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neoadjuvant chemoradiotherapy

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
Maryam Alfa-Wali, Samantha Muktar, Dimitrios Pissas, Ceri Slater
A 48-year-old man presented as an emergency with a 3-week history of rectal bleeding. Examination of his rectum revealed a circumferential tumour, 2 cm from the anal verge. An MRI scan reported a locally infiltrative mid-lower rectal tumour staged as T3d/T4 N2 MX. A colonoscopy revealed appearances of severe proctitis and biopsies did not show any evidence of dysplasia or malignancy. The patient was discussed at the regional colorectal cancer multidisciplinary team meeting with a management plan for neoadjuvant chemoradiotherapy following repeat biopsies, which were again negative for malignancy...
March 15, 2018: BMJ Case Reports
Geny Piro, Carmine Carbone, Raffaela Santoro, Giampaolo Tortora, Davide Melisi
Introduction Esophageal and esophago-gastric junction (EGJ) adenocarcinomas remain a major health problem worldwide with a worryingly increasing incidence. Recent trials indicate survivals benefit for preoperative or perioperative chemoradiotherapy compared to surgery alone. Beside standard chemoradiotherapy regimens, new therapeutic approaches with targeted therapies have been proposed for the treatment of resectable disease. However, clinical outcomes remain extremely poor due to drug resistance phenomena...
March 16, 2018: Expert Review of Molecular Diagnostics
David Vrana, Viktor Hlavac, Veronika Brynychova, Radka Vaclavikova, Cestmir Neoral, Jiri Vrba, Rene Aujesky, Marcel Matzenauer, Bohuslav Melichar, Pavel Soucek
The prognosis of esophageal cancer (EC) is poor, despite considerable effort of both experimental scientists and clinicians. The tri-modality treatment consisting of neoadjuvant chemoradiation followed by surgery has remained the gold standard over decades, unfortunately, without significant progress in recent years. Suitable prognostic factors indicating which patients will benefit from this tri-modality treatment are missing. Some patients rapidly progress on the neoadjuvant chemoradiotherapy, which is thus useless and sometimes even harmful...
March 15, 2018: International Journal of Molecular Sciences
Roelof J Beukinga, Jan Binne Hulshoff, Véronique E M Mul, Walter Noordzij, Gursah Kats-Ugurlu, Riemer H J A Slart, John T M Plukker
Purpose To assess the value of baseline and restaging fluorine 18 (18 F) fluorodeoxyglucose (FDG) positron emission tomography (PET) radiomics in predicting pathologic complete response to neoadjuvant chemotherapy and radiation therapy (NCRT) in patients with locally advanced esophageal cancer. Materials and Methods In this retrospective study, 73 patients with histologic analysis-confirmed T1/N1-3/M0 or T2-4a/N0-3/M0 esophageal cancer were treated with NCRT followed by surgery (Chemoradiotherapy for Esophageal Cancer followed by Surgery Study regimen) between October 2014 and August 2017...
March 14, 2018: Radiology
Penny Fang, Wen Jiang, Rajayogesh Davuluri, Cai Xu, Sunil Krishnan, Radhe Mohan, Albert C Koong, Charles C Hsu, Steven H Lin
BACKGROUND AND PURPOSE: Neoadjuvant chemoradiation (nCRT) can reduce tumor infiltrating lymphocytes. We examined absolute lymphocyte count (ALC) nadir during nCRT for esophageal cancer (EC) and pathologic complete response (pCR). MATERIALS AND METHODS: Patients with stage I-IVA EC (n = 313) treated 2007-2013 with nCRT followed by surgery were analyzed. ALC was obtained before, during/weekly, and one month after CRT. pCR was defined as no viable tumor cells at surgery...
March 9, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
L R van der Werf, J L Dikken, M I van Berge Henegouwen, V E P P Lemmens, G A P Nieuwenhuijzen, B P L Wijnhoven
BACKGROUND: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. STUDY DESIGN: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included...
March 9, 2018: Annals of Surgical Oncology
Yoichi Hamai, Jun Hihara, Manabu Emi, Takaoki Furukawa, Yuji Murakami, Ikuno Nishibuchi, Yasushi Nagata, Yuta Ibuki, Ichiko Yamakita, Tomoaki Kurokawa, Morihito Okada
BACKGROUND: The accurate prediction of a pathologic complete response (ypT0N0M [LYM] 0 ypStage 0) before operation is essential for selecting appropriate strategies for treating esophageal cancer after neoadjuvant chemoradiotherapy. METHODS: We reviewed 130 consecutive patients with esophageal squamous cell carcinoma who were evaluated preoperatively using upper gastrointestinal endoscopy, computed tomography, and18 F-fluorodeoxyglucose-positron emission tomography after neoadjuvant chemoradiotherapy and subsequently underwent esophagectomy...
March 5, 2018: Surgery
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
Rodica Birla, Petre Hoara, Andrei Caragui, Marica Cristian, Silviu Constantinoiu
Adenocarcinoma of the gastroesophageal junction is more common in the West. Preoperative chemotherapy or chemoradiotherapy is performed for locally advanced disease. Recent studies are suggesting higher rates of curative resection and reduced rates of local recurrence in patients with neoadjuvant combination of chemotherapy and radiation therapy. The role of targeted agents in neoadjuvant therapy is under investigation.
January 2018: Chirurgia
Y H M Claassen, H H Hartgrink, J L Dikken, W O de Steur, J W van Sandick, N C T van Grieken, A Cats, A K Trip, E P M Jansen, W M Meershoek-Klein Kranenbarg, J P B M Braak, H Putter, M I van Berge Henegouwen, M Verheij, C J H van de Velde
BACKGROUND: In order to determine the optimal combination of perioperative chemotherapy and chemoradiotherapy for Western patients with advanced resectable gastric cancer, the international multicentre CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) was initiated. In this trial, patients with resectable gastric cancer were randomised before start of treatment between adjuvant chemotherapy or adjuvant chemoradiotherapy following neoadjuvant chemotherapy plus gastric cancer resection...
February 9, 2018: European Journal of Surgical Oncology
J X Zhang, Z Yang, P Fan, J J Zhang, L Xin, L N Hou, X S Du, X T Yang
Objective: To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery. Methods: A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Lucas Goense, Alicia S Borggreve, Sophie E Heethuis, Astrid Lhmw van Lier, Richard van Hillegersberg, Stella Mook, Gert J Meijer, Peter Sn van Rossum, Jelle P Ruurda
OBJECTIVE: The perceived burden of diagnostic tests by patients during the assessment of oesophageal cancer warrants attention with the current increase in repeated imaging for purposes of disease monitoring during and after treatment. The purpose of this prospective study was to evaluate the experienced burden associated with repeated MRI and PET/CT examinations during neoadjuvant treatment for oesophageal cancer from the perspective of the patient. METHODS: In 27 patients receiving neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer MRI and PET/CT examinations were performed before nCRT, during nCRT and before surgery...
March 2, 2018: British Journal of Radiology
Daniele Bernardi, Emanuele Asti, Alberto Aiolfi, Gianluca Bonitta, Alberto Luporini, Luigi Bonavina
BACKGROUND: In the real-world setting outside clinical trials, neoadjuvant chemoradiation therapy followed by esophagectomy may represent overtreatment in some elderly individuals with multiple comorbidities. PATIENTS AND METHODS: Through an observational cohort study, consecutive patients with esophageal cancer treated with the protocol of the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) were compared to patients of similar age who underwent upfront surgery during the same study period...
March 2018: Anticancer Research
Hiroshi Saeki, Yuichiro Nakashima, Kensuke Kudou, Shun Sasaki, Tomoko Jogo, Kosuke Hirose, Keitaro Edahiro, Shotaro Korehisa, Daisuke Taniguchi, Ryota Nakanishi, Nobuhide Kubo, Koji Ando, Akira Kabashima, Eiji Oki, Yoshihiko Maehara
BACKGROUND: Since the clinical impact of sarcopenia on multimodal therapy for patients with esophageal cancer is not well understood, this study was conducted to determine the influence of sarcopenia on the efficacy of neoadjuvant chemoradiotherapy (NACRT) for locally advanced esophageal cancer. METHODS: The skeletal muscle index was quantified at the level of the third lumbar vertebra on computed tomography images, and sarcopenia was defined as a skeletal muscle index that was less than the average for each gender...
February 27, 2018: World Journal of Surgery
Amy C Moreno, Waqar Haque, Vivek Verma, Penny Fang, Steven H Lin
BACKGROUND: Following complete resection of pN2 non-small cell lung cancer (NSCLC), national guidelines recommend either sequential (sCRT) or concurrent chemoradiotherapy (cCRT). This is the largest study to date evaluating survival between both approaches. In sCRT patients, sequencing 'chemotherapy first' versus 'radiotherapy first' was also addressed. METHODS: The National Cancer Data Base (NCDB) was queried for patients with primary NSCLC undergoing surgery (without neoadjuvant radiotherapy or chemotherapy), pN2 disease with negative surgical margins, and receiving postoperative CRT...
February 26, 2018: Annals of Surgical Oncology
Takahiro Muroya, Naoki Wajima, Takafumi Yachi, Takanobu Akaishi, Satoko Umetsu, Tatsuya Yoshida, Yusuke Wakasa, Kentaro Sato, Yuto Mitsuhashi, Kotaro Umemura, Takahiro Suzuki, Satoru Tsuruta, Kenichi Hakamada
Myocardial metastasis for esophageal squamous cell carcinoma(ESCC)is relatively rare and it is diagnosed as a part of widespread metastasis in the terminal stage. We experienced a case of myocardial metastasis of ESCC treated effectively with chemoradiotherapy. A 56-year-old man was diagnosed ESCC(clinical T3N2M0, Stage III). He received neoadjuvant chemotherapy of 5-fluorouracil plus cisplatin followed by subtotal esophagectomy with dissection of the 3 regional lymph nodes. The pathological diagnosis was moderate differentiated squamous cell carcinoma, CT-pT3(T3), pN1, sM0, fStage III...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Lucas Goense, Els Visser, Nadia Haj Mohammad, Stella Mook, Rob H A Verhoeven, Gert J Meijer, Peter S N van Rossum, Jelle P Ruurda, Richard van Hillegersberg
BACKGROUND: The aim of this population-based cohort study was to determine whether the addition of neoadjuvant chemoradiotherapy (nCRT) to surgery is associated with improved pathologic outcomes and survival in patients with cT2N0M0 esophageal cancer. METHODS: Patients who underwent nCRT followed by surgery or surgery alone for cT2N0M0 esophageal cancer were identified from The Netherlands Cancer Registry database (2005-2014). Accuracy of clinical staging was assessed using the resection specimen as gold standard...
February 13, 2018: European Journal of Surgical Oncology
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
A S Patil, N V Gulavani, N P Dharmadhikari, K C Polavarapu, S S Sharma, R C Mistry
AIMS: : To compare perioperative complications in esophagectomy after neoadjuvant therapy v/s primary surgery. SETTINGS AND DESIGN: : Retrospective analysis of perioperative complications in a prospectively maintained data base of patients who underwent esophagectomy as Primary surgery or after neoadjuvant therapy was done. METHODS AND MATERIAL: : 238 cases of esophagectomies performed for esophageal carcinoma were analysed and compared, out of which 125(52...
April 2017: Indian Journal of Cancer
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