Top-notch scientific research naturally translates into excellent clinical care for patients with early or advanced colorectal cancer.
The research within the Colorectal Cancer Center has as ultimate aim to improve the outcome of patients with colorectal cancer and to prevent colorectal cancer. The research varies from Fundamental to Translational, Clinical and Epidemiological research. For this research there is an intensive collaboration between the partners participating to this ACE, as exemplified by shared grant applications, (co-) promotorships and regular joint research meetings.
The list of grants, the wide range of studies and shared publications are examples to emphasize the multidisciplinarity of this ACE. Several members of the ACE have international collaborations, which result in international faculties, publications and student exchanges. Fundamental and translational research in this ACE has a focus on identification of prognostic factors for cancer progression and analyses of the effect of the provided treatment.
To unravel the pathogenesis and identification of biomarkers must lead to a better treatment and consequent survival. (e.g. Stemcell research, DNA/Micro-organism in stool, circulating cell free DNA and circulating tumor cells, protein analyses in urine, micro tissue array of primary tumor and metastases.
Clinical and Epidemiological research is focussing on identification on prognostic factors for different treatment opportunities and the development and optimalization of screening and surveillance programs. New treatment strategies are investigated in phase I, II and randomized controlled phase III studies. The aim of all this research is to gain insight in the development of colorectal cancer and towards personalised health and personalised medicine to reduce costs, optimize resources and an improvent of overall survival with an adequate quality of life.
The ACE participates actively in the Bachelor and Master fases. Numerous PhD students are employed in the ACE, as are master students, residents and fellows. Both SETQ and D-RECT are in broad use and the results are discussed in the staff, on which measures are taken as needed.
Moreover, the ACE organizes/is involved in regional, national and international courses on colorectal cancer. The ACE sees the construction of this Ace as an excellent opportunity to train residents and (international) fellows in a disease-directed manner, as opposed to organ-directed training. Multidisciplinary care is of the essence in this objective. We aim to offer truly multidisciplinary fellowships, with an emphasis on the fellows main specialty. Similarly, we aim to offer multidisciplinary traineeships to residents of all specialties involved in the ACE. Both developments are innovative and unprecedented.
Our goal is to train colorectal cancer doctors with a comprehensive view of the treatment of colorectal cancer, both clinically and with regard to research. They will regard multidisciplinarity as a prerogative for good colorectal cancer care, and will accept nothing less in the institutions they will work in. These will be doctors that are trained to initiate, improve and lead colorectal cancer programs on the level their institution of employment requires. By introducing this type of training, we hope to innovate and improve the care for colorectal cancer patients and oncological patients in general.
Societal Relevance to Research, Education and Patient Care
This ACE plays a major role in the care for colorectal cancer in the Netherlands. With regard to care, examples of this role are the introduction of the national screening program for colorectal cancer. Another example is the regional/national role our center plays as a tertiary referral center, but also as the main coordinator of colorectal cancer care in the Southwest region of the Netherlands (5.000.000 inhabitants).
Participants in the ACE have contributed to the national guideline for colorectal cancer and are contributing to international guidelines, such as those provided by ESMO and NCCN. Participants are involved in the medical curriculum, both in the Bachelor fase as in the organization of several minors. Participants are also involved in education of patients, through non-scientific articles, books, lectures and internet.
Viability of Research, Education and Patient Care
Multidisciplinary tumor board meets weekly, which are also attended by residents and specialists from radiology, medical oncology, surgery, radiotherapy, pathology, gynecology, and diverse PhD students. Furthermore, a multidisciplinary research group consisting of PhD students and supervisors also meet regularly.
There are currently +/- 5 master students and +/- 9 PhD students doing fundamental/translational/clinical/epidemiological research. There is no specific system for talent identification active within the ACE. A bibliometric network analysis is not available.
The reputation of some of the participants is however internationally recognized as exemplified by invited editorials, reviews, editorial board membership of medical journals, invitations to become chair/member of scientific committees for international meetings, membership and chairmen of (inter)national tumorboards and societies, membership of the Dutch Cancer Society.
Key and relevant publications of the last five years
- Secreted Phospholipases A2 Are Intestinal Stem Cell Niche Factors with Distinct Roles in Homeostasis, Inflammation, and Cancer. Schewe et al, Cell Stem Cell. 2016 Jun 7. pii: S1934-5909(16)30107-2.
- Statins augment the chemosensitivity of colorectal cancer cells inducing epigenetic reprogramming and reducing colorectal cancer cell 'stemness' via the bone morphogenetic protein pathway. Kodach et al, Gut. 2011 Nov;60(11):1544-53
- Activated tumor-infiltrating CD4+ regulatory T cells restrain antitumor immunity in patients with primary or metastatic liver cancer. Pedroza-Gonzalez et al, Hepatology.2013 Jan;57(1):183-94.
- Immunochemical faecal occult blood testing to screen for colorectal cancer: can the screening interval be extended? Haug et al, Gut. 2016 Mar 22
- Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial. Bretthauer et al, JAMA Intern Med. 2016 May 2
- Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: the CHARISMA randomized multicenter clinical trial. Ayez et al, BMC Cancer. 2015 Mar 26;15:180.
- A randomized comparison of two faecal immunochemical tests in population-based colorectal cancer. Grobbee et al, accepted for publication, Gut, 2016.
- Prognostic value of circulating tumour cells for early recurrence after resection of colorectal liver metastases.Lalmahomed et al, Br J Cancer. 2015 Feb 3;112(3):556-61.
- Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study).
- Molecular characteristics of circulating tumor cells resemble the liver metastasis more closely than the primary tumor in metastatic colorectal cancer. Onstenk et al, Oncotarget. 2016 Jun 20
PhD theses of the last five years
- Surgery for colorectal metastases, Technical aspects, prognostic factors & timing. N. Ayez, March 2016.
- Dedicated MRI of the Lower Pelvis. R.S. Dwarkasing, February 2016
- Hepatic steatosis in liver surgery: novel diagnostics and experimental therapy. H.A. Marsman, February 2012
- Stereotactic body radiation therapy for liver tumors. A. Mendez Romero, March 2011
- Teaching Colonoscopy, A. Koch, July 2014
- Yaser Atlasi. Wnt Signaling in Stem Cells and Cancer. 2013
- Colorectal cancer screening by means of repeated faecal immunochemical testing (FIT). A. Kapidzic, February 2015
- Pitfalls and Opportunities in Colorectal Cancer Screening. P. Van Putten, June 2013
- Sabrina Roth. Silent waters run deep. 2012
- Colorectal Cancer Screening: From test performance to participant experience. L. van Dam, September 2013