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Watch and wait cancer rectal

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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
#1
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 Camargo, 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...
August 17, 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
#2
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...
July 28, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28742703/organ-preservation-in-ct2n0-rectal-cancer-after-neoadjuvant-chemoradiation-therapy-the-impact-of-radiation-therapy-dose-escalation-and-consolidation-chemotherapy
#3
Angelita Habr-Gama, Guilherme Pagin São Julião, Bruna Borba Vailati, Jorge Sabbaga, Patricia Bailão Aguilar, Laura Melina Fernandez, Sergio Eduardo Alonso Araújo, Rodrigo Oliva Perez
OBJECTIVE: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. BACKGROUND: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28690773/recent-advances-in-the-management-of-rectal-cancer-no-surgery-minimal-surgery-or-minimally-invasive-surgery
#4
REVIEW
Joseph M Plummer, Pierre-Anthony Leake, Matthew R Albert
Over the last decade, with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer, there has been a significant increase in the literature regarding treatment options available to patients affected by this disease. That treatment related decisions should be made at a high volume multidisciplinary tumor board, after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision (TME) are accepted standard of care. More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders, which may be appropriate in 20% of patients...
June 27, 2017: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28686505/what-conclusions-can-be-drawn-from-the-stockholm-iii-rectal-cancer-trial-in-the-era-of-watch-and-wait
#5
B Glimelius, A Martling
No abstract text is available yet for this article.
July 7, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28676107/study-protocol-multi-parametric-magnetic-resonance-imaging-for-therapeutic-response-prediction-in-rectal-cancer
#6
Trang Thanh Pham, Gary Liney, Karen Wong, Robba Rai, Mark Lee, Daniel Moses, Christopher Henderson, Michael Lin, Joo-Shik Shin, Michael Bernard Barton
BACKGROUND: Response to neoadjuvant chemoradiotherapy (CRT) of rectal cancer is variable. Accurate imaging for prediction and early assessment of response would enable appropriate stratification of management to reduce treatment morbidity and improve therapeutic outcomes. Use of either diffusion weighted imaging (DWI) or dynamic contrast enhanced (DCE) imaging alone currently lacks sufficient sensitivity and specificity for clinical use to guide individualized treatment in rectal cancer...
July 4, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28655076/-diagnosis-and-treatment-strategy-for-clinical-complete-responders-after-chemoradiotherapy-for-rectal-cancer-is-watch-and-wait-policy-safe
#7
H W Yao, Y H Liu
Neo-adjuvant chemoradiotherapy (NACRT) combined with total mesorectal excision (TME) surgery is the main treatment for locally advanced middle-low rectal cancer, and NACRT significantly improves the local control rate of rectal cancer. According to the current guidelines, patients who receive clinical complete response (cCR) after NACRT are recommended for treatment with TME surgery. A few studies have shown that the watch-and-wait (WAW) policy is safe and could ensure anorectal function and quality of life in patients with cCR...
July 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28609648/when-no-treatment-is-the-best-treatment-active-surveillance-strategies-for-low-risk-prostate-cancers
#8
REVIEW
V Stavrinides, C C Parker, C M Moore
Although the incidence of prostate cancer is rising due to PSA screening and increased life expectancy, the metastatic potential of low-grade, organ-confined disease remains low. An increasing number of studies suggest that radical treatment in such cases confers little or no survival benefit at a significant cost to morbidity. Active surveillance is a promising management approach of such low-risk cancers: eligible patients are selected based on clinical and pathological findings at diagnosis and are regularly monitored with digital rectal examinations, PSA testing and biopsies...
July 2017: Cancer Treatment Reviews
https://www.readbyqxmd.com/read/28537787/the-feasibility-of-short-course-radiotherapy-in-a-watch-and-wait-policy-for-rectal-cancer
#9
K Bujko, L Pietrzak, M Partycki, M Szczepkowski, L Wyrwicz, M Rupiński, A Rutkowski, A Mróz
No abstract text is available yet for this article.
May 24, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28501249/new-strategies-in-rectal-cancer
#10
REVIEW
Guilherme Pagin São Julião, Angelita Habr-Gama, Bruna Borba Vailati, Sergio Eduardo Alonso Araujo, Laura Melina Fernandez, Rodrigo Oliva Perez
In recent years, our understanding of rectal cancer has improved, including how locally advanced disease responds to chemotherapy and radiation. This has led to new innovations and advances in the treatment of rectal cancer, which includes organ-preserving strategies for responsive disease, and minimally invasive approaces for the performance of total mesorectal excision/protectomyh for persistently advanced disease. This article discusses new strategies for rectal cancer therapy, including Watch and Wait, local excision, minimally invasive proctectomy, and transanal total mesorectal excision particularly in the setting of preoperative multimodality treatment...
June 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28479373/what-is-there-to-learn-for-watch-and-wait-in-rectal-cancer
#11
Maxime J M van der Valk, Denise E Hilling, Cornelis J H van de Velde
No abstract text is available yet for this article.
May 4, 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28479372/a-watch-and-wait-approach-for-locally-advanced-rectal-cancer-after-a-clinical-complete-response-following-neoadjuvant-chemoradiation-a-systematic-review-and-meta-analysis
#12
Fahima Dossa, Tyler R Chesney, Sergio A Acuna, Nancy N Baxter
BACKGROUND: A watch-and-wait approach for patients with clinical complete response to neoadjuvant chemoradiation could avoid the morbidity of conventional surgery for rectal cancer. However, the safety of this approach is unclear. We synthesised the evidence for watch-and-wait as a treatment for rectal cancer. METHODS: We systematically searched MEDLINE, Embase, and the grey literature (up to June 28, 2016) for studies of patients with rectal adenocarcinoma managed by watch-and-wait after complete clinical response to neoadjuvant chemoradiation...
May 4, 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28476941/systemic-chemotherapy-as-salvage-treatment-for-locally-advanced-rectal-cancer-patients-who-fail-to-respond-to-standard-neoadjuvant-chemoradiotherapy
#13
Francesco Sclafani, Gina Brown, David Cunningham, Sheela Rao, Paris Tekkis, Diana Tait, Federica Morano, Chiara Baratelli, Eleftheria Kalaitzaki, Shahnawaz Rasheed, David Watkins, Naureen Starling, Andrew Wotherspoon, Ian Chau
BACKGROUND: The potential of chemotherapy as salvage treatment after failure of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC) has never been explored. We conducted a single-center, retrospective analysis to address this question. PATIENTS AND METHODS: Patients with newly diagnosed LARC who were inoperable or candidates for extensive (i.e., beyond total mesorectal excision [TME]) surgery after long-course chemoradiotherapy and who received salvage chemotherapy were included...
June 2017: Oncologist
https://www.readbyqxmd.com/read/28462648/predicting-response-to-neoadjuvant-chemoradiotherapy-in-locally-advanced-rectal-cancer-with-serum-biomarkers
#14
T L Clarke, D A White, M E Osborne, A M Shaw, N J Smart, I R Daniels
Introduction The aim of this study was to identify patient factors including serum biomarkers that may predict response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer staged on magnetic resonance imaging. Prediction of response may be helpful when selecting patients for a non-operative programme. Methods A retrospective review was carried out of patients undergoing neoadjuvant CRT for rectal cancer, conducted at the Royal Devon and Exeter Hospital. All patients were managed through the multidisciplinary team...
May 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28440523/-outcome-of-watch-and-wait-strategy-or-organ-preservation-for-rectal-cancer-following-neoadjuvant-chemoradiotherapy-report-of-35-cases-from-a-single-cancer-center
#15
Aiwen Wu, Lin Wang, Changzheng Du, Yifan Peng, Yunfeng Yao, Jun Zhao, Tiancheng Zhan, Yong Cai, Yongheng Li, Yingshi Sun, Jiafu Ji
OBJECTIVE: To investigate the safety and efficacy of organ preservation surgery or "watch and wait" strategy for rectal cancer patients who are evaluated as clinical complete response(cCR) or near-cCR following neoadjuvant chemoradiotherapy (nCRT). METHOD: From March 2011 to June 2016, 35 patients with mid-low rectal cancers who were diagnosed as cCR or near-cCR following nCRT underwent organ preservation surgery with local excision or surveillance following "watch and wait" strategy in the Peking University Cancer Hospital...
April 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28324284/nonoperative-management-or-watch-and-wait-for-rectal-cancer-with-complete-clinical-response-after-neoadjuvant-chemoradiotherapy-a-critical-appraisal
#16
Tarik Sammour, Brandee A Price, Kate J Krause, George J Chang
BACKGROUND: There is increasing interest in nonoperative management (NOM) for rectal cancer with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT). OBJECTIVE: The aim of this systematic review was to summarize the available data on NOM, with the intention of formulating standardized protocols on which to base future investigations. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted...
July 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28267003/prediction-of-pathological-complete-response-using-endoscopic-findings-and-outcomes-of-patients-who-underwent-watchful-waiting-after-chemoradiotherapy-for-rectal-cancer
#17
COMPARATIVE STUDY
Kazushige Kawai, Soichiro Ishihara, Hiroaki Nozawa, Keisuke Hata, Tomomichi Kiyomatsu, Teppei Morikawa, Masashi Fukayama, Toshiaki Watanabe
BACKGROUND: Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. OBJECTIVE: This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach...
April 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28256956/on-a-prolonged-interval-between-rectal-cancer-chemo-radiotherapy-and-surgery
#18
Bengt Glimelius
Preoperative radiotherapy (RT) or chemoradiotherapy (CRT) is often required before rectal cancer surgery to obtain low local recurrence rates or, in locally advanced tumours, to radically remove the tumour. RT/CRT in tumours responding completely can allow an organ-preserving strategy. The time from the end of the RT/CRT to surgery or to the decision not to operate has been prolonged during recent years. After a brief review of the literature, the relevance of the time interval to surgery is discussed depending upon the indication for RT/CRT...
March 2017: Upsala Journal of Medical Sciences
https://www.readbyqxmd.com/read/28177997/outcome-and-salvage-surgery-following-watch-and-wait-for-rectal-cancer-after-neoadjuvant-therapy-a-systematic-review
#19
REVIEW
Joseph C Kong, Glen R Guerra, Satish K Warrier, Robert G Ramsay, Alexander G Heriot
BACKGROUND: Currently there is no reliable test to predict pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer. However, there is increasing interest in using clinical complete response as a surrogate marker, allowing a subset of patients with locally advanced rectal cancer to be allocated into a "watch and wait" pathway. Little is known about the oncological safety of the "watch and wait" approach or the rate of salvage surgery in cases of tumor regrowth...
March 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27997526/organ-preservation-with-local-excision-or-active-surveillance-following-chemoradiotherapy-for-rectal-cancer
#20
MULTICENTER STUDY
B Creavin, E Ryan, S T Martin, A Hanly, P R O'Connell, K Sheahan, D C Winter
BACKGROUND: Organ preservation has been proposed as an alternative to radical surgery for rectal cancer to reduce morbidity and mortality, and to improve functional outcome. METHODS: Locally advanced non-metastatic rectal cancers were identified from a prospective database. Patients staged ⩾T3 or any stage N+ were referred for neoadjuvant chemoradiotherapy (CRT) (50-54 Gy and 5-fluorouracil), and were reassessed 6-8 weeks post treatment. An active surveillance programme ('watch and wait') was offered to patients who were found to have a complete endoluminal response...
January 17, 2017: British Journal of Cancer
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