Extended neoadjuvant chemotherapy is well tolerated by patients with borderline resectable pancreatic head adenocarcinoma, selects a subset of patients for curative surgery with low perioperative morbidity, and is associated with favorable survival.

Background Information about adenosquamous carcinoma of the colon and rectum is scarce due to its extremely low incidence. Objective To examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma compared to adenocarcinoma of the colon and rectum. Design Retrospective study. Setting California Cancer Regisry data from 1994 through 2004 with follow up through 2008. Patients Surgically treated cases of cancer of the colon and rectum excluding anus with tumor histology of adenocarcinoma and adenosquamous carcinoma. Main outcome measures Histology-specific survival analyses (using Kaplan-Meier method), and overall and colorectal-specific mortality (using multivariable Cox proportional hazards regression analyses). Results A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma 99.91%, and adenosquamous carcinoma: 0.09%). There was no significant difference in sex, age, race and socioeconomic status between two groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right colon and transverse colon. The adenosquamous carcinoma group was significantly associated with higher rate of metastasis at the time of operation (adenosquamous carcinoma: 36.56% vs. adenocarcinoma: 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma: 65.96% vs. adenocarcinoma: 19.74%) compared to the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) compared with the adenosquamous carcinoma group (35.3 months). Using multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (Hazard Ratio: 1.67) and colorectal-specific mortality (Hazard Ratio: 1.69) compared with adenocarcinoma. Conclusions This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal-specific mortality compared with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic features.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.