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Rectal Cancer and complete response

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https://www.readbyqxmd.com/read/29341150/effect-of-akt-activation-and-experimental-pharmacological-inhibition-on-responses-to-neoadjuvant-chemoradiotherapy-in-rectal-cancer
#1
F C Koyama, C M Lopes Ramos, F Ledesma, V A F Alves, J M Fernandes, B B Vailati, G P São Julião, A Habr-Gama, J Gama-Rodrigues, R O Perez, A A Camargo
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) is one of the preferred initial treatment strategies for locally advanced rectal cancer. Responses are variable, and most patients still require surgery. The aim of this study was to identify molecular mechanisms determining poor response to CRT. METHODS: Global gene expression and pathway enrichment were assessed in pretreatment biopsies from patients with non-metastatic cT2-4 N0-2 rectal cancer within 7 cm of the anal verge...
January 2018: British Journal of Surgery
https://www.readbyqxmd.com/read/29337443/-update-in-surgical-oncology
#2
Daniel Clerc, Didier Roulin, Nicolas Demartines, Emmanuel Melloul
In 2017, data from large multicentre randomized controlled trials assessed the safety of minimally invasive techniques for liver or esophagus resection with similar oncologic outcome compared to open approach. Patients also benefit from progress in medical oncology in particular with the development of new targeted therapies, offering surgery to patients with initially non-resectable disease. The increase in complete tumor response after neoadjuvant treatment allows more conservative approaches, like organ preserving surgery for rectal cancer...
January 10, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29332339/p21-does-but-p53-does-not-predict-pathological-response-to-preoperative-chemoradiotherapy-in-locally-advanced-rectal-cancer
#3
Suzana Stojanovic-Rundic, Radmila Jankovic, Marjan Micev, Vladimir Nikolic, Ivan Popov, Dusica Gavrilovic, Vesna Plesinac-Karapandzic, Aleksandra Djuric-Stefanovic, Zoran Krivokapic, Sinisa Radulovic
PURPOSE: Preoperative chemoradiotherapy (CRT) is the standard treatment option in locally advanced rectal cancer. The tumor response is assessed through tumor and nodal downstaging and the tumor regression grade. Currently, there is no method to predict a tumor response to CRT. We aimed to evaluate whether p21 and p53 expressions could be a reliable predictors of pathological response to CRT. METHODS: Fifty patients with locally advanced rectal cancer were treated with preoperative radiotherapy combined with mitomycin C and capecitabine...
November 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29332248/performance-of-diffusion-weighted-magnetic-resonance-imaging-at-3-0t-for-early-assessment-of-tumor-response-in-locally-advanced-rectal-cancer-treated-with-preoperative-chemoradiation-therapy
#4
Andrea Delli Pizzi, Roberta Cianci, Domenico Genovesi, Gianluigi Esposito, Mauro Timpani, Alessandra Tavoletta, Pierluigi Pulsone, Raffaella Basilico, Daniela Gabrielli, Consuelo Rosa, Luciana Caravatta, Monica Di Tommaso, Massimo Caulo, Antonella Filippone
PURPOSE: The purpose of the article is to determine whether changes in apparent diffusion coefficient (ADC) values of locally advanced rectal cancer (LARC) obtained 2 weeks after the beginning of chemoradiation therapy (CRT) allow to predict treatment response and whether correlate with tumor histopathologic response. METHODS: Forty-three patients receiving CRT for LARC and 3.0T magnetic resonance imaging with diffusion-weighted sequences before treatment, 2 weeks during, and 8 weeks post the completion of CRT were included...
January 13, 2018: Abdominal Radiology
https://www.readbyqxmd.com/read/29329555/exercise-during-and-after-neoadjuvant-rectal-cancer-treatment-the-exert-trial-study-protocol-for-a-randomized-controlled-trial
#5
Andria R Morielli, Nawaid Usmani, Normand G Boulé, Diane Severin, Keith Tankel, Tirath Nijjar, Kurian Joseph, Alysa Fairchild, Kerry S Courneya
BACKGROUND: Standard treatment for locally advanced rectal cancer includes 5-6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6-8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning that may impede quality of life (QoL), treatment completion, treatment response, and long-term prognosis. Interventions to improve treatment outcomes and manage side effects that are safe, tolerable and low-cost are highly desirable...
January 12, 2018: Trials
https://www.readbyqxmd.com/read/29299358/pacritinib-to-inhibit-jak-stat-signaling-in-refractory-metastatic-colon-and-rectal-cancer
#6
Thomas Regenbogen, Ling Chen, Kathryn Trinkaus, Andrea Wang-Gillam, Benjamin R Tan, Manik Amin, Katrina S Pedersen, Haeseong Park, Rama Suresh, Kian-Huat Lim, Emily Ratchford, Amberly Brown, A Craig Lockhart
Background: Treatment options for patients with refractory colorectal cancer are limited and typically provide a chance of only modest benefit. The goal of this study was to evaluate the benefit of inhibiting the JAK/STAT inflammatory pathway with single agent pacritinib in patients with metastatic refractory colorectal adenocarcinoma. Methods: A single arm institutional trial was initiated and enrolled patients with metastatic colorectal cancer refractory to at least two standard lines of treatment...
December 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29288615/synchronous-locally-advanced-rectal-cancer-with-clinical-complete-remission-and-important-downstaging-after-neoadjuvant-radiochemotherapy-personalised-therapeutic-approach
#7
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-save-the-rectum-by-watchful-waiting-or-transanal-microsurgery-following-chemo-radiotherapy-versus-total-mesorectal-excision-for-early-rectal-cancer-star-trec-study-protocol-for-a-multicentre-randomised-feasibility-study
#8
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/29281151/quantitative-intravoxel-incoherent-motion-parameters-derived-from-whole-tumor-volume-for-assessing-pathological-complete-response-to-neoadjuvant-chemotherapy-in-locally-advanced-rectal-cancer
#9
Qiaoyu Xu, Yanyan Xu, Hongliang Sun, Queenie Chan, Kaining Shi, Aiping Song, Wu Wang
BACKGROUND: Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE: To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC...
December 27, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/29277386/outcomes-of-persistent-lymph-node-involvement-after-neoadjuvant-therapy-for-stage-iii-rectal-cancer
#10
Anne M Dinaux, Lieve Leijssen, Liliana G Bordeianou, Hiroko Kunitake, Ramzi Amri, David L Berger
INTRODUCTION: Lymph node involvement is a well-known predictor of recurrent rectal cancer in patient who did not undergo neoadjuvant therapy patients. The role of persistent lymph node disease after neoadjuvant treatment, however, is debatable. This study compares outcomes of patients with clinical, stage III rectal cancer who had nodal disease on surgical pathology after neoadjuvant treatment to patients with negative nodes. METHODS: We reviewed retrospectively a consecutive cohort of all clinical, American Joint Committee on Cancer stage III rectal cancer patients who received neoadjuvant chemoradiotherapy and had an R0 resection at the Massachusetts General Hospital between 2004 and 2015...
December 22, 2017: Surgery
https://www.readbyqxmd.com/read/29275912/advances-in-organ-preserving-strategies-in-rectal-cancer-patients
#11
REVIEW
Rutger C H Stijns, Mike-Stephen R Tromp, Niek Hugen, Johannes H W de Wilt
Treatment of rectal cancer patients has been subjected to change over the past thirty years. Total mesorectal excision is considered the cornerstone of rectal cancer treatment, but is also associated with significant morbidity resulting in an impaired quality of life. The addition of neoadjuvant chemoradiotherapy to surgery has shown to improve survival and local control and may lead to a partial or even complete response (CR). This raises questions regarding the necessity for subsequent radical surgery. After careful patient selection local excision and wait-and-see approaches are explored, aiming to improve quality of life without compromising oncological outcome...
December 12, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29273921/is-it-possible-a-conservative-approach-after-radiochemotherapy-in-locally-advanced-rectal-cancer-larc-a-systematic-review-of-the-literature-and-meta-analysis
#12
Francesco Fiorica, Marco Trovò, Gabriele Anania, Daniele Marcello, Fabrizio Di Benedetto, Marina Marzola, Fabrizio D'Acapito, Guglielmo Nasti, Massimiliano Berretta
BACKGROUND: Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy. METHODS: Computerized literature search was performed to identify relevant articles...
December 22, 2017: Journal of Gastrointestinal Cancer
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
#13
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...
December 13, 2017: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/29247263/pretreatment-identification-of-patients-likely-to-have-pathologic-complete-response-after-neoadjuvant-chemoradiotherapy-for-rectal-cancer
#14
Frederik J van der Sluis, Henderik L van Westreenen, Boudewijn van Etten, Barbara L van Leeuwen, Geertruida H de Bock
PURPOSE: In selected patients, a wait-and-see strategy after chemoradiotherapy for rectal cancer might be feasible provided that the probability of pathologic complete response (pCR) is high. This study aimed to identify clinical parameters associated with pCR. Furthermore, we attempted to identify subgroups with increased probability of pCR that might aid in clinical decision making. METHODS: A total of 6444 patients that underwent surgical resection of a single primary carcinoma of the rectum after neoadjuvant chemoradiotherapy (nCRT) between January 2009 and December 2016 in the Netherlands were included in the study...
December 15, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29241084/neoadjuvant-radiotherapy-combined-with-capecitabine-and-sorafenib-in-patients-with-advanced-kras-mutated-rectal-cancer-a-phase-i-ii-trial-sakk-41-08
#15
Roger von Moos, Dieter Koeberle, Sabina Schacher, Stefanie Hayoz, Ralph C Winterhalder, Arnaud Roth, György Bodoky, Panagiotis Samaras, Martin D Berger, Daniel Rauch, Piercarlo Saletti, Ludwig Plasswilm, Daniel Zwahlen, Urs R Meier, Pu Yan, Paola Izzo, Dirk Klingbiel, Daniela Bärtschi, Kathrin Zaugg
BACKGROUND: KRAS mutation occurs in ∼40% of locally advanced rectal cancers (LARCs). The multitarget tyrosine kinase inhibitor sorafenib has radiosensitising effects and might improve outcomes for standard preoperative chemoradiotherapy in patients with KRAS-mutated LARC. METHODS: Adult patients with KRAS-mutated T3/4 and/or N1/2M0 LARC were included in this phase I/II study. The phase I dose-escalation study of capecitabine plus sorafenib and radiotherapy was followed by a phase II study assessing efficacy and safety...
December 11, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/29233486/cetuximab-combined-with-induction-oxaliplatin-and-capecitabine-followed-by-neoadjuvant-chemoradiation-for-locally-advanced-rectal-cancer-swog-0713
#16
Cynthia Gail Leichman, Shannon L McDonough, Stephen R Smalley, Kevin G Billingsley, Heinz-Josef Lenz, Matthew A Beldner, Aram F Hezel, Mario R Velasco, Katherine A Guthrie, Charles D Blanke, Howard S Hochster
BACKGROUND: Neoadjuvant chemoradiation (NCRT) is standard treatment for locally advanced rectal cancer. Pathologic complete response (pCR) has associated with improved survival. In modern phase III trials of NCRT, pCR ranges from 10% to 20%. Cetuximab improves response in KRAS (KRAS proto-oncogene) wild type (wt) metastatic colorectal cancer. S0713 was designed to assess improvement in pCR with additional use of cetuximab with induction chemotherapy and NCRT for locally advanced, KRAS-wt rectal cancer...
October 24, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29230678/fractal-based-radiomic-approach-to-predict-complete-pathological-response-after-chemo-radiotherapy-in-rectal-cancer
#17
Davide Cusumano, Nicola Dinapoli, Luca Boldrini, Giuditta Chiloiro, Roberto Gatta, Carlotta Masciocchi, Jacopo Lenkowicz, Calogero Casà, Andrea Damiani, Luigi Azario, Johan Van Soest, Andre Dekker, Philippe Lambin, Marco De Spirito, Vincenzo Valentini
The aim of this study was to propose a methodology to investigate the tumour heterogeneity and evaluate its ability to predict pathologically complete response (pCR) after chemo-radiotherapy (CRT) in locally advanced rectal cancer (LARC). This approach consisted in normalising the pixel intensities of the tumour and identifying the different sub-regions using an intensity-based thresholding. The spatial organisation of these subpopulations was quantified using the fractal dimension (FD). This approach was implemented in a radiomic workflow and applied to 198 T2-weighted pre-treatment magnetic resonance (MR) images of LARC patients...
December 11, 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/29229327/dose-escalation-using-contact-x-ray-brachytherapy-after-external-beam-radiotherapy-as-nonsurgical-treatment-option-for-rectal-cancer-outcomes-from-a-single-center-experience
#18
Arthur Sun Myint, Fraser McLean Smith, Simon Gollins, Helen Wong, Christopher Rao, Karen Whitmarsh, Raj Sripadam, Paul Rooney, Michael Hershman, D Mark Pritchard
PURPOSE: To review the outcomes of rectal cancer patients treated with a nonsurgical approach using contact x-ray brachytherapy (CXB) when suspicious residual disease (≤3 cm) was present after external beam chemoradiation therapy/radiation therapy (EBCRT/EBRT). METHODS AND MATERIALS: Outcome data for rectal cancer patients referred to our institution from 2003 to 2012 were retrieved from an institutional database. These patients were referred after initial local multidisciplinary team discussion because they were not suitable for, or had refused, surgery...
October 20, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29225479/density-of-cd8-lymphocytes-in-biopsy-samples-combined-with-the-circulating-lymphocyte-ratio-predicts-pathologic-complete-response-to-chemoradiotherapy-for-rectal-cancer
#19
Binyi Xiao, Jianhong Peng, Rongxin Zhang, Jing Xu, Yongchun Wang, Yujing Fang, Junzhong Lin, Zhizhong Pan, Xiaojun Wu
Objectives: The systemic status and local immune status, as determined by the neutrophil-lymphocyte ratio (NLR) or the lymphocyte ratio (LYMR) and tumor-infiltrating lymphocyte (TIL) count, respectively, have been suggested as predictors of the tumor response to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer, although the utility of these measures remains controversial. We aimed to investigate the values of the LYMR, NLR and TIL count and their combinations (TIL-LYMR/TIL-NLR) in predicting pathologic complete response (pCR) after nCRT...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/29218690/neoadjuvant-volumetric-modulated-arc-therapy-in-rectal-cancer-and-the-correlation-of-pathological-response-with-diffusion-weighted-mri-and-apoptotic-markers
#20
Necla Gurdal, Merdan Fayda, Nijat Alishev, Baris Bakir, Didem Tastekin, Faruk Aykan, Ugur Gezer, Emre Balik, Esra Kaytan Saglam, Ethem Nezih Oral, Mine Gulluoglu, Ahmet Kizir
PURPOSE: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. METHODS: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy...
December 6, 2017: Tumori
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