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Watch and wait cancer rectal

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https://www.readbyqxmd.com/read/29878682/session-4-trying-to-augment-response-with-chemotherapy-a-triumph-of-hope-over-experience
#1
N J Battersby, R O Perez, N Baxter, B Moran, G Brown
As part of an approach to improve tumour regression and increase the proportion of patients with complete clinical and radiological response, Dr Perez reviews the methods and evidence base for augmenting therapy and thus augmenting response rates preoperatively. Much of the data reviewed were in the context of patients undergoing a watch-and-wait approach for rectal cancer after initial treatment with chemoradiotherapy.
May 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/29784739/management-of-locoregional-rectal-cancer
#2
Christopher G Willett
The NCCN Guidelines for Rectal Cancer are now more closely aligned with those for colon cancer. A new MRI-based definition of the rectum has been included and the use of MRI in staging has been elevated in importance. There is a new emphasis on neoadjuvant therapy, especially the concurrent use of chemotherapy and radiotherapy. One of the biggest changes is more acceptance of an observational approach-"watch and wait, nonoperative management"-for select patients experiencing a complete clinical response with no evidence of residual disease after neoadjuvant therapy...
May 2018: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/29746338/oncological-and-survival-outcomes-in-watch-and-wait-patients-with-a-clinical-complete-response-after-neoadjuvant-chemoradiotherapy-for-rectal-cancer-a-systematic-review-and-pooled-analysis
#3
Mit Dattani, Richard J Heald, Ghaleb Goussous, Jack Broadhurst, Guilherme P São Julião, Angelita Habr-Gama, Rodrigo Oliva Perez, Brendan J Moran
OBJECTIVE: The aim of this study was to evaluate the oncological and survival outcomes of a Watch and Wait policy in rectal cancer after a clinical complete response (cCR) following neoadjuvant chemoradiotherapy. BACKGROUND: The detection of a cCR after neoadjuvant treatment may facilitate a nonoperative approach in selected patients. However, the long-term safety of this strategy remains to be validated. METHOD: This is a systematic review of the literature to determine the oncological outcomes in Watch and Wait patients...
May 9, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29594024/can-active-surveillance-really-reduce-the-harms-of-overdiagnosing-prostate-cancer-a-reflection-of-real-life-clinical-practice-in-the-prias-study
#4
Frank-Jan H Drost, Antti Rannikko, Riccardo Valdagni, Tom Pickles, Yoshiyuki Kakehi, Sebastiaan Remmers, Henk G van der Poel, Chris H Bangma, Monique J Roobol
Background: Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent long-term PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices. Methods: Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results...
February 2018: Translational Andrology and Urology
https://www.readbyqxmd.com/read/29576755/watch-and-wait-as-a-therapeutic-strategy-in-rectal-cancer
#5
REVIEW
Laurence Bernier, Svetlana Balyasnikova, Diana Tait, Gina Brown
Purpose of Review: Pathological complete response is seen in approximately one fifth of rectal cancer patients following neoadjuvant chemoradiation. Since these patients have excellent oncological outcomes, there has been a rapidly growing interest in organ preservation for those who develop a clinical complete response. We review the watch-and-wait strategy and focus on all aspects of this hot topic, including who should be considered for this approach, how should we identify treatment response and what are the expected outcomes...
2018: Current Colorectal Cancer Reports
https://www.readbyqxmd.com/read/29420434/quality-of-life-in-patients-with-rectal-cancer-after-chemoradiation-watch-and-wait-policy-versus-standard-resection-are-we-comparing-apples-to-oranges
#6
COMMENT
Bruna Borba Vailati, Angelita Habr-Gama, Adrian E Mattacheo, Guilherme Pagin São Julião, Rodrigo Oliva Perez
No abstract text is available yet for this article.
March 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29398323/delaying-surgery-after-neoadjuvant-chemoradiotherapy-in-rectal-cancer-has-no-influence-in-surgical-approach-or-short-term-clinical-outcomes
#7
Nuno Figueiredo, Sofoklis Panteleimonitis, Sotiris Popeskou, Jose F Cunha, Tahseen Qureshi, Geerard L Beets, Richard J Heald, Amjad Parvaiz
AIMS: In rectal cancer, increasing the interval between the end of neoadjuvant chemoradiotherapy (CRT) and surgery could improve the pathological complete response (pCR) rates, allow full-dose neoadjuvant chemotherapy, and select patients with a clinical complete response (cCR) for inclusion in a "watch & wait" program (W&W). However, controversy arises from waiting more than 8-12 weeks after CRT, as it might increase fibrosis around the total mesorectal excision (TME) plane potentially leading to technical difficulties and higher surgical morbidity...
April 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29388060/how-is-rectal-cancer-managed-a-survey-exploring-current-practice-patterns-in-canada
#8
A Crawford, J Firtell, A Caycedo-Marulanda
INTRODUCTION: Locally advanced rectal cancers are most often treated with neoadjuvant chemoradiation followed by surgical resection. However, there are differing opinions surrounding management of rectal cancer, including a lack of consensus on the optimal time interval between chemoradiation and surgery, and the management of patients with complete clinical response following neoadjuvant therapy. This study seeks to summarize management trends for rectal cancer among a sample of Canadian surgeons...
February 1, 2018: Journal of Gastrointestinal Cancer
https://www.readbyqxmd.com/read/29362144/gas-induced-susceptibility-artefacts-on-diffusion-weighted-mri-of-the-rectum-at-1-5-t-effect-of-applying-a-micro-enema-to-improve-image-quality
#9
Joost J M van Griethuysen, Elyse M Bus, Michael Hauptmann, Max J Lahaye, Monique Maas, Leon C Ter Beek, Geerard L Beets, Frans C H Bakers, Regina G H Beets-Tan, Doenja M J Lambregts
PURPOSE: Assess whether application of a micro-enema can reduce gas-induced susceptibility artefacts in Single-shot Echo Planar Imaging (EPI) Diffusion-weighted imaging of the rectum at 1.5 T. MATERIALS AND METHODS: Retrospective analysis of n = 50 rectal cancer patients who each underwent multiple DWI-MRIs (1.5 T) from 2012 to 2016 as part of routine follow-up during a watch-and-wait approach after chemoradiotherapy. From March 2014 DWI-MRIs were routinely acquired after application of a preparatory micro-enema (Microlax® ; 5 ml; self-administered shortly before acquisition); before March 2014 no bowel preparation was given...
February 2018: European Journal of Radiology
https://www.readbyqxmd.com/read/29288615/synchronous-locally-advanced-rectal-cancer-with-clinical-complete-remission-and-important-downstaging-after-neoadjuvant-radiochemotherapy-personalised-therapeutic-approach
#10
Dragoş Eugen Georgescu, Mihai Teodor Georgescu, Florin Teodor Bobircă, Teodor Florin Georgescu, Horia Doran, Traian Pătraşcu
Introduction: The current practice for patients with good response, important downstaging or complete remission after preoperative chemoradiation, is to perform surgery on the basis of initial pretherapeutical staging. In literature, varying approaches, like transanal endoscopic microsurgery and even "wait and see", are described for patients with good response after chemoradiation. However, considering the present level of available evidence, the wide-spread adoption of a "watch and wait" policy in those achieving a complete clinical remission cannot be justified...
November 2017: Chirurgia
https://www.readbyqxmd.com/read/29288190/can-we-s-ave-the-rectum-by-watchful-waiting-or-t-rans-a-nal-microsurgery-following-chemo-r-adiotherapy-versus-t-otal-mesorectal-excision-for-early-re-ctal-c-ancer-star-trec-study-protocol-for-a-multicentre-randomised-feasibility-study
#11
Anouk J M Rombouts, Issam Al-Najami, Natalie L Abbott, Ane Appelt, Gunnar Baatrup, Simon Bach, Aneel Bhangu, Karen-Lise Garm Spindler, Richard Gray, Kelly Handley, Manjinder Kaur, Ellen Kerkhof, Camilla Jensenius Kronborg, Laura Magill, Corrie A M Marijnen, Iris D Nagtegaal, Lars Nyvang, Femke P Peters, Per Pfeiffer, Cornelis Punt, Philip Quirke, David Sebag-Montefiore, Mark Teo, Nick West, Johannes H W de Wilt
INTRODUCTION: Total mesorectal excision (TME) is the highly effective standard treatment for rectal cancer but is associated with significant morbidity and may be overtreatment for low-risk cancers. This study is designed to determine the feasibility of international recruitment in a study comparing organ-saving approaches versus standard TME surgery. METHODS AND ANALYSIS: STAR-TREC trial is a multicentre international randomised, three-arm parallel, phase II feasibility study in patients with biopsy-proven adenocarcinoma of the rectum...
December 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/29248311/a-cost-effectiveness-analysis-of-contact-x-ray-brachytherapy-for-the-treatment-of-patients-with-rectal-cancer-following-a-partial-response-to-chemoradiotherapy
#12
C Rao, F M Smith, A P Martin, A S Dhadda, A Stewart, S Gollins, B Collins, T Athanasiou, A Sun Myint
AIMS: Following chemoradiotherapy in patients with rectal cancer, the addition of contact X-ray brachytherapy (CXB) in partial responders might increase the proportion of patients with a clinical complete response (cCR) and who are thus suitable for watch and wait management. However, the long-term cost-effectiveness of this approach has not been evaluated. MATERIALS AND METHODS: Decision analytical modelling and a Markov simulation were used to compare long-term costs, quality-adjusted life years (QALYs) and cost-effectiveness from a third-party payer (National Health Service) perspective for treatment strategies after chemoradiotherapy; watch and wait with CXB when a cCR was not initially achieved after external beam radiotherapy (EBRT) (WWCXB ), watch and wait with EBRT alone (WWEBRT ) and radical surgery for all patients...
March 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/29217398/is-neoadjuvant-chemoradiation-with-dose-escalation-and-consolidation-chemotherapy-sufficient-to-increase-surgery-free-and-distant-metastases-free-survival-in-baseline-ct3-rectal-cancer
#13
Guilherme Pagin São Julião, Angelita Habr-Gama, Bruna Borba Vailati, Patricia Bailão Aguilar, Jorge Sabbaga, Sérgio Eduardo Alonso Araújo, Adrian Mattacheo, Flavia Andrea Alexandre, Laura Melina Fernandez, Diogo Bugano Gomes, Joaquim Gama-Rodrigues, Rodrigo Oliva Perez
Patients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in "extended" nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3 patients undergoing standard or extended nCRT...
January 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29184475/management-of-the-complete-clinical-response
#14
REVIEW
Angelita Habr-Gama, Guilherme Pagin São Julião, Bruna Borba Vailati, Ivana Castro, Debora Raffaele
Organ preservation is considered in the management of selected patients with rectal cancer. Complete clinical response observed after neoadjuvant chemoradiation for rectal cancer is one of these cases. Patients who present complete clinical response are candidates to the watch-and-wait approach, when radical surgery is not immediately performed and is offered only to patients in the event of a local relapse. These patients are included in a strict follow-up, and up of 70% of them will never be operated during the follow-up...
November 2017: Clinics in Colon and Rectal Surgery
https://www.readbyqxmd.com/read/29134378/organ-preservation-in-rectal-cancer-after-chemoradiation-should-we-extend-the-observation-period-in-patients-with-a-clinical-near-complete-response
#15
Britt J P Hupkens, Monique Maas, Milou H Martens, Marit E van der Sande, Doenja M J Lambregts, Stéphanie O Breukink, Jarno Melenhorst, Janneke B Houwers, Christiaan Hoff, Meindert N Sosef, Jeroen W A Leijtens, Maaike Berbee, Regina G H Beets-Tan, Geerard L Beets
BACKGROUND: To assess whether extending the observation period in patients with a near clinical complete response (near cCR) after chemoradiation (CRT) leads to an impaired oncological outcome. METHODS: Patients who had a clinical complete response (cCR) 8-10 weeks after CRT restaging with magnetic resonance imaging and endoscopy were offered a watch-and-wait strategy (W&W1), while patients with a near cCR were offered to undergo local excision or a second restaging 6-12 weeks later...
January 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29112561/nodal-disease-in-rectal-cancer-patients-with-complete-tumor-response-after-neoadjuvant-chemoradiation-danger-below-calm-waters
#16
Rebeccah B Baucom, Lillias H Maguire, Sandra L Kavalukas, Timothy M Geiger, Molly M Ford, Roberta L Muldoon, M Benjamin Hopkins, Alexander T Hawkins
BACKGROUND: A subset of patients with rectal cancer who undergo neoadjuvant chemoradiation therapy will develop a complete pathologic tumor response. Complete nodal response is not universal in these patients and is difficult to assess clinically. Quantifying the risk of nodal disease would allow for targeted therapy with either radical resection or "watchful waiting." OBJECTIVE: This study aimed to identify risk factors for residual nodal disease in ypT0 rectal adenocarcinoma...
December 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28937269/dose-escalation-using-contact-x-ray-brachytherapy-papillon-for-rectal-cancer-does-it-improve-the-chance-of-organ-preservation
#17
Arthur Sun Myint, Fraser McLean Smith, Simon William Gollins, Helen Wong, Christopher Rao, Karen Whitmarsh, Raj Sripadam, Paul Rooney, Michael Jeremy Hershman, Zsolt Fekete, Kate Perkins, D Mark Pritchard
OBJECTIVE: A watch and wait policy for patients with a clinical complete response (cCR) after external beam chemoradiotherapy (EBCRT) for rectal cancer is an attractive option. However, approximately one-third of tumours will regrow, which requires surgical salvage for cure. We assessed whether contact X-ray brachytherapy (CXB) can improve organ preservation by avoiding surgery for local regrowth. METHODS: From our institutional database, we identified 200 of 573 patients treated by CXB from 2003 to 2012...
December 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28891846/quality-of-life-in-rectal-cancer-patients-after-chemoradiation-watch-and-wait-policy-versus-standard-resection-a-matched-controlled-study
#18
MULTICENTER STUDY
Britt J P Hupkens, Milou H Martens, Jan H Stoot, Maaike Berbee, Jarno Melenhorst, Regina G Beets-Tan, Geerard L Beets, Stéphanie O Breukink
BACKGROUND: Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome. OBJECTIVE: The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group)...
October 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28819868/one-level-step-section-histological-analysis-is-insufficient-to-confirm-complete-pathological-response-after-neoadjuvant-chemoradiation-for-rectal-cancer
#19
M A Pereira, A R Dias, S F Faraj, C S R Nahas, A R Imperiale, C F S Marques, G C Cotti, B C Azevedo, S C Nahas, E S de Mello, U Ribeiro
BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) for rectal cancer may lead to cure. As we currently lack reliable methods to clinically confirm the absence of disease, some patients undergo radical resection and have pathological complete response (pCR) still undergo surgery. Furthermore, it is uncertain if conventional one-level histopathological analysis is accurate enough to determine complete response. Confirming pCR is essential to determine the prognosis and to consider the patient's inclusion in trials of adjuvant therapy...
September 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28755256/rectal-sparing-approach-after-preoperative-radio-and-or-chemotherapy-resarch-in-patients-with-rectal-cancer-a-multicentre-observational-study
#20
A Barina, A De Paoli, P Delrio, M Guerrieri, A Muratore, F Bianco, D Vespa, C Asteria, E Morpurgo, A Restivo, C Coco, U Pace, C Belluco, C Aschele, S Lonardi, V Valentini, G Mantello, I Maretto, P Del Bianco, A Perin, S Pucciarelli
BACKGROUND: Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment. STUDY DESIGN: Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7-8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial...
August 2017: Techniques in Coloproctology
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