04-05
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2451-8654
    ISSN (online) 2451-8654
    DOI 10.1016/j.conctc.2023.101126
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  4. Article ; Online: Feasibility, engagement, and acceptability of a behavioral pain management intervention for colorectal cancer survivors with pain and psychological distress: data from a pilot randomized controlled trial.

    Kelleher, Sarah A / Fisher, Hannah M / Winger, Joseph G / Somers, Tamara J / Uronis, Hope E / Wright, Arianna N / Keefe, Francis J

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2021  Volume 29, Issue 9, Page(s) 5361–5369

    Abstract: ... i.e., accrual, attrition, and adherence to study procedures), engagement, acceptability, and ...

    Abstract Purpose: Colorectal cancer survivors report pain and psychological distress to be burdensome long-term cancer consequences. Quality cancer survivorship care includes interventions for managing these symptoms. Yet, no studies have tested the efficacy of an accessible behavioral intervention for colorectal cancer survivors with pain and comorbid psychological distress. This paper reports on the feasibility (i.e., accrual, attrition, and adherence to study procedures), engagement, acceptability, and descriptive outcomes of a telephone-based coping skills training (CST) intervention.
    Methods: This randomized pilot trial assigned colorectal cancer patients (N=31) to 5 sessions of CST or standard care. CST sessions focused on cognitive-behavioral theory-based coping skills tailored to colorectal cancer symptoms of pain and psychological distress. Participants completed assessments of pain severity, self-efficacy for pain management, health-related quality of life, and psychological distress at baseline, post-treatment, and 3-month follow-up.
    Results: Data indicated strong feasibility, evidenced by high completion rates for intervention sessions and assessments (93% completed all sessions; M=48.7 days; baseline=100%; post-treatment=97%; 3-month follow-up=94%). Participants demonstrated robust engagement with CST (M days per week with reported skills use=3.8) and reported high protocol satisfaction (M=3.6/4.0). Descriptive statistics showed self-efficacy for pain management and health-related quality of life improved for all participants.
    Conclusion: Findings suggest that a telephone-based CST intervention has strong feasibility, evidenced by accrual, low attrition, and adherence to intervention sessions and assessments. Likewise, participant engagement and acceptability with CST were high. These data provide a foundation for larger randomized efficacy trials of the telephone-based CST intervention.
    MeSH term(s) Adaptation, Psychological ; Cancer Survivors ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/therapy ; Feasibility Studies ; Health Behavior ; Humans ; Pain ; Pain Management ; Pilot Projects ; Psychological Distress ; Quality of Life
    Language English
    Publishing date 2021-03-08
    Publishing country Germany
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-021-06126-8
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    Zs.A 3697: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Trends in Receipt of Adjuvant Chemotherapy and its Impact on Survival in Resected Biliary Tract Cancers.

    Rhodin, Kristen E / Liu, Annie / Bartholomew, Alex / Kramer, Ryan / Parameswaran, Anika / Uronis, Hope / Strickler, John / Hsu, David / Morse, Michael A / Shah, Kevin N / Herbert, Garth / Zani, Sabino / Nussbaum, Daniel P / Allen, Peter J / Lidsky, Michael E

    Annals of surgical oncology

    2023  Volume 30, Issue 8, Page(s) 4813–4821

    Abstract: Background: Resection remains the cornerstone of curative-intent treatment for biliary tract cancers (BTCs). However, recent randomized data also support a role for adjuvant chemotherapy (AC). This study aimed to characterize trends in the use of AC and ...

    Abstract Background: Resection remains the cornerstone of curative-intent treatment for biliary tract cancers (BTCs). However, recent randomized data also support a role for adjuvant chemotherapy (AC). This study aimed to characterize trends in the use of AC and subsequent outcomes in gallbladder cancer and cholangiocarcinoma (CCA).
    Methods: The National Cancer Database (NCDB) was queried for patients with resected, localized BTC from 2010 to 2018. Trends in AC were compared among BTC subtypes and stages of disease. Multivariable logistic regression was used to identify factors associated with receipt of AC. Survival analysis was performed with Kaplan-Meier and multivariable Cox proportional hazards methods.
    Results: The study identified 7039 patients: 4657 (66%) with gallbladder cancer, 1159 (17%) with intrahepatic CCA (iCCA), and 1223 (17%) with extrahepatic CCA (eCCA). Adjuvant chemotherapy was administered to 2172 (31%) patients, increasing from 23% in 2010 to 41% in 2018. Factors associated with AC included female sex, year of diagnosis, private insurance, care at an academic center, higher education, eCCA (vs iCCA), positive margins, and stage II or III disease (vs stage I). Alternatively, increasing age, higher comorbidity score, gallbladder cancer (vs iCCA), and farther travel distance for treatment were associated with reduced odds of AC. Overall, AC was not associated with a survival advantage. However, subgroup analysis showed that AC was associated with a significant reduction in mortality among patients with eCCA.
    Conclusions: Among the patients with resected BTC, those who received AC were in the minority. In the context of recent randomized data and evolving recommendations, emphasis on guideline concordance with a focus on at-risk populations may improve outcomes.
    MeSH term(s) Humans ; Female ; Gallbladder Neoplasms/drug therapy ; Gallbladder Neoplasms/surgery ; Gallbladder Neoplasms/pathology ; Biliary Tract Neoplasms/drug therapy ; Biliary Tract Neoplasms/surgery ; Biliary Tract Neoplasms/pathology ; Cholangiocarcinoma/pathology ; Chemotherapy, Adjuvant ; Bile Duct Neoplasms/pathology ; Bile Ducts, Intrahepatic/pathology
    Language English
    Publishing date 2023-05-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-13567-4
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    Zs.A 4042: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Virtual reality for improving pain and pain-related symptoms in patients with advanced stage colorectal cancer: A pilot trial to test feasibility and acceptability.

    Kelleher, Sarah A / Fisher, Hannah M / Winger, Joseph G / Miller, Shannon N / Amaden, Grace H / Somers, Tamara J / Colloca, Luana / Uronis, Hope E / Keefe, Francis J

    Palliative & supportive care

    2022  Volume 20, Issue 4, Page(s) 471–481

    Abstract: Objective: Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related ... ...

    Abstract Objective: Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related symptoms in advanced colorectal cancer patients. A qualitative exit interview was conducted to understand preferences, thoughts, and feelings about the VR session.
    Method: Participants (
    Results: All participants (100%) completed the VR Blue session. There was 100% data collection at the pre- and post-assessments. Satisfaction with VR Blue was high
    Significance of results: This work supports the feasibility, acceptability, and safety of VR Blue for advanced colorectal cancer patients. Participants showed significant pre-post improvement in pain and pain-related symptoms hinting to the potential feasibility of VR interventions in this population. Larger, randomized trials with a control condition are needed to examine the efficacy of VR-based interventions for patients with advanced colorectal cancer and pain.
    MeSH term(s) Colorectal Neoplasms/complications ; Colorectal Neoplasms/therapy ; Feasibility Studies ; Humans ; Pain/etiology ; Pilot Projects ; Virtual Reality
    Language English
    Publishing date 2022-01-22
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2454009-2
    ISSN 1478-9523 ; 1478-9515
    ISSN (online) 1478-9523
    ISSN 1478-9515
    DOI 10.1017/S1478951521002017
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  7. Article ; Online: CT-derived body composition measurements as predictors for neoadjuvant treatment tolerance and survival in gastroesophageal adenocarcinoma.

    DeFreitas, Mariana R / Toronka, Amadu / Nedrud, Marybeth A / Cubberley, Sarah / Zaki, Islam H / Konkel, Brandon / Uronis, Hope E / Palta, Manisha / Blazer, Dan G / Lafata, Kyle J / Bashir, Mustafa R

    Abdominal radiology (New York)

    2022  Volume 48, Issue 1, Page(s) 211–219

    Abstract: Purpose: Treatment for gastroesophageal adenocarcinomas can result in significant morbidity and mortality. The purpose of this study is to supplement methods for choosing treatment strategy by assessing the relationship between CT-derived body ... ...

    Abstract Purpose: Treatment for gastroesophageal adenocarcinomas can result in significant morbidity and mortality. The purpose of this study is to supplement methods for choosing treatment strategy by assessing the relationship between CT-derived body composition, patient, and tumor features, and clinical outcomes in this population.
    Methods: Patients with neoadjuvant treatment, biopsy-proven gastroesophageal adenocarcinoma, and initial staging CTs were retrospectively identified from institutional clinic encounters between 2000 and 2019. Details about patient, disease, treatment, and outcomes (including therapy tolerance and survival) were extracted from electronic medical records. A deep learning semantic segmentation algorithm was utilized to measure cross-sectional areas of skeletal muscle (SM), visceral fat (VF), and subcutaneous fat (SF) at the L3 vertebra level on staging CTs. Univariate and multivariate analyses were performed to assess the relationships between predictors and outcomes.
    Results: 142 patients were evaluated. Median survival was 52 months. Univariate and multivariate analysis showed significant associations between treatment tolerance and SM and VF area, SM to fat and VF to SF ratios, and skeletal muscle index (SMI) (p = 0.004-0.04). Increased survival was associated with increased body mass index (BMI) (p = 0.01) and increased SMI (p = 0.004). A multivariate Cox model consisting of BMI, SMI, age, gender, and stage demonstrated that patients in the high-risk group had significantly lower survival (HR = 1.77, 95% CI = 1.13-2.78, p = 0.008).
    Conclusion: CT-based measures of body composition in patients with gastroesophageal adenocarcinoma may be independent predictors of treatment complications and survival and can supplement methods for assessing functional status during treatment planning.
    MeSH term(s) Humans ; Neoadjuvant Therapy ; Retrospective Studies ; Body Composition ; Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/therapy ; Tomography, X-Ray Computed/methods ; Prognosis
    Language English
    Publishing date 2022-10-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2839786-1
    ISSN 2366-0058 ; 2366-004X
    ISSN (online) 2366-0058
    ISSN 2366-004X
    DOI 10.1007/s00261-022-03695-y
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    Zs.A 1262: Show issues Location:
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  8. Article ; Online: mHealth Coping Skills Training for Symptom Management (mCOPE) for colorectal cancer patients in early to mid-adulthood

    Kelly A. Hyland / Grace H. Amaden / Allison K. Diachina / Shannon N. Miller / Caroline S. Dorfman / Samuel I. Berchuck / Joseph G. Winger / Tamara J. Somers / Francis J. Keefe / Hope E. Uronis / Sarah A. Kelleher

    Contemporary Clinical Trials Communications, Vol 33, Iss , Pp 101126- (2023)

    Study protocol for a randomized controlled trial

    2023  

    Abstract: ... by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family ... accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms ... standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation, activity ...

    Abstract Background: Colorectal cancer (CRC) patients in early to mid-adulthood (≤50 years) are challenged by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family, work). Cognitive behavioral theory (CBT)-based coping skills training interventions reduce symptoms and improve quality of life in cancer patients. However, traditional CBT-based interventions are not accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms within the context of this stage of life. We developed a mobile health (mHealth) coping skills training program for pain, fatigue and distress (mCOPE) for CRC patients in early to mid-adulthood. We utilize a randomized controlled trial to test the extent to which mCOPE reduces pain, fatigue and distress (multiple primary outcomes) and improves quality of life and symptom self-efficacy (secondary outcomes). Methods/Design: Patients (N = 160) ≤50 years with CRC endorsing pain, fatigue and/or distress are randomized 1:1 to mCOPE or standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation, activity pacing, cognitive restructuring) that was adapted for CRC patients in early to mid-adulthood. mCOPE utilizes mHealth technology (e.g., videoconference, mobile app) to deliver coping skills training, capture symptom and skills use data, and provide personalized support and feedback. Self-report assessments are completed at baseline, post-treatment (5–8 weeks post-baseline; primary endpoint), and 3- and 6-months later. Conclusions: mCOPE is innovative and potentially impactful for CRC patients in early to mid-adulthood. Hypothesis confirmation would demonstrate initial efficacy of a mHealth cognitive behavioral intervention to reduce symptom burden in younger CRC patients.
    Keywords Colorectal cancer ; Symptom management ; Psycho-oncology ; mHealth ; Medicine (General) ; R5-920
    Subject code 616 ; 150
    Language English
    Publishing date 2023-06-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
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  9. Article ; Online: Hepatic Artery Infusion Pumps: A Surgical Toolkit for Intraoperative Decision-Making and Management of Hepatic Artery Infusion-Specific Complications.

    Sharib, Jeremy M / Creasy, John M / Wildman-Tobriner, Benjamin / Kim, Charles / Uronis, Hope / Hsu, Shiaowen David / Strickler, John H / Gholami, Sepideh / Cavnar, Michael / Merkow, Ryan P / Kingham, Peter / Kemeny, Nancy / Zani, Sabino / Jarnagin, William R / Allen, Peter J / D'Angelica, Michael I / Lidsky, Michael E

    Annals of surgery

    2022  Volume 276, Issue 6, Page(s) 943–956

    Abstract: Background: Hepatic artery infusion (HAI) is a liver-directed therapy that delivers high-dose chemotherapy to the liver through the hepatic arterial system for colorectal liver metastases and intrahepatic cholangiocarcinoma. Utilization of HAI is ... ...

    Abstract Background: Hepatic artery infusion (HAI) is a liver-directed therapy that delivers high-dose chemotherapy to the liver through the hepatic arterial system for colorectal liver metastases and intrahepatic cholangiocarcinoma. Utilization of HAI is rapidly expanding worldwide.
    Objective and methods: This review describes the conduct of HAI pump implantation, with focus on common technical pitfalls and their associated solutions. Perioperative identification and management of common postoperative complications is also described.
    Results: HAI therapy is most commonly performed with the surgical implantation of a subcutaneous pump, and placement of its catheter into the hepatic arterial system for inline flow of pump chemotherapy directly to the liver. Intraoperative challenges and abnormal hepatic perfusion can arise due to aberrant anatomy, vascular disease, technical or patient factors. However, solutions to prevent or overcome technical pitfalls are present for the majority of cases. Postoperative HAI-specific complications arise in 22% to 28% of patients in the form of pump pocket (8%-18%), catheter (10%-26%), vascular (5%-10%), or biliary (2%-8%) complications. The majority of patients can be rescued from these complications with early identification and aggressive intervention to continue to deliver safe and effective HAI therapy.
    Conclusions: This HAI toolkit provides the HAI team a reference to manage commonly encountered HAI-specific perioperative obstacles and complications. Overcoming these challenges is critical to ensure safe and effective pump implantation and delivery of HAI therapy, and key to successful implementation of new programs and expansion of HAI to patients who may benefit from such a highly specialized treatment strategy.
    MeSH term(s) Humans ; Hepatic Artery/surgery ; Hepatic Artery/pathology ; Infusions, Intra-Arterial/adverse effects ; Colorectal Neoplasms/pathology ; Infusion Pumps, Implantable/adverse effects ; Liver Neoplasms/surgery ; Antineoplastic Combined Chemotherapy Protocols
    Language English
    Publishing date 2022-03-09
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005434
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  10. Article ; Online: Is bevacizumab effective and safe in combination with chemotherapy in patients with colorectal cancer?

    Uronis, Hope E / Hurwitz, Herbert I

    Nature clinical practice. Oncology

    2007  Volume 4, Issue 4, Page(s) 214–215

    Language English
    Publishing date 2007-04
    Publishing country England
    Document type Comment ; Journal Article
    ZDB-ID 2173301-6
    ISSN 1743-4262 ; 1743-4254
    ISSN (online) 1743-4262
    ISSN 1743-4254
    DOI 10.1038/ncponc0748
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