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Neoadjuvant rectal cancer

Luigi A Sposato, Yick Lam, Chris Karapetis, Sina Vatandoust, Amitesh Roy, Paul Hakendorf, Andrew Dwyer, Dayan de Fontgalland, Paul Hollington, David Wattchow
AIM: Observation with close follow-up ("watch and wait") is a recognized treatment option in patients who achieve a complete clinical response to long course chemoradiotherapy. This review of a prospective database aims to evaluate the clinical outcomes among patients with a complete clinical response managed with observation. METHODS: A prospective study of 32 patients who achieved a complete clinical response was undertaken. The primary outcomes measured were overall and recurrence-free survival, and rate of organ preservation in patients who deferred immediate surgery...
June 22, 2018: Asia-Pacific Journal of Clinical Oncology
Pierfrancesco Franco, Francesca Arcadipane, Elisabetta Trino, Elena Gallio, Stefania Martini, Giuseppe Carlo Iorio, Cristina Piva, Francesco Moretto, Maria Grazia Ruo Redda, Roberta Verna, Vassiliki Tseroni, Cristina Bona, Gabriele Pozzi, Christian Fiandra, Riccardo Ragona, Oscar Bertetto, Umberto Ricardi
Objective: Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods: Two clinical cases of locally advanced rectal cancer were chosen...
June 2018: Clinical and Translational Radiation Oncology
Hisanori Shoji, Masahiko Motegi, Kiyotaka Osawa, Takayuki Asao, Hiroyuki Kuwano, Takeo Takahashi, Kyoji Ogoshi
The present study aimed to evaluate whether the neoadjuvant chemoradiation response with concurrent thermal therapy for the treatment of rectal cancer can be predicted following the first thermic treatment. Eighty patients with primary rectal adenocarcinoma (≤12 cm from the anal verge) were included in this study. Fifty-four received surgery and pathological response was evaluated. Intensity-modulated radiotherapy was administered conventionally once daily 5 times/week. Neoadjuvant radiotherapy consisted of 50 Gy delivered to the planning target volume in 25 fractions...
July 2018: Oncology Letters
Xiao-Xuan Jia, Yi Wang, Jin Cheng, Xun Yao, Mu-Jun Yin, Jing Zhou, Ying-Jiang Ye
OBJECTIVE: The objective of this study was to compare the prognoses of patients with low- and high-risk rectal cancer detected by MRI who were treated without neoadjuvant chemoradiotherapy (NCRT) and to determine independent risk factors. MATERIALS AND METHODS: This retrospective study included 185 patients with pathologically proven rectal adenocarcinoma who were treated without NCRT. Cancer was defined as high risk if one or more of the following factors were present: extramural depth of tumor invasion greater than 5 mm or stage T4a or T4b for tumor in the mid or high rectum; involvement of intersphincteric space, levators, or adjacent organs for tumor in the low rectum; extramural venous invasion (EMVI); or circumferential resection margin (CRM) involvement...
June 21, 2018: AJR. American Journal of Roentgenology
P Ursi, A Santoro, A Gemini, A Arezzo, D Pironi, C Renzi, R Cirocchi, F M Di Matteo, A Maturo, V D'Andrea, J Sagar
BACKGROUND: Low Rectal Anterior Resection (LAR) is challenging when anal canal mucosa and/or internal sphincter are involved by very low tumors. In these cases, Intersphincteric resection (ISR) with the removal of the internal sphincter is designed to increase the distal margin of resection, thus preserving the external sphincter and pubo-rectalis muscle complex. Aim is to compare results after ISR with those of LAR, including subgroup analysis of open, laparoscopic and robotic ISR. METHODS: Studies published from January 1991 to January 2017 describing ISR and comparing results with LAR in adults were included irrespective of the technique...
May 2018: Il Giornale di Chirurgia
Eren Esen, Erman Aytac, Orhan Ağcaoğlu, Serkan Zenger, Emre Balik, Bilgi Baca, İsmail Hamzaoğlu, Tayfun Karahasanoğlu, Dursun Buğra
In this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index ≥30 kg/m), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001)...
June 16, 2018: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Akihiro Nishie, Yoshiki Asayama, Kousei Ishigami, Yasuhiro Ushijima, Yukihisa Takayama, Daisuke Okamoto, Nobuhiro Fujita, Daisuke Tsurumaru, Osamu Togao, Koji Sagiyama, Tatsuya Manabe, Eiji Oki, Yuichiro Kubo, Tomoyuki Hida, Minako Hirahashi-Fujiwara, Jochen Keupp, Hiroshi Honda
BACKGROUND AND AIM: The amount of proteins and peptides can be estimated with amide proton transfer (APT) imaging. Previous studies demonstrated the usefulness of APT imaging to predict tumor malignancy. We determined whether APT imaging can predict the tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). METHODS: Seventeen patients with LARC who underwent a pretherapeutic magnetic resonance examination including APT imaging and NAC (at least two courses) were enrolled...
June 13, 2018: Journal of Gastroenterology and Hepatology
Annefleur E M Berkel, Joost M Klaase, Feike de Graaff, Marjolein G J Brusse-Keizer, Bart C Bongers, Nico L U van Meeteren
BACKGROUND/AIMS: To investigate the relation between skeletal muscle measurements (muscle mass, radiation attenuation, and sarcopenic obesity), postoperative morbidity, and survival after treatment of locally advanced rectal cancer. METHODS: This explorative retrospective study identified 99 consecutive patients who underwent neoadjuvant chemoradiation and surgery between January 2007 and May 2012. Skeletal muscle mass was measured as total psoas area and total abdominal muscle area (TAMA) at 3 anatomical levels using the patient's preoperative computed tomography scan...
June 13, 2018: Digestive Surgery
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
Yuki Aisu, Shigeru Kato, Yoshio Kadokawa, Daiki Yasukawa, Yusuke Kimura, Yuichi Takamatsu, Taku Kitano, Tomohide Hori
BACKGROUND The feasibility of additional dissection of the lateral pelvic lymph nodes (LPLNs) in patients undergoing total mesorectal excision (TME) combined with neoadjuvant chemotherapy (NAC) for locally advanced rectal cancer (LARC) is controversial. The use of laparoscopic surgery is also debated. In the present study, we evaluated the utility of laparoscopic dissection of LPLNs during TME for patients with LARC and metastatic LPLNs after NAC, based on our experience with 19 cases. MATERIAL AND METHODS Twenty-five patients with LARC with swollen LPLNs who underwent laparoscopic TME and LPLN dissection were enrolled in this pilot study...
June 11, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Favil Singh, Daniel A Galvão, Robert U Newton, Nigel A Spry, Michael K Baker, Dennis R Taaffe
BACKGROUND: Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT. METHODS: Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m2 ) receiving CRT undertook supervised resistance and aerobic exercise twice weekly...
June 1, 2018: Integrative Cancer Therapies
U B Patel, A Cervantes, C Fernández-Martos, F Sclafani, D Cunningham, P Nilsson, G Brown
The potential of preoperative chemotherapy in rectal cancer is the subject of investigation in a number of global randomized trials. In this overview and expert discussion, Professor Cervantes summarizes the findings of numerous Phase II trials testing neoadjuvant chemotherapy. The crucial points in the next phase of trials include: patient selection, whether radiotherapy can be omitted altogether and whether chemotherapy can be used to augment the initial response to chemoradiotherapy. Finally, with the emergence of Magnetic Resonance Tumour Regression Grade a reliable method for assessing response after initial chemoradiotherapy, we ask if this can be used to drive the use of further selective chemotherapy to augment response...
May 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
S Balyasnikova, T Vuong, A Wale, I Chong, H Rutten, G Brown
Neoadjuvant pelvic radiotherapy is widely used for patients with advanced rectal cancer. The trade-off between dose and response is well-established, yet little consensus remains on the precise methods of delivery and doses given in different scenarios. Professor Vuong reviews the evidence base and trial evidence on the escalation of radiotherapy dose and the methods of achieving this.
May 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
M Dattani, C Marijnen, B Moran, D Tait, C Cunningham, M Rodriguez-Bigas, G Brown
Preoperative radiotherapy continues to be widely used in patients with operable rectal cancer. However, the indications and goals for such treatment are evolving. Professor Marijnen reviews the historic and current evidence base for the use of preoperative neoadjuvant radiotherapy and the future challenges in tailoring the therapy according to the patients' needs and tumour stage.
May 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
J Bhoday, A Martling, J Straßburg, G Brown
The impact of quality of surgery, colorectal surgical specialization, training and expertise has been far greater on survival outcomes than adjuvant and neoadjuvant therapies. The review of the evidence by Professor Martling and expert discussion addresses the evidence base and the crucial importance of the surgeon as a prognostic factor, and how this has been relatively neglected in comparison to other resources invested in improving the treatment of colorectal cancer.
May 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Campbell S Roxburgh, Jinru Shia, Efsevia Vakiani, Tanisha Daniel, Martin R Weiser
Strategies to enhance tumor immunogenicity may expand the role of immunotherapy beyond the mismatch repair-deficient subtype. In this pilot study, biopsies were performed at baseline and after four cycles of FOLFOX in eight patients receiving neoadjuvant chemotherapy for stage II/III locally advanced rectal cancer. Immunostaining was performed for T cell subsets (CD3+, CD8+, CD45RO+); macrophages (CD163+); T regulatory cells (FOXP3+); and expression of MHC class I, PD-1 and PD-L1. Changes in cell number or intensity were quantified and correlated with treatment response...
2018: Oncoimmunology
Takashi Okuyama, Shinichi Sameshima, Emiko Takeshita, Ryuji Yoshioka, Yukinori Yamagata, Yuko Ono, Nobumi Tagaya, Tamaki Noie, Masatoshi Oya
BACKGROUND: Neoadjuvant chemoradiotherapy (NACRT) has now become the standard treatment for locally advanced rectal cancer (LARC). NACRT has decreased local relapse (LR) rate in patients with LARC; however, distant relapse has recently attracted much attention. This study aimed to assess the feasibility and efficiency of neoadjuvant chemotherapy (NAC) for LARC. METHODS: Data on patients with cT3/4 and N+ rectal cancer who were treated in our institution from April 2010 to February 2016 were reviewed retrospectively...
June 5, 2018: World Journal of Surgical Oncology
Nicola de'Angelis, Frederic Pigneur, Aleix Martínez-Pérez, Giulio Cesare Vitali, Filippo Landi, Teresa Torres-Sánchez, Victor Rodrigues, Riccardo Memeo, Giorgio Bianchi, Francesco Brunetti, Eloy Espin, Frederic Ris, Alain Luciani
Background: Locally advanced rectal cancer (LARC) requires a multimodal therapy tailored to the patient and tumor characteristics. Pretreatment magnetic resonance imaging (MRI) is necessary to stage the primary tumor, while restaging MRI, which is not systematically performed, may be of interest to identify poor responders to neoadjuvant chemoradiation therapy (NCRT), and redefine therapeutic approach. The EuMaRCS study group aimed to investigate the role and accuracy of pretreatment (including pelvimetry) and restaging MRIs in predicting surgical difficulties and surgical outcomes in LARC therapy...
May 18, 2018: Oncotarget
Zhao Lu, Pu Cheng, Fu Yang, Zhaoxu Zheng, Xishan Wang
Objective: For patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (NCRT), significant pathological response of the primary tumor has been proposed to identify candidates for organ preservation. However, this does not address metastatic lymph nodes in the mesorectum. The aim of this study was to assess the incidence of lymph node metastases in ypT0 patients treated with NCRT and curative resection and to explore risk factors associated with survival...
April 2018: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Ying Xiao, Dong Xu, Haixing Ju, Chen Yang, Liping Wang, Jinming Wang, John D Hazle, Dongguo Wang
PURPOSE: To determine the accuracy of biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer. MATERIALS AND METHODS: Fifty-three patients with advanced lower rectal cancer were examined before and after neoadjuvant chemoradiotherapy with use of TRUS plus UE and CEUS and were diagnosed as having T stage disease. We compared ultrasonic T stages before and after neoadjuvant chemoradiotherapy and analyzed any changes...
July 2018: European Journal of Radiology
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