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Rectal Cancer and complete response

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
Xin Yu, Qiao-Xuan Wang, Wei-Wei Xiao, Hui Chang, Zhi-Fan Zeng, Zhen-Hai Lu, Xiao-Jun Wu, Gong Chen, Zhi-Zhong Pan, De-Sen Wan, Pei-Rong Ding, Yuan-Hong Gao
BACKGROUND: Neoadjuvant chemoradiotherapy followed by surgery is recommended as the standard of care for locally advanced rectal cancer, reducing local recurrence but not distant metastasis. Intensified systemic therapy is warranted to reduce the risk of distant metastasis. The present study aimed to evaluate the safety and efficacy of neoadjuvant oxaliplatin and capecitabine (XELOX) combined with bevacizumab plus radiotherapy for locally advanced rectal cancer. METHODS: Patients with stages II to III rectal cancer received one cycle of induction chemotherapy and concurrent chemoradiotherapy with XELOX plus bevacizumab...
May 21, 2018: Cancer communications
Medhat Aker, Darren Boone, Anuradha Chandramohan, Bruce Sizer, Roger Motson, Tan Arulampalam
BACKGROUND: The diagnostic accuracy of Magnetic Resonance Imaging (MRI) in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemo-radio therapy (NCRT) has been under recent scrutiny. There is limited data on the accuracy of MRI and its timing in assessing tumor regression grade (TRG) and in identifying patients with complete response (CR). NCRT seems to cause tissue inflammation and oedema which renders reading the scans difficult for radiologist. AIM: This study aims to assess the accuracy of MRI at different time intervals after NCRT in staging TRG and in identifying CR...
May 16, 2018: Abdominal Radiology
Yong Joon Lee, Sat Byol Lee, Suk Kyung Beak, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Nam Kyu Kim, Byung Soh Min
We measured systemic changes in the immune response in 92 patients receiving preoperative chemoradiation therapy (CRT) and subsequent surgery for rectal cancer. The peripheral blood was sampled five times from the onset of CRT until surgery. Lymphocytes decreased continuously during CRT but increased after CRT. The increased lymphocyte population was predominantly CD8+ T lymphocytes, which accounted for a significantly larger proportion in patients without residual lymph node metastasis than in those with residual lymph node metastasis...
May 15, 2018: Scientific Reports
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
Chang Woo Kim, Byung Mo Kang, Ik Yong Kim, Ji Yeon Kim, Sun Jin Park, Won Cheol Park, Ki Beom Bae, Byung-Noe Bae, Seong Kyu Baek, Seung Hyuk Baik, Gyung Mo Son, Yoon Suk Lee, Suk-Hwan Lee
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) has been a standard treatment option for locally advanced rectal cancer with improved local control. However, systemic recurrence despite neoadjuvant CRT remained unchanged. The only significant prognostic factor proven to be important was pathologic complete response (pCR) after neoadjuvant CRT. Several efforts have been tried to improve survival of patients who treated with neoadjuvant CRT and to achieve more pCR including adding cytotoxic chemotherapeutic agents, chronologic modification of chemotherapy schedule or adding chemotherapy during the perioperative period...
May 8, 2018: BMC Cancer
Akiko Chino, Tsuyoshi Konishi, Atsushi Ogura, Hiroshi Kawachi, Hiroki Osumi, Toshiyuki Yoshio, Teruhito Kishihara, Daisuke Ide, Shoichi Saito, Masahiro Igarashi, Takashi Akiyoshi, Masashi Ueno, Junko Fujisaki
BACKGROUND AND AIMS: Precise endoscopic assessment of complete response to neoadjuvant chemoradiotherapy before surgery is important for optimizing surgical and non-surgical treatment. We prospectively evaluated the accuracy of the newly proposed endoscopic criteria to identify complete response, using magnifying chromoendoscopy. METHODS: New endoscopic criteria were created to define endoscopic complete response, near complete response and incomplete response, using magnifying chromoendoscopy...
April 25, 2018: European Journal of Surgical Oncology
Manish Chand, Rodrigo Oliva Perez
No abstract text is available yet for this article.
June 2018: Diseases of the Colon and Rectum
Vincenzo Formica, Michaela Benassi, Giovanna Del Vecchio Blanco, Elena Doldo, Laura Martano, Ilaria Portarena, Antonella Nardecchia, Jessica Lucchetti, Cristina Morelli, Emilia Giudice, Piero Rossi, Alessandro Anselmo, Pierpaolo Sileri, Giuseppe Sica, Augusto Orlandi, Riccardo Santoni, Mario Roselli
A platinum salt (oxaliplatin or cisplatin) is widely used to enhance chemoradation (CRT) response. The potential of cisplatin in neoadjuvant CRT for locally advanced rectal cancer (LARC) has not been fully investigated. Consecutive patients with histologically confirmed LARC were treated with standard pelvic radiotherapy and concurrent cisplatin plus capecitabine (CisCape CRT). Surgery and eight cycles of adjuvant FOLFOX4 were offered to all patients after CRT. Common biochemical variables and key germline genetic polymorphisms were analyzed as predictors of pathological complete response (pCR)...
May 2, 2018: Medical Oncology
Robin Krol, Gill M McColl, Wim P M Hopman, Robert J Smeenk
BACKGROUND AND PURPOSE: Late anorectal toxicity influences quality of life after external beam radiotherapy (EBRT) for prostate cancer. A daily inserted endorectal balloon (ERB) during EBRT aims to reduce anorectal toxicity. Our goal is to objectify anorectal function over time after prostate intensity-modulated radiotherapy (IMRT) with ERB. MATERIAL AND METHODS: Sixty men, irradiated with IMRT and an ERB, underwent barostat measurements and anorectal manometry prior to EBRT and 6 months, one year and 2 years after radiotherapy...
April 28, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Consuelo Rosa, Monica Di Tommaso, Luciana Caravatta, Annamaria Vinciguerra, Antonietta Augurio, Francesca Perrotti, Albina Allajbej, Marco Regoli, Isaia Al Zecca, Marta Di Nicola, Domenico Genovesi
PURPOSE: To report long-term effects on anorectal function and bowel disorders and late toxicity rate of preoperative chemoradiotherapy in patients with locally advanced rectal cancer. METHODS: Between 2000 and 2016, 201 patients treated with different neoadjuvant schedules of chemotherapy and radiotherapy doses were retrospectively analyzed. The Memorial Sloan-Kettering Cancer Center score was used for the evaluation of anal sphincter function. RESULTS: The median follow-up time was 68 months (interquartile range 35-113 months)...
April 1, 2018: Tumori
Fahima Dossa, Sergio A Acuna, Aaron S Rickles, Mariana Berho, Steven D Wexner, Fayez A Quereshy, Nancy N Baxter, Sami A Chadi
Importance: Although American guidelines recommend use of adjuvant chemotherapy in patients with locally advanced rectal cancer, individuals who achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy are less likely to receive adjuvant treatment than incomplete responders. The association and resection of adjuvant chemotherapy with survival in patients with pCR is unclear. Objective: To determine whether patients with locally advanced rectal cancer who achieve pCR after neoadjuvant chemoradiation therapy and resection benefit from the administration of adjuvant chemotherapy...
April 19, 2018: JAMA Oncology
Patricio M Polanco, Ali A Mokdad, Hong Zhu, Michael A Choti, Sergio Huerta
Importance: Adjuvant chemotherapy (AC) in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy (nCRT) and resection is recommended by treatment guidelines. However, its role in this setting is equivocal because data supporting benefits are lacking. Objective: To compare the overall survival (OS) between AC and postoperative observation (OB) in patients with rectal cancer with pathologic complete response following nCRT and resection...
April 19, 2018: JAMA Oncology
Gemma Bruera, Mario Di Staso, Pierluigi Bonfili, Antonio Galvano, Rosa Manetta, Gino Coletti, Roberto Vicentini, Stefano Guadagni, Corrado Ficorella, Ernesto Di Cesare, Antonio Russo, Enrico Ricevuto
Introduction: Proper administration timing, dose-intensity, efficacy/toxicity ratio of oxaliplatin added to fluoropyrimidin should be improved to safely perform two-drugs intensive preoperative chemoradiotherapy in locally advanced rectal cancer (LARC). This dose-finding study investigated recommended oxaliplatin dose, safety of oxaliplatin/capecitabine regimen and preliminary activity. Methods: Schedule: oxaliplatin dose-levels, 35-40 mg/m2 /week; capecitabine 825 mg/m2 / twice daily, radiotherapy on rectum/nodes, 50/45 Gy, 45 and 9 boost/45 Gy, in first 5 and subsequent patients, 5 days/week, respectively; for 5 weeks...
April 3, 2018: Oncotarget
Hiroshi Miyakita, Sotaro Sadahiro, Takashi Ogimi, Gota Saito, Kazutake Okada, Akira Tanaka, Toshiyuki Suzuki, Hiroshi Kajiwara, Hiroshi Yamamuro, Takeshi Akiba
BACKGROUND: Mucinous rectal carcinoma has been reported to have a lower survival rate and a poorer histologic response to chemoradiotherapy(CRT). Magnetic resonance imaging (MRI) can accurately evaluate the amount of mucin pools (MP) in primary cancer tissue. We compared the degree of MP on MRI before and after CRT with the histologic findings of resected specimens to investigate the predictors of response to CRT. METHODS: The study group comprised 205 patients with rectal adenocarcinoma who received preoperative CRT...
April 26, 2018: International Journal of Colorectal Disease
Erta Kalanxhi, Sebastian Meltzer, Jakob Vasehus Schou, Finn Ole Larsen, Svein Dueland, Kjersti Flatmark, Benny Vittrup Jensen, Knut Håkon Hole, Therese Seierstad, Kathrine Røe Redalen, Dorte Lisbet Nielsen, Anne Hansen Ree
BACKGROUND: Systemic failure remains a challenge in rectal cancer. We investigated the possible systemic anti-tumour immune activity invoked within oxaliplatin-based neoadjuvant therapy. METHODS: In two high-risk patient cohorts, we assessed the circulating levels of the fms-like tyrosine kinase 3 ligand (Flt3L), a factor reflecting both therapy-induced myelosuppression and activation of tumour antigen-presenting dendritic cells, at baseline and following induction chemotherapy and sequential chemoradiotherapy, both modalities containing oxaliplatin...
April 26, 2018: British Journal of Cancer
A B Mariathasan, K Boye, K E Giercksky, B Brennhovd, H P Gullestad, H L Emblemsvåg, K K Grøholt, S Dueland, K Flatmark, S G Larsen
BACKGROUND: In locally advanced rectal cancer (LARC), beyond total mesorectal excision (bTME) is often necessary to obtain complete resection (R0). The aim of this study was to identify prognostic determinants and compare morbidity and survival in LARC cases requiring bTME or TME surgery. METHOD: Single centre cohort study of LARC cases where all patients received neoadjuvant radiotherapy (n = 332). Data was registered prospectively in an institutional database linked to the National Registry...
April 12, 2018: European Journal of Surgical Oncology
A J M Rombouts, N Hugen, R H A Verhoeven, M A G Elferink, P M P Poortmans, I D Nagtegaal, J H W de Wilt
BACKGROUND: In the era of organ preserving strategies in rectal cancer, insight into the efficacy of preoperative therapies is crucial. The goal of the current study was to evaluate and compare tumor response in rectal cancer patients according to their type of preoperative therapy. METHODS: All rectal cancer patients diagnosed between 2005 and 2014, receiving radiation therapy (RT, 5 × 5Gy; N = 764) or chemoradiation therapy (CRT; N = 5070) followed by total mesorectal excision after an interval of 5-15 weeks were retrieved from the nationwide Netherlands Cancer registry...
March 27, 2018: European Journal of Surgical Oncology
Nidal Issa, Yaniv Fenig, Rachel Gingold-Belfer, Muhammad Khatib, Wisam Khoury, Lea Wolfson, Hemda Schmilovitz-Weiss
BACKGROUND: Patients' selection for transanal endoscopic microsurgery (TEM) depends on diagnostic modalities; however, there are still some limitations in the preoperative diagnosis of rectal lesions, and in some reports, up to third of the adenomas resected by TEM were found to be adenocarcinoma; therefore, salvage radical resection (RR) remains necessary for achieving oncological resection. Salvage RR may encounter some technical problems as the violation of the mesorectum and the scar formation...
April 18, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Per Loftås, Margrét Sturludóttir, Olof Hallböök, Karin Almlöv, Gunnar Arbman, Lennart Blomqvist
OBJECTIVE: To assess the accuracy of MRI to predict remaining lymph node metastases in patients with complete pathological luminal response (ypT0) after neoadjuvant therapy. METHODS: Data from a national registry were used. Nineteen patients with histopathologically remaining lymph node metastases (ypT0N+) were identified. Another 19 patients without lymph node metastases (ypT0N0) were used as matched controls. Two radiologists blinded to all patient information evaluated staging and restaging MRI that was compared to histopathological findings of the resected specimen...
April 18, 2018: British Journal of Radiology
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