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https://www.readbyqxmd.com/read/27618750/management-of-rectal-cancer-without-radical-resection
#1
Geerard L Beets, Nuno F Figueiredo, Regina G H Beets-Tan
The basis of the current treatment of rectal cancer is a radical total mesorectal excision of the rectum, and although this provides excellent oncological control, it is associated with morbidity and functional problems in cancer survivors. Organ-preservation alternatives are local excision alone for very early tumors, chemoradiation followed by either local excision of a small tumor remnant or, when there is a complete clinical response, a nonoperative watch-and-wait approach. The functional advantage of these alternatives is clear, but there is some concern about the oncological risk...
September 8, 2016: Annual Review of Medicine
https://www.readbyqxmd.com/read/27509881/long-term-outcome-of-an-organ-preservation-program-after-neoadjuvant-treatment-for-rectal-cancer
#2
Milou H Martens, Monique Maas, Luc A Heijnen, Doenja M J Lambregts, Jeroen W A Leijtens, Laurents P S Stassen, Stephanie O Breukink, Christiaan Hoff, Eric J Belgers, Jarno Melenhorst, Rob Jansen, Jeroen Buijsen, Ton G M Hoofwijk, Regina G H Beets-Tan, Geerard L Beets
BACKGROUND: The aim of this study was to establish the oncological and functional results of organ preservation with a watch-and-wait approach (W&W) and selective transanal endoscopic microsurgery (TEM) in patients with a clinical complete or near-complete response (cCR) after neoadjuvant chemoradiation for rectal cancer. METHODS: Between 2004 and 2014, organ preservation was offered if response assessment with digital rectal examination, endoscopy, and MRI showed (near) cCR...
December 2016: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/27331883/mri-for-evaluation-of-treatment-response-in-rectal-cancer
#3
Ivana M Blazic, Naomi M Campbell, Marc J Gollub
MRI plays an increasingly pivotal role in the clinical staging of rectal cancer in the baseline and post-treatment settings. An accurate evaluation of response to neoadjuvant treatment is crucial because of its major influence on patient management and quality of life. However, evaluation of treatment response is challenging for both imaging and clinical assessments owing to treatment-related inflammation and fibrosis. At one end of the spectrum are clinical yT4 rectal cancers, wherein precise post-treatment MRI evaluation of tumour spread is particularly important for avoiding unnecessary exenterative surgery...
August 2016: British Journal of Radiology
https://www.readbyqxmd.com/read/27313145/the-treatment-of-all-mri-defined-low-rectal-cancers-in-a-single-expert-centre-over-a-5-year-period-is-there-room-for-improvement
#4
M Kusters, A Slater, M Betts, R Hompes, R J Guy, O M Jones, B D George, I Lindsey, N J Mortensen, D R James, C Cunningham
AIM: Outcomes following treatment for low rectal cancers still remain inferior to those for upper rectal cancers. A clear definition of 'low' rectal cancer is lacking and consensus is more likely using a definition based on MRI criteria. This study aimed to determine disease presentation and treatment outcome of low rectal cancer based on a strict anatomical definition. METHOD: A low rectal cancer was defined as one with a lower border below the pelvic attachment of the levator muscles on sagittal MRI...
June 17, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/27306709/neoadjuvant-combined-modality-therapy-for-locally-advanced-rectal-cancer-and-its-future-direction
#5
REVIEW
Mohamed E Salem, Marion Hartley, Keith Unger, John L Marshall
Rectal cancer treatment presents a challenge, and its optimal management requires a multidisciplinary approach involving surgical, medical, and radiation oncologists. Advances in surgical techniques, radiotherapy, and medical imaging technology have transformed the therapeutic landscape and have led to substantial improvements in both local disease control and patient survival. The currently established standard of care for patients with locally advanced rectal cancer involves preoperative (neoadjuvant) concurrent radiotherapy and infusional fluorouracil-based or oral capecitabine-based chemotherapy, also known as chemoradiotherapy (CRT), followed by surgery...
June 2016: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/27238472/definitive-chemoradiotherapy-watch-and-wait-approach
#6
REVIEW
Karyn A Goodman
Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision has been the standard of care for locally advanced patients with rectal cancer. Some patients achieve a pathologic complete response (pCR) to CRT and the oncologic outcomes are particularly favorable in this group. The role of surgery in patients with a pCR is now being questioned as radical rectal resection is associated with significant morbidity and long-term effects on quality of life. In an attempt to better tailor therapy, there is an interest in a "watch-and-wait" approach in patients who have a clinical complete response (cCR) after CRT with the goal of omitting surgery and allowing for organ preservation...
July 2016: Seminars in Radiation Oncology
https://www.readbyqxmd.com/read/27190581/microrna-in-rectal-cancer
#7
REVIEW
Azadeh Azizian, Jens Gruber, B Michael Ghadimi, Jochen Gaedcke
In rectal cancer, one of the most common cancers worldwide, the proper staging of the disease determines the subsequent therapy. For those with locally advanced rectal cancer, a neoadjuvant chemoradiotherapy (CRT) is recommended before any surgery. However, response to CRT ranges from complete response (responders) to complete resistance (non-responders). To date we are not able to separate in advance the first group from the second, due to the absence of a valid biomarker. Therefore all patients receive the same therapy regardless of whether they reap benefits...
May 15, 2016: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/27175954/primary-care-of-the-prostate-cancer-survivor
#8
Erika M Noonan, Timothy W Farrell
This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated...
May 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27032644/watch-and-wait-is-surgery-always-necessary-for-rectal-cancer
#9
REVIEW
Alexander T Hawkins, Steven R Hunt
Despite decades of high-quality research, the treatment of rectal cancer remains a work in progress. The interplay between chemotherapy, radiotherapy, and surgery is under constant rearrangement and refinement. Through this all, the desire to preserve the anal sphincters and quality of life remains at the forefront. In the past decade, standard of care for stage II or III rectal cancers in the USA has been neoadjuvant chemoradiation therapy (CRT) followed by radical surgical resection of the rectum. While timing and sequence of the CRT continues to evolve, surgical resection has remained essential in treatment...
May 2016: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/27020587/kras-and-combined-kras-tp53-mutations-in-locally-advanced-rectal-cancer-are-independently-associated-with-decreased-response-to-neoadjuvant-therapy
#10
Oliver S Chow, Deborah Kuk, Metin Keskin, J Joshua Smith, Niedzica Camacho, Raphael Pelossof, Chin-Tung Chen, Zhenbin Chen, Karin Avila, Martin R Weiser, Michael F Berger, Sujata Patil, Emily Bergsland, Julio Garcia-Aguilar
BACKGROUND: The response of rectal cancers to neoadjuvant chemoradiation (CRT) is variable, but tools to predict response remain lacking. We evaluated whether KRAS and TP53 mutations are associated with pathologic complete response (pCR) and lymph node metastasis after adjusting for neoadjuvant regimen. METHODS: Retrospective analysis of 229 pretreatment biopsies from patients with stage II/III rectal cancer was performed. All patients received CRT. Patients received 0-8 cycles of FOLFOX either before or after CRT, but prior to surgical excision...
August 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/26991060/watch-and-wait-after-neoadjuvant-therapy-for-rectal-cancer
#11
M Dattani, B J Moran
No abstract text is available yet for this article.
March 17, 2016: British Journal of Surgery
https://www.readbyqxmd.com/read/26980259/locally-advanced-rectal-cancer-preliminary-results-of-rectal-preservation-after-neoadjuvant-chemoradiotherapy
#12
Carlos Alberto Vaccaro, Federico Julio Yazyi, Guillermo Ojra Quintana, Juan Pablo Santino, Mabel Edith Sardi, Damián Beder, Joaquin Tognelli, Fernando Bonadeo, José María Lastiri, Gustavo Leandro Rossi
INTRODUCTION: The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. METHODS: This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum...
May 2016: Cirugía Española
https://www.readbyqxmd.com/read/26959731/-anorectal-symptoms-after-prostate-radiotherapy
#13
Robin Krol, Robert J Smeenk, Emile N J T van Lin, Wim P M Hopman
Prostate cancer is the most common cancer in Dutch men and has a relatively good survival rate. Anorectal symptoms after irradiation of the prostate, including rectal blood loss and faecal incontinence, can have a serious impact on quality of life. On endoscopy, the Vienna Rectoscopy Score may reveal telangiectasia or other mucosal changes, but there may also be other causes of blood loss. Endoscopy or watchful waiting can be considered in patients with rectal bleeding. Sucralfate enemas, argon plasma coagulation and hyperbaric oxygen therapy are effective treatments...
2015: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/26953984/impact-of-organ-preserving-strategies-on-anorectal-function-in-patients-with-distal-rectal-cancer-following-neoadjuvant-chemoradiation
#14
COMPARATIVE STUDY
Angelita Habr-Gama, Patricio B Lynn, J Márcio N Jorge, Guilherme P São Julião, Igor Proscurshim, Joaquim Gama-Rodrigues, Laura M Fernandez, Rodrigo O Perez
BACKGROUND: Organ-preserving strategies have been considered for patients with distal rectal cancer and complete or near-complete response to neoadjuvant chemoradiation to avoid the functional consequences of radical surgery. Transanal endoscopic microsurgery and no immediate surgery (watch and wait) have been considered in selected patients. OBJECTIVE: The aim of this study is to compare anorectal function following these 2 organ-preserving strategies (transanal endoscopic microsurgery and watch and wait) for rectal cancer with complete or near-complete response to neoadjuvant chemoradiation...
April 2016: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/26953983/pathologic-complete-response-in-rectal-cancer-can-we-detect-it-lessons-learned-from-a-proposed-randomized-trial-of-watch-and-wait-treatment-of-rectal-cancer
#15
RANDOMIZED CONTROLLED TRIAL
Sergio Carlos Nahas, Caio Sergio Rizkallah Nahas, Carlos Frederico Sparapan Marques, Ulysses Ribeiro, Guilherme Cutait Cotti, Antonio Rocco Imperiale, Fernanda Cunha Capareli, Andre Tsin Chih Chen, Paulo M Hoff, Ivan Cecconello
BACKGROUND: Chemoradiotherapy has the potential to downsize and downstage tumors before surgery, decrease locoregional recurrence, and induce a complete sterilization of tumor cells for middle and low locally advanced rectal cancer. A watch-and-wait tactic has been proposed for patients with clinical complete response. OBJECTIVE: The purpose of this study was to verify our ability to identify complete clinical response in patients with rectal cancer based on clinical and radiologic criteria...
April 2016: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/26876570/contact-radiotherapy-boost-in-association-with-watch-and%C3%A2-wait-for-rectal-cancer-initial-experience-and-outcomes-from-a-shared-programme-between-a-district-general-hospital-network-and-a-regional-oncology-centre
#16
F M Smith, A Al-Amin, A Wright, J Berry, J J Nicoll, A Sun Myint
AIM: Recent data have highlighted the potential of more intensive neoadjuvant protocols to increase and sustain the rate of complete response in rectal cancer managed nonoperatively. This study aimed to review the outcome of all patients from our district general hospitals network who had received standard neoadjuvant therapy and were additionally referred to a centre of excellence for contact X-ray brachytherapy or high-dose-rate brachytherapy boost. METHOD: A retrospective, chart-based review of all patients co-managed in this manner was performed...
September 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/26734570/predictors-of-complete-response-and-disease-recurrence-following-chemoradiation-for-rectal-cancer
#17
Danielle S Bitterman, Lucas Resende Salgado, Harvey G Moore, Nicholas J Sanfilippo, Ping Gu, Ioannis Hatzaras, Kevin L Du
OBJECTIVE: Approximately 10-40% of rectal patients have a complete response (CR) to neoadjuvant chemoradiation (CRT), and these patients have improved survival. Thus, non-operative management ("watch-and-wait" approach) may be an option for select patients. We aimed to identify clinical predictors of CR following CRT. METHODS: Patients treated with definitive CRT for T3-T4, locally unresectable T1-T2, low-lying T2, and/or node-positive rectal cancer from August 2004 to February 2015 were retrospectively reviewed...
2015: Frontiers in Oncology
https://www.readbyqxmd.com/read/26705854/watch-and-wait-approach-versus-surgical-resection-after-chemoradiotherapy-for-patients-with-rectal-cancer-the-oncore-project-a-propensity-score-matched-cohort-analysis
#18
COMPARATIVE STUDY
Andrew G Renehan, Lee Malcomson, Richard Emsley, Simon Gollins, Andrew Maw, Arthur Sun Myint, Paul S Rooney, Shabbir Susnerwala, Anthony Blower, Mark P Saunders, Malcolm S Wilson, Nigel Scott, Sarah T O'Dwyer
BACKGROUND: Induction of a clinical complete response with chemoradiotherapy, followed by observation via a watch-and-wait approach, has emerged as a management option for patients with rectal cancer. We aimed to address the shortage of evidence regarding the safety of the watch-and-wait approach by comparing oncological outcomes between patients managed by watch and wait who achieved a clinical complete response and those who had surgical resection (standard care). METHODS: Oncological Outcomes after Clinical Complete Response in Patients with Rectal Cancer (OnCoRe) was a propensity-score matched cohort analysis study, that included patients of all ages diagnosed with rectal adenocarcinoma without distant metastases who had received preoperative chemoradiotherapy (45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy) at a tertiary cancer centre in Manchester, UK, between Jan 14, 2011, and April 15, 2013...
February 2016: Lancet Oncology
https://www.readbyqxmd.com/read/26649153/watch-and-wait-approach-to-rectal-cancer-a-review
#19
REVIEW
Marcos E Pozo, Sandy H Fang
In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality...
November 27, 2015: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/26625960/complete-response-after-chemoradiotherapy-in-rectal-cancer-watch-and-wait-have-we-cracked-the-code
#20
REVIEW
R Glynne-Jones, R Hughes
Patients with locally advanced rectal cancer receive preoperative chemoradiation as the standard of care, producing a pathological complete response in 10-20% and a complete clinical response (CCR) in 20-30%. Small observational studies suggest a selective non-operative management with rigorous surveillance is an option and is increasingly being advocated in many parts of the world for patients who achieve a CCR or near CCR. The assumption is that oncological outcomes for good responders, who are observed, compare favourably with patients subjected to radical surgery...
February 2016: Clinical Oncology: a Journal of the Royal College of Radiologists
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