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https://www.readbyqxmd.com/read/29329555/exercise-during-and-after-neoadjuvant-rectal-cancer-treatment-the-exert-trial-study-protocol-for-a-randomized-controlled-trial
#1
Andria R Morielli, Nawaid Usmani, Normand G Boulé, Diane Severin, Keith Tankel, Tirath Nijjar, Kurian Joseph, Alysa Fairchild, Kerry S Courneya
BACKGROUND: Standard treatment for locally advanced rectal cancer includes 5-6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6-8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning that may impede quality of life (QoL), treatment completion, treatment response, and long-term prognosis. Interventions to improve treatment outcomes and manage side effects that are safe, tolerable and low-cost are highly desirable...
January 12, 2018: Trials
https://www.readbyqxmd.com/read/29308324/neoadjuvant-radiochemotherapy-decreases-the-total-amount-of-tumor-infiltrating-lymphocytes-but-increases-the-number-of-cd8-granzyme-b-grzb-cytotoxic-t-cells-in-rectal-cancer
#2
Armin Jarosch, Ulrich Sommer, Andreas Bogner, Christoph Reißfelder, Jürgen Weitz, Mechthild Krause, Gunnar Folprecht, Gustavo B Baretton, Daniela E Aust
Although neoadjuvant radiochemotherapy (nRCTx) is an established oncological treatment in patients with advanced rectal cancer, little is known about its effects on the tumor microenvironment. Quantity and composition of tumor infiltrating lymphocytes (TILs) are known to influence patients' prognosis but nRCTx-induced modifications are still unclear. We determined the composition of the immune cell infiltrate in rectal cancer after nRCTx and its influence on tumor regression, local recurrence rate and survival...
2018: Oncoimmunology
https://www.readbyqxmd.com/read/29299359/short-course-radiation-as-a-component-of-definitive-multidisciplinary-treatment-for-select-patients-with-metastatic-rectal-adenocarcinoma
#3
Emma B Holliday, Andrew Hunt, Y Nancy You, George J Chang, John M Skibber, Miguel A Rodriguez-Bigas, Brian K Bednarski, Cathy Eng, Eugene J Koay, Bruce D Minsky, Cullen Taniguchi, Sunil Krishnan, Joseph M Herman, Prajnan Das
Background: Select patients with rectal adenocarcinoma with metastatic disease at presentation can be cured with multimodality management. However, the optimal components and sequencing of therapy is unknown. The aim of this study is to evaluate outcomes for patients treated with chemotherapy, short course radiation therapy (SCRT) and surgical resection. Methods: Patients with newly diagnosed metastatic rectal adenocarcinoma who received SCRT from 2010-2016 were identified...
December 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29291032/monitoring-neoadjuvant-therapy-responses-in-rectal-cancer-using-multimodal-nonlinear-optical-microscopy
#4
Lian-Huang Li, Zhi-Fen Chen, Xing-Fu Wang, Xing Liu, Wei-Zhong Jiang, Shuang-Mu Zhuo, Li-Wei Jiang, Guo-Xian Guan, Jian-Xin Chen
Most patients with rectal cancer have a better prognosis after receiving neoadjuvant therapy because of its remarkable curative effect. However, no device delivers real-time histopathologic information on treatment response to help clinicians tailor individual therapeutic strategies. We assessed the potential of multimodal nonlinear optical microscopy to monitor therapeutic responses, including tumoral and stromal responses. We found that two-photon excited fluorescence imaging can, without labeling, identify colloid response, inflammatory cell infiltration, vascular proliferation, and tumor regression...
December 5, 2017: Oncotarget
https://www.readbyqxmd.com/read/29290999/impact-of-neoadjuvant-and-adjuvant-radiotherapy-on-disease-specific-survival-in-patients-with-stages-ii-iv-rectal-cancer
#5
Yinying Wu, Haiyang Liu, Xianglin L Du, Fan Wang, Jing Zhang, Xiaohai Cui, Enxiao Li, Jin Yang, Min Yi, Yunfeng Zhang
Objectives: The purposes of this study were to determine whether neoadjuvant or adjuvant radiotherapy affected disease-specific survival (DSS) in patients with rectal cancer and whether stratification by tumor stage affected the results. Results: 55.5% patients had neoadjuvant-radiotherapy (NRT), and 18.3% patients had adjuvant- radiotherapy (ART). Multivariable models showed that treatment type was independently associated with DSS. Patients with stages III/IV tumors who received ART plus chemotherapy had significantly worse DSS than did those who received NRT plus chemotherapy (NCRT) (P = 0...
December 5, 2017: Oncotarget
https://www.readbyqxmd.com/read/29290917/tumor-stroma-ratio-as-prognostic-factor-for-survival-in-rectal-adenocarcinoma-a-retrospective-cohort-study
#6
René Scheer, Alexi Baidoshvili, Shorena Zoidze, Marloes A G Elferink, Annefleur E M Berkel, Joost M Klaase, Paul J van Diest
AIM: To evaluate the prognostic value of the tumor-stroma ratio (TSR) in rectal cancer. METHODS: TSR was determined on hematoxylin and eosin stained histological sections of 154 patients treated for rectal adenocarcinoma without prior neoadjuvant treatment in the period 1996-2006 by two observers to assess reproducibility. Patients were categorized into three categories: TSR-high [carcinoma percentage (CP) ≥ 70%], TSR-intermediate (CP 40%, 50% and 60%) and TSR-low (CP ≤ 30%)...
December 15, 2017: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29288615/synchronous-locally-advanced-rectal-cancer-with-clinical-complete-remission-and-important-downstaging-after-neoadjuvant-radiochemotherapy-personalised-therapeutic-approach
#7
Dragoş Eugen Georgescu, Mihai Teodor Georgescu, Florin Teodor Bobircă, Teodor Florin Georgescu, Horia Doran, Traian Pătraşcu
Introduction: The current practice for patients with good response, important downstaging or complete remission after preoperative chemoradiation, is to perform surgery on the basis of initial pretherapeutical staging. In literature, varying approaches, like transanal endoscopic microsurgery and even "wait and see", are described for patients with good response after chemoradiation. However, considering the present level of available evidence, the wide-spread adoption of a "watch and wait" policy in those achieving a complete clinical remission cannot be justified...
November 2017: Chirurgia
https://www.readbyqxmd.com/read/29281151/quantitative-intravoxel-incoherent-motion-parameters-derived-from-whole-tumor-volume-for-assessing-pathological-complete-response-to-neoadjuvant-chemotherapy-in-locally-advanced-rectal-cancer
#8
Qiaoyu Xu, Yanyan Xu, Hongliang Sun, Queenie Chan, Kaining Shi, Aiping Song, Wu Wang
BACKGROUND: Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE: To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC...
December 27, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/29279593/diagnostic-conundrum-of-a-perineal-tumour-a-rectal-gastrointestinal-stromal-tumour-mimic
#9
R Shi, M H Chew, W Q Leow
Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall...
December 2017: Malaysian Journal of Pathology
https://www.readbyqxmd.com/read/29277386/outcomes-of-persistent-lymph-node-involvement-after-neoadjuvant-therapy-for-stage-iii-rectal-cancer
#10
Anne M Dinaux, Lieve Leijssen, Liliana G Bordeianou, Hiroko Kunitake, Ramzi Amri, David L Berger
INTRODUCTION: Lymph node involvement is a well-known predictor of recurrent rectal cancer in patient who did not undergo neoadjuvant therapy patients. The role of persistent lymph node disease after neoadjuvant treatment, however, is debatable. This study compares outcomes of patients with clinical, stage III rectal cancer who had nodal disease on surgical pathology after neoadjuvant treatment to patients with negative nodes. METHODS: We reviewed retrospectively a consecutive cohort of all clinical, American Joint Committee on Cancer stage III rectal cancer patients who received neoadjuvant chemoradiotherapy and had an R0 resection at the Massachusetts General Hospital between 2004 and 2015...
December 22, 2017: Surgery
https://www.readbyqxmd.com/read/29275912/advances-in-organ-preserving-strategies-in-rectal-cancer-patients
#11
REVIEW
Rutger C H Stijns, Mike-Stephen R Tromp, Niek Hugen, Johannes H W de Wilt
Treatment of rectal cancer patients has been subjected to change over the past thirty years. Total mesorectal excision is considered the cornerstone of rectal cancer treatment, but is also associated with significant morbidity resulting in an impaired quality of life. The addition of neoadjuvant chemoradiotherapy to surgery has shown to improve survival and local control and may lead to a partial or even complete response (CR). This raises questions regarding the necessity for subsequent radical surgery. After careful patient selection local excision and wait-and-see approaches are explored, aiming to improve quality of life without compromising oncological outcome...
December 12, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29275310/mmp7-modulation-by-short-and-long-term-radiotherapy-in-patients-with-rectal-cancer
#12
Christina Stene, Andrea Polistena, Alexander Gaber, Björn Nodin, Bianca Ottochian, Diya Adawi, Nicola Avenia, Karin Jirström, Louis Banka Johnson
BACKGROUND/AIM: Matrix metalloproteinase 7 (MMP7) expression is highly associated with colorectal cancer and modulates tumour growth and invasion. Radiation injury induces inflammation with increases in MMP7 and in transforming growth factor beta (TGFβ). The aim of this study was to investigate the effect on MMP7 and TGFβ. expression in patients with rectal cancer undergoing different regimens of neoadjuvant radiotherapy (RT). PATIENTS AND METHODS: We studied 53 patients in three RT treatment groups receiving RT of 25 Gy, long-term RT 50 Gy and controls receiving no RT...
January 2018: In Vivo
https://www.readbyqxmd.com/read/29273921/is-it-possible-a-conservative-approach-after-radiochemotherapy-in-locally-advanced-rectal-cancer-larc-a-systematic-review-of-the-literature-and-meta-analysis
#13
Francesco Fiorica, Marco Trovò, Gabriele Anania, Daniele Marcello, Fabrizio Di Benedetto, Marina Marzola, Fabrizio D'Acapito, Guglielmo Nasti, Massimiliano Berretta
BACKGROUND: Locally advanced rectal cancer is usually treated with a preoperative approach with radiochemotherapy followed by surgery. Patients obtaining a pathologic complete response have a very favorable long-term prognosis. This study was intended to assess whether major surgery can reduce tumor recurrences and prolong survival of patients with a complete response after radiochemotherapy. METHODS: Computerized literature search was performed to identify relevant articles...
December 22, 2017: Journal of Gastrointestinal Cancer
https://www.readbyqxmd.com/read/29273261/genotype-driven-phase-i-study-of-weekly-irinotecan-in-combination-with-capecitabine-based-neoadjuvant-chemoradiation-for-locally-advanced-rectal-cancer
#14
Ji Zhu, Xinxiang Li, Yunzhu Shen, Yun Guan, Weilie Gu, Peng Lian, Weiqi Sheng, Sanjun Cai, Zhen Zhang
PURPOSE: We aimed to identify the maximum tolerated dose (MTD) of weekly irinotecan in combination with capecitabine-based neoadjuvant chemoradiation according to the UGT1A1∗28 genotype in patients with locally advanced rectal cancer. PATIENTS AND METHODS: Patients with clinical stage T3-4, N0-2 who were eligible for preoperative chemoradiotherapy were screened for the UGT1A1∗28 genotype. Twenty-six patients with either the ∗1∗1 or ∗1∗28 genotype were eligible for dose escalation of irinotecan, and patients with a ∗28∗28 genotype were excluded...
December 19, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29260978/dna-hypermethylation-as-a-predictor-of-extramural-vascular-invasion-emvi-in-rectal-cancer
#15
Rory F Kokelaar, Huw G Jones, Jeremy Williamson, Namor Williams, A Paul Griffiths, John Beynon, Gareth J Jenkins, Dean A Harris
Structured Abstract Purpose: DNA hypermethylation in gene promoter regions (CpG islands) is emerging as an important pathway in colorectal cancer tumourigenesis. Whilst genetic mutations have been associated with extramural vascular invasion (EMVI) in rectal cancer, no such association has yet been made with epigenetic factors. METHODS: 100 consecutive neoadjuvant-naïve patients undergoing curative surgery for rectal were classified according to the presence or absence of EMVI on histopathological examination...
December 20, 2017: Cancer Biology & Therapy
https://www.readbyqxmd.com/read/29247263/pretreatment-identification-of-patients-likely-to-have-pathologic-complete-response-after-neoadjuvant-chemoradiotherapy-for-rectal-cancer
#16
Frederik J van der Sluis, Henderik L van Westreenen, Boudewijn van Etten, Barbara L van Leeuwen, Geertruida H de Bock
PURPOSE: In selected patients, a wait-and-see strategy after chemoradiotherapy for rectal cancer might be feasible provided that the probability of pathologic complete response (pCR) is high. This study aimed to identify clinical parameters associated with pCR. Furthermore, we attempted to identify subgroups with increased probability of pCR that might aid in clinical decision making. METHODS: A total of 6444 patients that underwent surgical resection of a single primary carcinoma of the rectum after neoadjuvant chemoradiotherapy (nCRT) between January 2009 and December 2016 in the Netherlands were included in the study...
December 15, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29243454/the-use-of-laparoscopy-for-locally-advanced-rectal-cancer
#17
Niccolò Petrucciani, Aleix Martínez-Pérez, Giorgio Bianchi, Riccardo Memeo, Francesco Brunetti, Nicola De' Angelis
INTRODUCTION: In the last decades, the use of minimally invasive surgery has dramatically increased for the treatment of rectal cancer. However, no clear evidence exists on the role of laparoscopy for locally advanced rectal cancer, especially for cT4 tumors, after neoadjuvant therapy. EVIDENCE ACQUISITION: A literature search was performed on Embase, Medline, and Cochrane databases to identify relevant studies published up to November 2017 analyzing the outcomes of laparoscopic surgery for locally advanced rectal cancer...
December 14, 2017: Minerva Chirurgica
https://www.readbyqxmd.com/read/29241084/neoadjuvant-radiotherapy-combined-with-capecitabine-and-sorafenib-in-patients-with-advanced-kras-mutated-rectal-cancer-a-phase-i-ii-trial-sakk-41-08
#18
Roger von Moos, Dieter Koeberle, Sabina Schacher, Stefanie Hayoz, Ralph C Winterhalder, Arnaud Roth, György Bodoky, Panagiotis Samaras, Martin D Berger, Daniel Rauch, Piercarlo Saletti, Ludwig Plasswilm, Daniel Zwahlen, Urs R Meier, Pu Yan, Paola Izzo, Dirk Klingbiel, Daniela Bärtschi, Kathrin Zaugg
BACKGROUND: KRAS mutation occurs in ∼40% of locally advanced rectal cancers (LARCs). The multitarget tyrosine kinase inhibitor sorafenib has radiosensitising effects and might improve outcomes for standard preoperative chemoradiotherapy in patients with KRAS-mutated LARC. METHODS: Adult patients with KRAS-mutated T3/4 and/or N1/2M0 LARC were included in this phase I/II study. The phase I dose-escalation study of capecitabine plus sorafenib and radiotherapy was followed by a phase II study assessing efficacy and safety...
December 11, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/29237218/-cylindric-abdominoperineal-rectum-exstirpation-with-partial-vulvar-and-vaginal-resection-as-well-as-perineal-and-vaginal-defect-reconstruction-by-a-vertical-rectus-abdominis-myocutaneous-vram-flap
#19
Christian Krautz, Klaus Weber, Roland Croner, Axel Denz, Matthias Maak, Raymund E Horch, Robert Grützmann
Introduction Patients with low rectal cancer or anal cancer undergoing abdominoperineal excision (APE) benefit from extended surgery and the subsequent avoidance of surgical "waisting" at the level of the puborectalis muscle. The method of cylindrical APE was introduced by T. Holm and led to a reduction of intraoperative perforations and involvement of circumferential resection margins, and subsequently reduced the risk of local recurrence. The use of myocutaneous flaps reduces perineal wound complications, which occur in up to 60% of patients with primary closure of perineal defects, especially following neoadjuvant radiochemotherapy...
December 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/29234923/non-inferiority-multicenter-prospective-randomized-controlled-study-of-rectal-cancer-t2-t3s-superficial-n0-m0-undergoing-neoadjuvant-treatment-and-local-excision-tem-vs-total-mesorectal-excision-tme
#20
X Serra-Aracil, C Pericay, T Golda, L Mora, E Targarona, S Delgado, A Reina, F Vallribera, J M Enriquez-Navascues, S Serra-Pla, J C Garcia-Pacheco
PURPOSE: The standard treatment of rectal adenocarcinoma is total mesorectal excision (TME), in many cases requires a temporary or permanent stoma. TME is associated with high morbidity and genitourinary alterations. Transanal endoscopic microsurgery (TEM) allows access to tumors up to 20 cm from the anal verge, achieves minimal postoperative morbidity and mortality rates, and does not require an ostomy. The treatment of T2, N0, and M0 cancers remains controversial. Preoperative chemoradiotherapy (CRT) in association with TEM reduces local recurrence and increases survival...
December 12, 2017: International Journal of Colorectal Disease
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