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Rectal Cancer and complete response

Yankai Meng, Chongda Zhang, Shuangmei Zou, Xinming Zhao, Kai Xu, Hongmei Zhang, Chunwu Zhou
To evaluate the importance of MRI texture analysis in prediction and early assessment of treatment response before and early neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). This retrospective study comprised of 59 patients. The tumoral texture parameters were compared between pre- and early nCRT. Area Under receiver operating characteristic (ROC) Curves [AUCs] were used to compare the diagnostic performance of statistically significant difference parameters and logistic regression analysis predicted probabilities for discriminating responders and nonresponders...
February 23, 2018: Oncotarget
Aeris Jane D Nacion, Youn Young Park, Nam Kyu Kim
Advancements in rectal cancer treatment have resulted in improvement only in locoregional control and have failed to address distant relapse, which is the predominant mode of treatment failure in rectal cancer. As the efficacy of conventional chemoradiotherapy (CRT) followed by total mesorectal excision (TME) reaches a plateau, the need for alternative strategies in locally advanced rectal cancer (LARC) has grown in relevance. Several novel strategies have been conceptualized to address this issue, including: 1) neoadjuvant induction and consolidation chemotherapy before CRT; 2) neoadjuvant chemotherapy alone to avoid the sequelae of radiation; and 3) nonoperative management for patients who achieved pathological or clinical complete response after CRT...
February 2018: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Carmine Pinto, Maurizio Di Bisceglie, Francesca Di Fabio, Annamaria Bochicchio, Tiziana Latiano, Stefano Cordio, Gerardo Rosati, Carlo Aschele, Antonella Marino, Francesca Bergamo, Sara Bustreo, Luca Frassineti, Fortunato Ciardiello, Angela Damato, Stefania Giaquinta, Daniela Baldari, Luca Boni
BACKGROUND: Treatment with fluoropyrimidines and concomitant long-course external radiotherapy (RTE) is the standard of care in locally advanced rectal cancer (LARC) preoperative chemoradiation. A randomized phase II study (RaP/STAR-03) was conducted that aimed to evaluate the activity and safety of the monoclonal antibody anti-epidermal growth factor receptor panitumumab as a single agent in combination with radiotherapy in low-risk LARC preoperative treatment. MATERIALS AND METHODS: Patients had adenocarcinoma of the mid-low rectum, cT3N- or cT2-T3N+, KRAS wild-type status, and negative circumferential radial margin...
March 9, 2018: Oncologist
Mirko Omejc, Maja Potisek
Background: The majority of rectal cancers are discovered in locally advanced forms (UICC stage II, III). Treatment consists of preoperative radiochemotherapy, followed by surgery 6-8 weeks later and finally by postoperative chemotherapy. The aim of this study was to find out if tumor regression affected long-term survival in patients with localy advanced rectal cancer, treated with neoadjuvant radiochemotherapy. Patients and methods: Patients with rectal cancer stage II or III, treated between 2006 and 2010, were included in a retrospective study...
March 2018: Radiology and Oncology
Jasna But-Hadzic, Vaneja Velenik
Background: The aim of the study was to investigate the feasibility and safety of experimental fractionation using intensity modulated radiation therapy with a simultaneous integrated boost (IMRT-SIB) to shorten the overall treatment time without dose escalation in preoperative radiochemotherapy of locally advanced rectal cancer. Patients and methods: Between January 2014 and November 2015, a total of 51 patients with operable stage II-III rectal adenocarcinoma were treated...
March 2018: Radiology and Oncology
D L Bowden, P A Sutton, M A Wall, P V Jithesh, R E Jenkins, D H Palmer, C E Goldring, J L Parsons, B K Park, N R Kitteringham, D Vimalachandran
BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) is used in locally advanced rectal cancer when tumours threaten the circumferential resection margin, with varying response to treatment. This experimental study aimed to identify significantly differentially expressed proteins between patients responding and not responding to CRT, and to validate any proteins of interest. METHODS: Mass spectrometry (with isobaric tagging for relative quantification) analysis of rectal cancers pre- and post-CRT, and at resection...
March 5, 2018: Journal of Proteomics
Natally Horvat, Harini Veeraraghavan, Monika Khan, Ivana Blazic, Junting Zheng, Marinela Capanu, Evis Sala, Julio Garcia-Aguilar, Marc J Gollub, Iva Petkovska
Purpose To investigate the value of T2-weighted-based radiomics compared with qualitative assessment at T2-weighted imaging and diffusion-weighted (DW) imaging for diagnosis of clinical complete response in patients with rectal cancer after neoadjuvant chemotherapy-radiation therapy (CRT). Materials and Methods This retrospective study included 114 patients with rectal cancer who underwent magnetic resonance (MR) imaging after CRT between March 2012 and February 2016. Median age among women (47 of 114, 41%) was 55...
March 7, 2018: Radiology
William H Ward, Elin R Sigurdson, Andrew C Esposito, Karen J Ruth, Samuel M Manstein, Eric C Sorenson, Brian D Wernick, Jeffrey M Farma
BACKGROUND: Despite advances in the treatment of rectal adenocarcinoma, the management of locally advanced disease remains a challenge. The standard of care for patients with stages II and III rectal cancer includes neoadjuvant chemoradiation followed by total mesorectal excision and postoperative chemotherapy. Much effort has been dedicated to the identification of predictive factors associated with pathologic complete response (pCR). The aim of our study was to examine our institutional experience and determine whether any association exists between anatomic tumor location and the rate of pCR...
April 2018: Journal of Surgical Research
Daniel Kerr, Damian Laber, Nathan Visweshwar, Michael Jaglal
Oxaliplatin is a platinum-based chemotherapy that is an integral part of several regimens for colorectal cancer. We present the case of a patient, a 58-year-old male, who had initially presented aged 56 years with rectal bleeding for several months. His serum carcinoembryonic antigen (CEA) level at the time of diagnosis was 4.6 ng/ml. His CEA level increased significantly during oxaliplatin-based chemotherapy and declined to a near normal level after completion of therapy. There was no evidence of disease during this time and he remains disease-free...
March 2018: Anticancer Research
Tomohiro Tate, Yudai Fukui, Kenji Tomizawa, Yutaka Hanaoka, Shigeo Toda, Shuichiro Matoba, Hiroya Kuroyanagi
BACKGROUND: The local recurrence of rectal cancer classifies 4 types, anterior, posterior, lateral compartment and anastomotic site. This study evaluates outcome of laparoscopic lateral lymph node dissection(LLND)against the lateral lymph node recurrence. METHOD: Five patients were diagnosed as the lateral lymph node recurrence and underwent laparoscopic LLND. We diagnosed the lateral lymph node recurrence by CT, MRI and PET-CT. All cases revealed abnormal uptake on PET-CT...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Nicolò DE Manzini, Gabriele Bellio, Pio Corleone, Marina Troian
The management of rectal cancer has considerably changed over the last decades and complete response to neoadjuvant chemoradiotherapy is becoming a common clinical entity. There is still no consensus on the definition of complete response to neoadjuvant treatment prior to surgery. Treatment programs are mostly heterogeneous and non-randomized. In addition, techniques to diagnose complete response are still unclear and there is no uniformity in surveillance modality of those patients managed without operative intervention...
February 21, 2018: Minerva Chirurgica
Georgios Karagkounis, Leo Thai, Adam G Mace, Homer Wiland, Rish K Pai, Scott R Steele, James M Church, Matthew F Kalady
OBJECTIVE: To evaluate the independent prognostic ability of the American Joint Committee on Cancer (AJCC) tumor regression scores within pathologic stage II and III rectal cancers. BACKGROUND: Response to neoadjuvant chemoradiation (nCRT) has been debated as a biologic surrogate for tumor biology and prognosis in rectal cancer. AJCC regression scores have been shown to correlate with prognosis. METHODS: Patient demographics, tumor characteristics, and AJCC scores (0 = complete response; 1 = isolated tumor cells remaining; 2 = residual cancer outgrown by fibrosis; 3 = extensive residual cancer) were assessed from 545 rectal cancer patients treated by nCRT followed by surgery at a single institution...
February 20, 2018: Annals of Surgery
Xi Zhong, Zhonghua Wu, Peng Gao, Jinxin Shi, Jingxu Sun, Zhexu Guo, Zhenning Wang, Yongxi Song
Patients with locally advanced rectal cancer (LARC) are at tremendous risk of metastatic diseases. To improve the prognoses of LARC patients, the efficacy of adding targeted agents to neoadjuvant therapy has been investigated by many researchers but remains controversial. A literature search of relevant databases was conducted through December 2016, 804 studies were identified and 32 investigations were ultimately included. A total of 1196 patients from 31 cohorts of 29 studies were eligible for quantitative synthesis in this single-arm setting meta-analysis...
February 21, 2018: Cancer Medicine
A Palmisano, A Esposito, A Di Chiara, A Ambrosi, P Passoni, N Slim, C Fiorino, L Albarello, N Di Muzio, R Calandrino, R Rosati, A Del Maschio, F De Cobelli
AIM: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6-8 weeks after the end of CRT (postMRI)...
February 17, 2018: Clinical Radiology
Chongda Zhang, Feng Ye, Yuan Liu, Han Ouyang, Xinming Zhao, Hongmei Zhang
Purpose: To evaluate the value of morphological parameters that can be obtained conveniently by MRI for predicting pathologically complete response (pCR) in patients with rectal cancer. Materials and Methods: A cohort of 101 patients was examined using MRI before and after Neoadjuvant chemoradiotherapy (nCRT). Morphological parameters including maximum tumor area (MTA), maximum tumor length (MTL) and maximum tumor thickness (MTT), as well as cylindrical approximated tumor volume (CATV), distance to anal verge (DTA), and the reduction rates were evaluated by two experienced readers independently...
January 12, 2018: Oncotarget
Peng Diao, Julien Langrand-Escure, Max-Adrien Garcia, Sophie Espenel, Amel Rehailia-Blanchard, Blandine de Lavigerie, Nicolas Vial, Guy de Laroche, Alexis Vallard, Nicolas Magné
BACKGROUND AND PURPOSE: There is paucity of data on the efficacy and toxicity of radiotherapy in rectal cancer (RC) elderly patients. The objective was to identify management strategies and resulting outcomes in RC patients ≥70 years undergoing radiotherapy. MATERIAL AND METHODS: A retrospective study included consecutive RC patients ≥70 years undergoing rectal radiotherapy. RESULTS: From 2004-2015, 340 RC patients underwent pre-operative (n = 238; 70%), post-operative (n = 41, 12%), or exclusive (n = 61, 18%) radiotherapy, with a median age of 78...
February 3, 2018: Digestive and Liver Disease
J Martinez-Useros, I Moreno, M J Fernandez-Aceñero, M Rodriguez-Remirez, A Borrero-Palacios, A Cebrian, T Gomez Del Pulgar, L Del Puerto-Nevado, W Li, A Puime-Otin, N Perez, M S Soengas, J Garcia-Foncillas
BACKGROUND: Limited data are available regarding the ability of biomarkers to predict complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Complete response translates to better patient survival. DEK is a transcription factor involved not only in development and progression of different types of cancer, but is also associated with treatment response. This study aims to analyze the role of DEK in complete pathological response following chemoradiotherapy for locally advanced rectal cancer...
February 6, 2018: BMC Cancer
Dejan Juric, Jordi Rodon, Josep Tabernero, Filip Janku, Howard A Burris, Jan H M Schellens, Mark R Middleton, Jordan Berlin, Martin Schuler, Marta Gil-Martin, Hope S Rugo, Ruth Seggewiss-Bernhardt, Alan Huang, Douglas Bootle, David Demanse, Lars Blumenstein, Christina Coughlin, Cornelia Quadt, José Baselga
Purpose We report the first-in-human phase Ia study to our knowledge ( identifier: NCT01219699) identifying the maximum tolerated dose and assessing safety and preliminary efficacy of single-agent alpelisib (BYL719), an oral phosphatidylinositol 3-kinase α (PI3Kα)-selective inhibitor. Patients and Methods In the dose-escalation phase, patients with PIK3CA-altered advanced solid tumors received once-daily or twice-daily oral alpelisib on a continuous schedule. In the dose-expansion phase, patients with PIK3CA-altered solid tumors and PIK3CA-wild-type, estrogen receptor-positive/human epidermal growth factor receptor 2-negative breast cancer received alpelisib 400 mg once daily...
February 5, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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...
February 1, 2018: European Journal of Surgical Oncology
Philippe Bulens, Alice Couwenberg, Karin Haustermans, Annelies Debucquoy, Vincent Vandecaveye, Marielle Philippens, Mu Zhou, Olivier Gevaert, Martijn Intven
BACKGROUND AND PURPOSE: To safely implement organ preserving treatment strategies for patients with rectal cancer, well-considered selection of patients with favourable response is needed. In this study, we develop and validate an MRI-based response predicting model. METHODS: A multivariate model using T2-volumetric and DWI parameters before and 6 weeks after chemoradiation (CRT) was developed using a cohort of 85 rectal cancer patients and validated in an external cohort of 55 patients that underwent preoperative CRT...
January 30, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
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