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Neoadjuvant chemoradiation rectal cancer

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...
August 10, 2018: Techniques in Coloproctology
Lakshmi Shree Mahadevan, James Zhong, BhanuPrasad Venkatesulu, Harmeet Kaur, Shreerang Bhide, Bruce Minsky, William Chu, Martijn Intven, Uulke A van der Heide, Baukelien van Triest, Sunil Krishnan, William 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...
August 2, 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...
July 25, 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...
July 2, 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
J E Cutting, S E Hallam, M G Thomas, D E Messenger
AIM: Total mesorectal excision remains the cornerstone of treatment for rectal cancer. Significant morbidity means local excision may be more appropriate in selected patients. Adjuvant therapy reduces local recurrence and improves survival; however, there is a paucity of data on its impact following local excision, which this systematic review aims to address. METHODS: A systematic search of the MEDLINE, Embase and Cochrane databases using validated terms for rectal cancer, adjuvant therapy and local excision was performed...
July 10, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Byung Mo Kang, Jeong-Heum Baek, Sun Jin Park, Seong Kyu Baek, Ki-Jae Park, Hong-Jo Choi, Byung-Noe Bae, Sun Keun Choi, Kap Tae Kim, Jin-Su Kim, Suk-Hwan Lee
PURPOSE: This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation. METHODS: This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253)...
June 2018: Annals of Coloproctology
Andrew Kolarich, Thomas J George, Steven J Hughes, Daniel Delitto, Carmen J Allegra, William A Hall, George J Chang, Sanda A Tan, Christiana M Shaw, Atif Iqbal
BACKGROUND: The incidence of rectal cancer in patients younger than 50 years is increasing. To test the hypothesis that the biology in this younger cohort may differ, this study compared survival patterns, stratifying patients according to National Comprehensive Cancer Network (NCCN) guideline-driven care and age. METHODS: The National Cancer Data Base was queried for patients treated with curative-intent transabdominal resections with negative surgical margins for stage I to III rectal cancer between 2004 and 2014...
July 9, 2018: Cancer
Sare Hosseini, NamPhong Nguyen, Mohammad Mohammadianpanah, Sepideh Mirzaei, Ali Mohammad Bananzadeh
INTRODUCTION: Currently, neoadjuvant fluoropyrimidine-based chemoradiation followed by surgery is considered the standard of care for locally advanced rectal cancer. The current study aimed to investigate the predictive significance of mucinous histology on the pathologic complete response rate following neoadjuvant chemoradiation in locally advanced rectal cancer and to propose potential new treatment protocol for this specific histology. MATERIAL AND METHOD: This retrospective study was conducted on 403 patients with locally advanced (clinically T3-4 and/or N1-2) rectal adenocarcinoma who had been treated at three tertiary academic hospitals between 2010 and 2015...
July 9, 2018: Journal of Gastrointestinal Cancer
Leonardo Alfonso Bustamante-Lopez, Caio Sergio Rizkallah Nahas, Sergio Carlos Nahas, Carlos Frederico Sparapan Marques, Rodrigo Ambar Pinto, Guilherme Cutait Cotti, Antonio Rocco Imperiale, Evandro Sobroza de Mello, Ulysses Ribeiro, Ivan Cecconello
Studies have suggested that the use of neoadjuvant chemoradiation results in a lower lymph nodes yield in rectal cancer patients. OBJECTIVE: To evaluate factors associated with less than 12 lymph nodes harvested on patients with rectal cancer treated with preoperative chemoradiotherapy followed by total mesorectal excision. PATIENTS: This was a cohort/retrospective single cancer center study. Low and mid locally advanced rectal cancer or T2N0 under risk of sphincter resection underwent chemoradiotherapy followed by total mesorectal excision with curative intent...
July 5, 2018: International Journal of Surgery
Amol K Narang, Jeffrey Meyer
PURPOSE OF REVIEW: For patients with locally advanced rectal cancer, neoadjuvant hypofractionated short-course radiation remains an underutilized regimen in the USA. We review the current clinical literature highlighting the relative merits of short-course radiation, along with modern neoadjuvant strategies that incorporate its use. RECENT FINDINGS: As compared to long-course chemoradiation with delayed surgery, short-course radiation with early surgery offers similar oncologic efficacy for locally advanced rectal cancer patients...
July 5, 2018: Current Oncology Reports
Xiyu Sun, Huizhong Qiu, Bin Wu, Guole Lin, Haifeng Shi, Yi Xiao
OBJECTIVE: To investigate the treatment of colorectal anastomotic tubular stricture after anterior resection of rectal cancer. METHODS: A retrospective study on 23 cases of anastomotic tubular stricture after anterior resection of rectal cancer from 2008 to 2017 at the Division of Colorectal Surgery, Department of General Surgery of Peking Union Medical College Hospital was performed. The general conditions of the patients, surgical procedures of rectal cancer, perioperative treatment, specific conditions of anastomotic stricture, treatment methods and outcomes were summarized and analyzed...
June 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Aiwen Wu, Guoli He, Lin Wang, Qiushi Dong, Xinzhi Liu, Yingjie Li, Jiahua Leng, Xiao Zhang, Tingting Sun, Yue Zhang, Yunfeng Yao
OBJECTIVE: To explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations. METHODS: Clinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed...
June 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Dongfeng Niu, Weicheng Xue
Preoperative neoadjuvant therapy of rectal cancer has been widely promoted, and postoperative standardized pathological assessment has gradually attracted widespread attention. Accurate pathological examination plays an indicating role in the diagnosis and treatment of rectal cancer, which can not only evaluate the effects of neoadjuvant chemoradiation and surgical resection, but also guide postoperative adjuvant therapy and assess the prognosis. Tumor regression grade (TRG) and TNM staging are the bases of routine pathological diagnosis of rectal cancer, and they are closely related to patient survival and prognosis...
June 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Gulsen Atasoy, Naciye Cigdem Arslan, Funda Dinc Elibol, Ozgul Sagol, Funda Obuz, Selman Sokmen
PURPOSE: To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer. METHODS: Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed. RESULTS: 125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3...
June 30, 2018: Surgery Today
Andre R Dias, Marina Alessandra Pereira, Evandro Sobroza de Mello, Sergio Carlos Nahas, Ivan Cecconello, Ulysses Ribeiro
BACKGROUND: It is widely reported that neoadjuvant chemoradiation reduces lymph node yield in rectal cancer specimens. Some have questioned the adequacy of finding ≥12 lymph nodes for accurate staging, and fewer nodes were correlated with good response. Others reported that low lymph node count raises the chance for understaging and correlates with worse survival. In addition, a few studies demonstrated that diligent specimen analysis increases lymph node count. OBJECTIVE: The aim of this study was to compare Carnoy's solution and formalin concerning lymph node yield in specimens of patients with rectal cancer after neoadjuvant chemoradiation...
August 2018: Diseases of the Colon and Rectum
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