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Neoadjuvant chemoradiation rectal cancer

Henri Azaïs, Charles-Henri Canova, Elie Vesale, Jean-Marc Simon, Geoffroy Canlorbe, Catherine Uzan
OBJECTIVE: To describe a surgical technique for laparoscopic uterine fixation (LUF) to decrease uterine radiation therapy side effects in case of rectal or anal cancer. DESIGN: This video article uses a surgical case to demonstrate the detailed technique. Institutional Review Board approval was not required for this video presentation. SETTING: University hospital. PATIENT(S): A 26-year-old nulliparous female patient diagnosed with rectal adenocarcinoma and liver metastases...
October 2018: Fertility and Sterility
Marc J Gollub, Ivana Blazic, David D B Bates, Naomi Campbell, Andrea Knezevic, Mithat Gonen, Patricio Lynn, Martin R Weiser, Julio Garcia-Aguilar, Andreas M Hötker, Andrea Cercek, Leonard Saltz
OBJECTIVES: To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT). METHODS: In this IRB-approved, HIPAA-compliant, retrospective study between 1 January 2010-20 October 2014, pre- and post-ICT tumour T2 volume, relative T2 signal intensity (rT2SI), node size, signal intensity and border characteristics were assessed in 63 patients (65 tumours) by three readers...
October 2, 2018: European Radiology
R Glynne-Jones, M R Hall, A Lopes, S Pearce, V Goh, S Bosompem, J Bridgewater, I Chau, H Wasan, B Moran, L Melcher, N P West, P Quirke, W-L Wong, S Beare, N Hava, M Duggan, M Harrison
Background: Chemoradiation (CRT) or short-course radiotherapy (SCRT) are standard treatments for locally advanced rectal cancer (LARC). We evaluated the efficacy/safety of two neoadjuvant chemotherapy (NACT) regimens as an alternative prior to total mesorectal excision (TME). Methods/design: This multi-centre, phase II trial in patients with magnetic resonance imaging (MRI) defined high-risk LARC (>cT3b, cN2+ or extramural venous invasion) randomised patients (1:1) to FOLFOX + Bevacizumab (Arm 1) or FOLFOXIRI + bevacizumab (Arm 2) every 14 days for 6 cycles prior to surgery...
September 2018: Heliyon
Salvatore Amodeo, Alan S Rosman, Vincenzo Desiato, Nicole M Hindman, Elliot Newman, Russell Berman, H Leon Pachter, Marcovalerio Melis
OBJECTIVE: The purpose of this study was to assess the use of apparent diffusion coefficient (ADC) during DWI for predicting complete pathologic response of rectal cancer after neoadjuvant therapy. MATERIALS AND METHODS: A systematic review of available literature was conducted to retrieve studies focused on the identification of complete pathologic response of locally advanced rectal cancer after neoadjuvant chemoradiation, through the assessment of ADC evaluated before, after, or both before and after treatment, as well as in terms of the difference between pretreatment and posttreatment ADC...
September 21, 2018: AJR. American Journal of Roentgenology
Shaakir Hasan, Paul Renz, Rodney E Wegner, Gene Finley, Moses Raj, Dulabh Monga, James McCormick, Alexander Kirichenko
OBJECTIVE: The relationship between microsatellite instability (MSI) and response to neoadjuvant chemoradiation in rectal cancer is not well understood. BACKGROUND: We utilized the National Cancer Database (NCDB) to investigate the association between MSI and pathologic complete response (pCR) in this patient population. METHODS: We analyzed 5086 patients between 2010 and 2015 with locally advanced rectal cancer who were tested for MSI and treated definitively with chemoradiation followed by surgery...
September 13, 2018: Annals of Surgery
Michael R Marco, Lihong Zhou, Sujata Patil, Jorge E Marcet, Madhulika G Varma, Samuel Oommen, Peter A Cataldo, Steven R Hunt, Anjali Kumar, Daniel O Herzig, Alessandro Fichera, Blase N Polite, Neil H Hyman, Charles A Ternent, Michael J Stamos, Alessio Pigazzi, David Dietz, Yuliya Yakunina, Raphael Pelossof, Julio Garcia-Aguilar
BACKGROUND: Adding modified FOLFOX6 (folinic acid, fluorouracil, and oxaliplatin) after chemoradiotherapy and lengthening the chemoradiotherapy-to-surgery interval is associated with an increase in the proportion of rectal cancer patients with a pathological complete response. OBJECTIVE: The purpose of this study was to analyze disease-free and overall survival. DESIGN: This was a nonrandomized phase II trial. SETTINGS: The study was conducted at multiple institutions...
October 2018: Diseases of the Colon and Rectum
Hendrik Dapper, Markus Oechsner, Stefan Münch, Kai Borm, Jan Peeken, Michael Mayinger, Stephanie E Combs, Daniel Habermehl
BACKGROUND: The cranial border of the target volume (TV) in rectal cancer patients treated with neoadjuvant chemoradiation (nCRT) is mostly defined at the level of L5/S1. However, current studies have shown that relapse cranially of the target volume after neoadjuvant nCRT and surgery is very rare. A reduction of cranial TV margins could be reasonable to reduce toxicity to the organs at risk (OAR). In this study we compared the dose distribution to the OAR for different cranial longitudinal margins using a dose-volume histogram (DVH) analysis...
September 6, 2018: Radiation Oncology
John M David, Gillian Gresham, Salma K Jabbour, Matthew Deek, Shant Thomassian, John M Robertson, Neil B Newman, Joseph M Herman, Arsen Osipov, Peyman Kabolizadeh, Richard Tuli
Background: Neoadjuvant chemoradiation (NeoCRT) is standard of care for the treatment of locally advanced rectal cancer (LARC). Contemporary radiation techniques and pre-treatment imaging may impact toxicities and pathologic response (PR). Herein we compare intensity modulated radiotherapy (IMRT) and advanced pre-treatment imaging in the neoadjuvant treatment of LARC and resulting impact on toxicities and pathologic outcomes relative to 3 dimensional conformal radiotherapy (3DCRT). Methods: LARC patients treated at 4 large academic centers in the US from 2007-2016 were reviewed...
August 2018: Journal of Gastrointestinal Oncology
Sunil W Dutta, Clayton E Alonso, Taylor C Jones, Mark R Waddle, Einsley-Marie Janowski, Daniel M Trifiletti
INTRODUCTION: The purpose of this study was to compare the utilization, pathologic response, and overall survival (OS) between long-course neoadjuvant chemoradiation (LC-CRT) and short-course neoadjuvant radiation (SC-RT) in the treatment of non-metastatic rectal cancer. METHODS AND MATERIALS: Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with clinical stage II or III (limited to T3, any N or T1-2, N1-2) rectal cancer between 2004 and 2014 (28,193 patients)...
July 26, 2018: Clinical Colorectal Cancer
Corey Timmerman, Luis R Taveras, Sergio Huerta
The standard of care for locally advanced rectal cancer includes neoadjuvant chemoradiation with subsequent total mesorectal excision. This approach has shown various degrees of response to neoadjuvant chemoradiation (ranging from complete response to further tumor growth), which have substantial prognostic and therapeutic implications. A total regression of the tumor is a predictor of superior oncologic outcomes compared with partial responders and non-responders. Further, this concept has opened the possibility of nonoperative strategies for complete responders and explains the widespread research interest in finding clinical, radiographic, pathologic, and biochemical parameters that allow for identification of these patients...
October 2018: Expert Review of Molecular Diagnostics
Courtney C Moreno, Patrick S Sullivan, Pardeep K Mittal
MRI is an integral part of the multidisciplinary treatment of rectal adenocarcinoma. Staging MRI is performed to establish TNM stage and assess for prognostic factors, including circumferential resection margin status and presence of extramural vascular invasion. The results of staging MRI determine which patients will undergo preoperative neoadjuvant chemoradiation before resection. Restaging MRI is performed to evaluate for treatment response and may identify patients with no residual visible tumor who are candidates for a "watch and wait" strategy in lieu of resection...
September 2018: Gastroenterology Clinics of North America
I Mizrahi, M Abu-Gazala, A S Rickles, L M Fernandez, A Petrucci, J Wolf, D R Sands, S D Wexner
BACKGROUND: Anastomotic leak (AL) after low anterior resection (LAR) is associated with increased morbidity, mortality, cost and cancer recurrence rates. The aim of this study was to evaluate the impact of fluorescence angiography (FA) on AL following LAR for low rectal cancer. METHODS: This is a single surgeon retrospective cohort study with a historical, consecutively sampled case matched control group. The institution's prospectively maintained institutional review board (IRB)-approved database was queried for all patients who underwent a laparoscopic LAR for rectal neoplasia with a colorectal or coloanal anastomosis < 5 cm from the anal verge between 2013 and 2016...
July 2018: Techniques in Coloproctology
Lakshmi Shree Mahadevan, Jim Zhong, BhanuPrasad Venkatesulu, Harmeet Kaur, Shreerang Bhide, Bruce Minsky, William Chu, Martijn Intven, Uulke A van der Heide, Baukelien van Triest, Sunil Krishnan, William A Hall
The treatment protocols for rectal cancer continue to evolve, with increasing acceptance of a watch-and-wait policy for clinical complete responders to neoadjuvant chemoradiation therapy. It still, however, remains unclear who is likely to achieve a pathological complete response, which unequivocally portends a very favorable overall prognosis. Evolution of modern imaging techniques has paved the way for potential prediction of treatment response based on baseline, on-treatment, early post-treatment and subsequent follow-up imaging alone...
September 2018: Critical Reviews in Oncology/hematology
Hai-Hua Zou, Jing Yu, Yun Wei, Jiang-Fen Wu, Qing Xu
BACKGROUND: Tumor heterogeneity can be assessed by texture analysis (TA). TA has been applied using diffusion-weighted imaging and apparent diffusion coefficient maps to predict pathological responses to preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC). PURPOSE: To evaluate the texture parameters obtained from K trans maps derived from dynamic contrast-enhanced (DCE)-MRI for predicting pathological responses to preoperative CRT for LARCs...
August 5, 2018: Journal of Magnetic Resonance Imaging: JMRI
James Chi-Yong Ngu, Li-Jen Kuo, Ching-Huei Kung, Chi-Long Chen, Chia-Chun Kuo, Sheng-Wei Chang, Chia-Che Chen
BACKGROUND: Full-thickness local excision (FTLE) for rectal cancer showing clinical complete remission (cCR) after neoadjuvant chemoradiation therapy (NCRT) is associated with good oncological results. The purpose of this study was to report the results of robotic transanal minimally invasive surgery for such patients. METHODS: Patients were treated with a 5-fluorouracil-based NCRT regimen. The determination of cCR was based on digital rectal examination, colonoscopy, and magnetic resonance imaging...
October 2018: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Christian Galata, Kirsten Merx, Sabine Mai, Timo Gaiser, Frederik Wenz, Stefan Post, Peter Kienle, Ralf-Dieter Hofheinz, Karoline Horisberger
BACKGROUND: To investigate the importance of adjuvant chemotherapy in locally advanced rectal cancer (≥ cT3 or N+) staged ypT0-2 ypN0 on final histological work-up after neoadjuvant chemoradiation and radical resection. METHODS: The clinical course of patients with rectal cancer and ypT0-2 ypN0 stages after neoadjuvant chemoradiation and radical resection was analyzed from 1999 to 2012. Patients were divided into two groups depending on whether adjuvant chemotherapy was administered or not...
August 2, 2018: World Journal of Surgical Oncology
Tamara G Mullaney, Amy L Lightner, Michael Johnston, James Keck, David Wattchow
Surgery remains the cornerstone of rectal cancer treatment. However, there is significant morbidity and mortality associated with pelvic surgery, and the past decade has illustrated that a cohort of rectal cancer patients sustain a remission of local disease with chemoradiation alone. Thus, questions remain regarding the optimal management for rectal cancer; namely, accurately identifying patients who have a complete pathologic response and determining the oncologic safety of the observational approach for this patient group...
September 2018: ANZ Journal of Surgery
Huixun Jia, Xiaotao Shen, Yun Guan, Meimei Xu, Jia Tu, Miao Mo, Li Xie, Jing Yuan, Zhen Zhang, Sanjun Cai, Ji Zhu, ZhengJiang Zhu
PURPOSE: The present study aimed to identify a panel of potential metabolite biomarkers to predict tumor response to neoadjuvant chemo-radiation therapy (NCRT) in locally advanced rectal cancer (LARC). EXPERIMENTAL DESIGN: Liquid chromatography-mass spectrometry (LC-MS)-based untargeted metabolomics was used to profile human serum samples (n = 106) from LARC patients treated with NCRT. The samples were collected from Fudan University Shanghai Cancer Center (FUSCC) from July 2014 to January 2016...
September 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Abdullah Alsuhaibani, Ahmed Elashwah, Rana Mahmood, Alaa Abduljabbar, Samar Alhomoud, Luai Ashari, Shouki Bazarbashi, Ali Aljubran, Ahmed Alzahrani, Muhamed Mohiuddin, Hadeel Almanea, Hussah Alhussaini, Nasser AlSanea
PURPOSE: Assess feasibility-rate of PCR, short-term toxicity after neoadjuvant concurrent chemoradiation (NACRT) delivered via simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique for locally advanced rectal cancer. METHODS: Retrospective evaluation of patients with locally advanced rectal cancer treated with VMAT-SIB technique preoperatively at an academic tertiary care center in Riyadh, Saudi Arabia between February 2013 and March 2017...
July 14, 2018: Journal of Gastrointestinal Cancer
Jun Gon Kim, Kyoung Doo Song, Dong Ik Cha, Hee Cheol Kim, Jeong Il Yu
PURPOSE: We compared the treatment outcome between surgery-first and neoadjuvant chemoradiation therapy (nCRT)-first strategies in patients with indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging (MRI). METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Among 1910 patients who underwent rectal MRI between 2008 and 2012, 79 patients (mean age, 59.4 years, 49 men and 30 women) who had indistinguishable T2/T3-N0 rectal cancer on rectal MRI were included...
July 13, 2018: International Journal of Colorectal Disease
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