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Short course radiotherapy rectal cancer

D P Schaap, A Ogura, J Nederend, M Maas, J S Cnossen, G J Creemers, I van Lijnschoten, G A P Nieuwenhuijzen, H J T Rutten, M Kusters
BACKGROUND: Lateral nodal disease in rectal cancer remains a subject of debate and is treated differently in the East and the West. The predictive value of lateral lymph node and MRI-detected extramural vascular invasion (mrEMVI) features on oncological outcomes was assessed in this study. METHODS: In this retrospective cohort study, data on patients with cT3-4 rectal cancer within 8 cm from the anal verge were considered over a 5-year period (2009-2013). Lateral lymph node size, malignant features and mrEMVI features were evaluated and related to oncological outcomes...
August 6, 2018: British Journal of Surgery
Clayton A Smith, Lisa A Kachnic
Locally advanced rectal cancer (LARC) carries higher risks of local and distant recurrence when treated with surgical resection alone. Multiple treatment strategies have been investigated to reduce recurrence risk and improve survival. Currently, there are 3 primary strategies for managing LARC: (1) preoperative long-course radiotherapy (RT) combined with radiosensitizing chemotherapy, which is better tolerated than postoperative chemoradiotherapy and provides tumor downstaging and improved pathologic complete response (pCR), followed by postoperative chemotherapy; (2) preoperative short-course RT alone as an alternative strategy for reducing the risk of local recurrence, followed by adjuvant postoperative chemotherapy; and (3) total neoadjuvant therapy with induction chemotherapy followed by chemoradiotherapy to improve pCR and reduce the difficulty of delivering chemotherapy in the postoperative setting...
July 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Xin Wang, Bobo Zheng, Xinlan Lu, Ruhai Bai, Linlin Feng, Quan Wang, Yan Zhao, Shuixiang He
BACKGROUND AND PURPOSE: The role of preoperative short-course radiotherapy (SCRT) in rectal cancer treatment, when compared to long-course radiochemotherapy (LCRT), is still controversial. Thus the meta-analysis with trial sequential analysis (TSA) was performed to evaluate the long-term survival of SCRT and LCRT as therapeutic regimens for locally advanced rectal cancer. MATERIAL AND METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to August 2017 for eligible studies...
2018: PloS One
Daniëlle D Huijts, Julia T van Groningen, Onno R Guicherit, Jan Willem T Dekker, Leti van Bodegom-Vos, Esther Bastiaannet, Johannes A Govaert, Michel W Wouters, Perla J Marang-van de Mheen
Background: It is unclear whether emergency weekend colon and rectal cancer surgery are associated with worse outcomes (ie, weekend effect) because previous studies mostly used administrative data, which may insufficiently adjust for case-mix. Materials and Methods: Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=5,224) was used to examine differences in 30-day mortality and severe complication and failure-to-rescue rates for emergency weekend (Saturday and Sunday) versus Monday surgery, stratified for colon and rectal cancer...
June 2018: Journal of the National Comprehensive Cancer Network: JNCCN
Haoyan Wu, Chao Fang, Libin Huang, Chuanwen Fan, Cun Wang, Lie Yang, Yuan Li, Zongguang Zhou
BACKGROUND: The safety and efficacy of preoperative short-course radiotherapy had been verified in rectal cancer. However, the timing of surgery after radiation had not been well defined. Thus, we performed this meta-analysis to compare the interval time of surgery after short-course radiotherapy in rectal cancer: immediate surgery (<4 weeks) vs delayed surgery (>4 weeks). METHODS: We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library database. The primary endpoints were survival rates and pathological outcomes, and the second endpoints included sphincter preservation rate, R0 resection rate and postoperative complications...
May 25, 2018: International Journal of Surgery
Rogier M P H Crolla, Janneke J C Tersteeg, George P van der Schelling, Jan H Wijsman, Jennifer M J Schreinemakers
BACKGROUND: Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours. METHODS: This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017...
May 16, 2018: Surgical Endoscopy
Nelleke P M Brouwer, Rutger C H Stijns, Valery E P P Lemmens, Iris D Nagtegaal, Regina G H Beets-Tan, Jurgen J Fütterer, Pieter J Tanis, Rob H A Verhoeven, Johannes H W de Wilt
BACKGROUND: This study aims to provide insight in the quality of current daily practice in clinical lymph node staging in colorectal cancer (CRC) in the Netherlands. METHODS: Data of the nationwide population-based Netherlands Cancer Registry between 2003 and 2014 were used to analyze lymph node staging for cM0 CRC patients. Accuracy of clinical lymph node staging was calculated for the period 2011-2014. Analyses were performed for patients without preoperative treatment or treated with short-course radiotherapy (SCRT) followed by resection...
August 2018: European Journal of Surgical Oncology
Alice M Couwenberg, Martijn P W Intven, Johannes P M Burbach, Marleen J Emaus, Wilhelmina M U van Grevenstein, Helena M Verkooijen
BACKGROUND: Organ-sparing approaches, including wait-and-see and local excision, are increasingly being offered to patients with rectal cancer following a good response to neoadjuvant therapy. Preferences regarding these treatment strategies are yet unknown. OBJECTIVE: This study aimed to determine the preferences and utility scores for rectal cancer treatment approaches. DESIGN: This is a cross-sectional study. SETTING: This study was conducted at the Radiation-Oncology Department of the University Medical Center Utrecht...
August 2018: Diseases of the Colon and Rectum
Przemysław Wawok, Wojciech Polkowski, Piotr Richter, Marek Szczepkowski, Janusz Olędzki, Ryszard Wierzbicki, Tomasz Gach, Andrzej Rutkowski, Adam Dziki, Leszek Kołodziejski, Rafał Sopyło, Lucyna Pietrzak, Jacek Kryński, Katarzyna Wiśniowska, Mateusz Spałek, Konrad Pawlewicz, Marcin Polkowski, Teresa Kowalska, Krzysztof Paprota, Małgorzata Jankiewicz, Andrzej Radkowski, Justyna Chalubińska-Fendler, Wojciech Michalski, Krzysztof Bujko
BACKGROUND AND PURPOSE: It is uncertain whether local control is acceptable after preoperative radiotherapy and local excision (LE). An optimal preoperative dose/fractionation schedule has not yet been established. MATERIAL AND METHODS: In a phase III study, patients with cT1-2N0M0 or borderline cT2/T3N0M0 < 4 cm rectal adenocarcinomas were randomised to receive either 5 × 5 Gy plus 1 × 4 Gy boost or chemoradiation: 50.4 Gy in 28 fractions plus 3 × 1...
June 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Alice M Couwenberg, Johannes P M Burbach, Wilhelmina M U van Grevenstein, Anke B Smits, Esther C J Consten, Anandi H W Schiphorst, Niels A T Wijffels, Joost T Heikens, Martijn P W Intven, Helena M Verkooijen
INTRODUCTION: Rectal cancer surgery with neoadjuvant therapy is associated with substantial morbidity. The present study describes the course of quality of life (QOL) in rectal cancer patients in the first 2 years after the start of treatment. PATIENTS AND METHODS: We performed a prospective study within a colorectal cancer cohort including rectal cancer patients who were referred for neoadjuvant chemoradiation or short-course radiotherapy and underwent rectal surgery...
March 21, 2018: Clinical Colorectal Cancer
Andrzej Rutkowski, Lucyna Pietrzak, Jacek Kryński, Leszek Zając, Mariusz Bednarczyk, Tomasz Olesiński, Marek Szpakowski, Piotr Saramak, Ireneusz Pierzankowski, Piotr Hevelke, Piotr Surowski, Krzysztof Bujko
PURPOSE: A previous randomized study conducted by our group showed that application of gentamicin-collagen implant (GCI) into the pelvic cavity after total mesorectal excision (TME) reduced the incidence of distant metastases. Therefore, we decided to conduct a confirmatory study. METHODS: Patients with rectal cancer were included in the study if they met the following criteria: adenocarcinoma of the rectum, preoperative short-term radiotherapy (5 × 5 Gy), and WHO performance score 0-1...
August 2018: International Journal of Colorectal Disease
Sieske Hoendervangers, Alice M Couwenberg, Martijn P W Intven, Wilhelmina M U van Grevenstein, Helena M Verkooijen
INTRODUCTION: Patients with locally advanced rectal cancer (LARC) who are unfit for chemoradiation (CRT), are often offered short-course radiotherapy followed by delayed surgery (SCRT-delay). This entails a lower radiation dose, no chemotherapy and a shorter treatment period. This may lower their chances for complete tumor response and, as such, organ-sparing approaches. The purpose of this study was to compare the pathological complete response (pCR) rates between neoadjuvant CRT and SCRT-delay in patients with LARC in a nationwide database from the Netherlands...
July 2018: European Journal of Surgical Oncology
Mahdi Aghili, Sarvazad Sotoudeh, Reza Ghalehtaki, Mohammad Babaei, Borna Farazmand, Mohammad-Sadegh Fazeli, Amir Keshvari, Peiman Haddad, Farshid Farhan
PURPOSE: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. MATERIALS AND METHODS: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin...
March 2018: Radiation Oncology Journal
Cloë L Sparreboom, Zhouqiao Wu, Hester F Lingsma, Anand G Menon, Gert-Jan Kleinrensink, Joost J Nuyttens, Michel Wjm Wouters, Johan F Lange
BACKGROUND: Short-course preoperative radiotherapy is indicated in patients with resectable rectal cancer to control local recurrence. Although no clear evidence is available, short-course radiotherapy with operation within a week is common practice. The aim of this study was to investigate the impact of timing of operation for rectal cancer after short-course radiotherapy on anastomotic leakage. STUDY DESIGN: Data from the Dutch Colorectal Audit were used. All patients who received short-course preoperative radiotherapy and underwent elective operation within 14 days for rectal cancer between January 1, 2011 and December 31, 2016 were included...
August 2018: Journal of the American College of Surgeons
T D A Neely, C J Tan, S T Irwin
Aim: Surgery is the mainstay of treatment for invasive rectal cancer. Advances in surgical technique and radiotherapy over the past few decades have resulted in improved local control and survival.1 - 3 Some concern remains regarding the morbidity associated with performing surgery within a short window following radiotherapy. The current study assessed whether the interval between short-course radiotherapy and surgery influences all cause post-operative morbidity and mortality. Methods: All patients who had undergone short-course radiotherapy for rectal cancer within the Belfast Health and Social Care Trust from 2005 to 2014 held on a prospective database were included (n=102)...
September 2017: Ulster Medical Journal
Ke Chen, Guoming Xie, Qi Zhang, Yanping Shen, Taoqi Zhou
Aim: This study attempted to compare the prognostic performance of short- and long-course preoperative treatments for neoadjuvant therapy of rectal cancer by meta-analysis. Methods: Electronic databases of PubMed and Embase were searched for eligible studies updated to February 29, 2016. Studies were included based on several predefined inclusion criteria. Quality assessment was carried out according to the Cochrane Collaboration recommendations in Cochrane handbook...
2018: Journal of Cancer Research and Therapeutics
Tomasz Skóra, Jadwiga Nowak-Sadzikowska, Dariusz Martynów, Mariusz Wszołek, Beata Sas-Korczyńska
Objective: The purpose of this study was to evaluate the clinical outcome of preoperative short-course radiotherapy for rectal cancer patients. Methods: The study group comprised 210 patients with pathologically proven resectable rectal cancer. Between 2001 and 2013, they were treated preoperatively with short-course radiotherapy (25 Gy delivered in five fractions), followed by total mesorectal excision. Adjuvant 5-fluorouracil-based chemotherapy was administered at the discretion of the treating physician, depending on the pathological stage...
2018: Journal of Radiation Oncology
Milan Spasojevic, Anthony B Mariathasan, Mariusz Goscinski, Ebbe B Thorgersen, Arne M Solbakken, Hans-Petter Gullestad, Truls Ryder, Kjersti Flatmark, Stein G Larsen
BACKGROUND: Radiotherapy (RT) and subsequent abdominoperineal resection (APR) for locally advanced rectal cancer (LARC) is associated with significant perineal wound morbidity. The aim of the present study was to investigate if vertical rectus abdominis musculocutaneous (VRAM) flap repair after APR in LARC patients improves perineal wound healing compared with direct perineal wound closure (non-VRAM). METHODS: LARC patients (n = 329) operated with APR between January 2006 and December 2015 after neoadjuvant RT of ≥ 25 Gy were identified, including 260 and 69 patients in the non-VRAM and VRAM groups, respectively...
May 2018: Annals of Surgical Oncology
Susana Roselló, Federica Papaccio, Desamparados Roda, Noelia Tarazona, Andrés Cervantes
Curative treatment of rectal cancer depends on an optimal surgical resection, with the addition of neoadjuvant radiotherapy (RT) with or without concomitant chemotherapy (ChT) in more advanced tumors. The role of adjuvant ChT is controversial and a more intensified neoadjuvant approach with the addition of ChT before or after RT, or even as single modality, is currently being explored in trials. A systematic review selecting randomised phase II and III trials on the role of ChT in localized rectal cancer was performed...
February 2018: Cancer Treatment Reviews
Hironori Minami, Tsuyoshi Konishi, Hironori Fukuoka, Shun Miyanari, Satoshi Murahashi, Ian Fukudome, Shinsuke Suzuki, Hajime Ushigome, Toshiya Nagasaki, Takashi Akiyoshi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno
BACKGROUNDS: In the setting of routine use of preoperative chemoradiotherapy(CRT)for cStage II / III rectal cancer, shortcourse radiotherapy(short-RT)is selectively used for reducing local recurrence.The purpose of this study is to clarify the safety of laparoscopic surgery after preoperative short-RT for lower rectal cancer. METHODS: Twenty-eight patients who un- derwent short-RT followed by laparoscopic total mesorectal excision for cStage II / III lower rectal cancer were retrospectively analyzed...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
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