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Neoadjuvant chemoradiation rectal cancer

Avanish Saklani, P Sugoor, A Chaturvedi, R Bhamre, S Jatal, V Ostwal, R Engineer
The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC...
December 2018: Indian Journal of Surgical Oncology
Hendrik Dapper, Iván Rodríguez, Stefan Münch, Jan C Peeken, Kai Borm, Stephanie E Combs, Daniel Habermehl
BACKGROUND: Neoadjuvant radio- or chemoradiation (nIRT) therapy is the standard treatment for loco-regional advanced rectal cancer patients of the lower or middle third. Currently, intensity modulated radiation therapy (IMRT) is not the recommended radiation technique even though IMRT has advantages compared to 3D-radiation regarding dose sparing to organs at risk like small bowel and urinary bladder. So far, the benefit of IMRT concerning the anal sphincter complex is not examined. With this study we intended to evaluate the dose distribution on the anal sphincters of rectal cancer patients treated with IMRT in comparison with 3D-techniques...
December 3, 2018: Radiation Oncology
Yu-Min Huang, Yan Jiun Huang, Po-Li Wei
PURPOSE: Robotic surgery for colorectal cancer is an emerging technique. Potential benefits as compared with the conventional laparoscopic surgery have been demonstrated. However, experience with the previous da Vinci Si robotic system revealed several unsolved problems. The novel features of the new da Vinci Xi increase operational flexibility and maneuverability and are expected to facilitate the performance of multiquadrant surgery. METHODS: Between December 2011 and May 2015, 120 patients with colon or rectal cancer were operated on using the Si robotic system (the Si group)...
December 3, 2018: Surgical Innovation
J S Zhang, T Wang, H P Du, L Wu
Objective: To explore the best surgical timing after neoadjuvant chemoradiation for advanced rectal cancer patients. Methods: According to the time interval between neoadjuvant chemoradiation and surgery, 117 patients with advanced rectal cancer were divided into short interval group (≤7 weeks, n =54) and long interval group (>7 weeks, n =64). The endpoints included postoperative pathology, short-term efficacy, tumor recurrence and patient survival between the two groups. Results: There were 8 cases PCR in short interval group and 20 cases in long interval group( P =0...
November 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Jiawang Wei, Rong Huang, Suping Guo, Xuhui Zhang, Shaoyan Xi, Qiaoxuan Wang, Hui Chang, Xiaohao Wang, Weiwei Xiao, Zhifan Zeng, Yuanhong Gao
Background: The purpose of this study was to investigate the value of the postsurgical pathological T and N (ypTN) category combined with the American Joint Committee on Cancer-tumor regression grade (AJCC-TRG) in evaluating the prognosis of neoadjuvant chemoradiation therapy (NeoCRT) for locally advanced rectal cancer (LARC) to screen for a subgroup of patients with the worst prognosis. Patients and methods: In total, 265 patients with LARC were enrolled in the trial...
2018: Cancer Management and Research
William H Ward, Neha Goel, Karen J Ruth, Andrew C Esposito, Fernando Lambreton, Elin R Sigurdson, Joshua E Meyer, Jeffrey M Farma
BACKGROUND: Advances in treatment of rectal cancer have improved survival, but there is variability in response to therapy. Recent data suggest the utility of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in predicting survival. Our aim was to examine these ratios in rectal cancer patients and determine whether any association exists with overall survival (OS). METHODS: Using prospectively maintained institutional data, a query was completed for clinical stage II-III rectal adenocarcinoma patients treated from 2002 to 2016...
December 2018: Journal of Surgical Research
Georgios Karagkounis, David Liska, Matthew F Kalady
BACKGROUND: Disease-free survival estimated from the time of surgery does not account for the changing likelihood of survival based on time already accrued. Conditional disease-free survival is defined as the probability of remaining disease free after reaching a specific time point without recurrence. OBJECTIVE: The purpose of this study was to evaluate conditional disease-free survival for patients with rectal cancer who were treated by proctectomy after neoadjuvant chemoradiation...
November 15, 2018: Diseases of the Colon and Rectum
I Mizrahi, F B de Lacy, M Abu-Gazala, L M Fernandez, A Otero, D R Sands, A M Lacy, S D Wexner
BACKGROUND: The aim of this study was to evaluate the impact of fluorescence angiography (FA) on any change in proximal resection margin and/or anastomotic leak (AL) following transanal total mesorectal excision (TaTME) for rectal cancer (RC). METHODS: This retrospective cohort study was conducted at two centers by three senior surgeons. Both institutions' prospectively maintained Institutional Review Board-approved databases were retrospectively queried for all consecutive patients between July 2015 and May 2017 who had laparoscopic hybrid trans-abdominal total mesorectal excision (TME) and TaTME for RC with colorectal or coloanal anastomosis < 10 cm from the anal verge...
October 2018: Techniques in Coloproctology
Nicola de'Angelis, Frederic Pigneur, Aleix Martínez-Pérez, Giulio Cesare Vitali, Filippo Landi, Segundo A Gómez-Abril, Michela Assalino, Eloy Espin, Frederic Ris, Alain Luciani, Francesco Brunetti
AIM: Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluated the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and, additionally, proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. METHODS: This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis...
November 14, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
An-Sofie Verrijssen, Thirza Opbroek, Murillo Bellezzo, Gabriel P Fonseca, Frank Verhaegen, Jean-Pierre Gerard, Arthur Sun Myint, Evert J Van Limbergen, Maaike Berbee
PURPOSE: A clinical complete response is seen after neoadjuvant chemoradiation for rectal tumors in 15%-20% of patients. These patients can potentially be spared mutilating total mesorectal excision surgery through a watch-and-wait policy. Recent studies show that dose escalation by a radiation boost increases the clinical complete response rate. The boost dose to the tumor can be administered through external beam radiotherapy or through internal radiotherapy using techniques like contact therapy, low-dose-rate or high-dose-rate brachytherapy (BT)...
November 2, 2018: Brachytherapy
Daphna Y Spiegel, Matthew J Boyer, Julian C Hong, Christina D Williams, Michael J Kelley, Harvey Moore, Joseph K Salama, Manisha Palta
PURPOSE: Standard therapy for locally advanced rectal cancer includes neoadjuvant chemoradiation and surgery. Complete response (CR) rates after chemoradiation can be as high as 29%, suggesting that nonoperative management (NOM) may be reasonable with appropriately selected patients. We sought to identify potential NOM candidates. METHODS AND MATERIALS: Using the VA Central Cancer Registry, stage II-III rectal cancer patients receiving chemoradiation +/- subsequent surgery were identified...
October 22, 2018: International Journal of Radiation Oncology, Biology, Physics
Felipe Quezada-Diaz, Rosa M Jimenez-Rodriguez, Emmanouil P Pappou, J Joshua Smith, Sujata Patil, Iris Wei, Jose G Guillem, Philip B Paty, Garrett M Nash, Martin R Weiser, Julio Garcia-Aguilar
BACKGROUND: Neoadjuvant chemoradiation (CRT) impairs bowel function in patients with rectal cancer treated with total mesorectal excision (TME). The impact of other forms of neoadjuvant therapy such as neoadjuvant chemotherapy alone (NC) and induction chemotherapy followed by CRT (total neoadjuvant therapy or TNT) on postoperative bowel function has not been investigated. METHODS: We conducted a retrospective review of 176 rectal cancer patients treated between November 1, 2011, and August 31, 2017...
October 22, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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...
November 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
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