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Neoadjuvant rectal cancer

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https://www.readbyqxmd.com/read/29243454/the-use-of-laparoscopy-for-locally-advanced-rectal-cancer
#1
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
#2
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
#3
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
#4
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
https://www.readbyqxmd.com/read/29233486/cetuximab-combined-with-induction-oxaliplatin-and-capecitabine-followed-by-neoadjuvant-chemoradiation-for-locally-advanced-rectal-cancer-swog-0713
#5
Cynthia Gail Leichman, Shannon L McDonough, Stephen R Smalley, Kevin G Billingsley, Heinz-Josef Lenz, Matthew A Beldner, Aram F Hezel, Mario R Velasco, Katherine A Guthrie, Charles D Blanke, Howard S Hochster
BACKGROUND: Neoadjuvant chemoradiation (NCRT) is standard treatment for locally advanced rectal cancer. Pathologic complete response (pCR) has associated with improved survival. In modern phase III trials of NCRT, pCR ranges from 10% to 20%. Cetuximab improves response in KRAS (KRAS proto-oncogene) wild type (wt) metastatic colorectal cancer. S0713 was designed to assess improvement in pCR with additional use of cetuximab with induction chemotherapy and NCRT for locally advanced, KRAS-wt rectal cancer...
October 24, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29232533/laparoscopic-abdominal-transanal-proctocolectomy-with-coloanal-anastomosis-is-a-good-surgical-option-in-selective-patients-with-low-lying-rectal-cancer-a-retrospective-analysis-based-on-a-single-surgeon-s-experience
#6
Bong-Hyeon Kye, Jun-Gi Kim, Hyeon-Min Cho, Hyung-Jin Kim, Chung-Soo Chun
PURPOSE: We intended to identify the oncological outcome for rectal cancer over the past 20 years and whether or not sphincter-preserving surgery is an appropriate approach for low-lying rectal cancer. MATERIALS AND METHODS: The oncological outcomes from a total of 418 patients who electively underwent rectal cancer surgery for a lesion located within 8 cm of the anal verge by a single colorectal surgeon were reviewed retrospectively. RESULTS: Of 418 patients, 175 patients underwent low anterior resection (LAR), 172 laparoscopic abdominal transanal proctocolectomy with coloanal anastomosis (LATA), and 71 abdominoperineal resection (APR)...
December 12, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29230964/preventive-effect-of-diverting-stoma-on-anastomotic-leakage-after-laparoscopic-low-anterior-resection-with-double-stapling-technique-reconstruction-applied-based-on-risk-stratification
#7
Atsushi Hamabe, Masaaki Ito, Hideaki Nishigori, Yuji Nishizawa, Takeshi Sasaki
INTRODUCTION: During laparoscopic low anterior resection with double stapling technique reconstruction, it is necessary to securely implement rectal transection and anastomosis to prevent anastomotic leakage (AL). However, risk factors and preventive measures for AL are not known sufficiently. Therefore, this study aimed to elucidate risk factors associated with AL and to clarify strategies to prevent it. METHODS: We analyzed a total of 296 cases with rectal cancer who had undergone laparoscopic low anterior resection with double stapling technique reconstruction at the National Cancer Center Hospital East...
December 12, 2017: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/29229310/tumor-volume-predicts-local-recurrence-in-early-rectal-cancer-treated-with-radical-resection-a-retrospective-observational-study-of-270-patients
#8
Yanhui Jiang, Kaiyun You, Xingsheng Qiu, Zhuofei Bi, Huaqian Mo, Liting Li, Yimin Liu
OBJECTIVE: Radical resection is regarded as the primary treatment for early rectal cancer, and tumor volume is an independent predictor of many other types of cancer. The purpose of the present study is to assess the effect of tumor volume on the survival of patients with early rectal cancer treated with radical surgery. METHODS: A total of 270 patients with histologically confirmed stage T1/2 N0 rectal cancer who underwent radical resection between September 2006 and September 2014 were enrolled in this study...
December 8, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29228455/prognostic-significance-of-neoadjuvant-rectal-score-in-locally-advanced-rectal-cancer-after-neoadjuvant-chemoradiotherapy-and-construction-of-a-prediction-model
#9
Yanwu Sun, Yiyi Zhang, Xuejing Wu, Huiming Lin, Xingrong Lu, Ying Huang, Zongbin Xu, Shenghui Huang, Xiaojie Wang, Pan Chi
AIM: To evaluate the prognostic significance of neoadjuvant rectal (NAR) score after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC), and to develop a nomogram predicting disease-free survival (DFS). METHOD: A total of 522 LARC patients undergoing nCRT and surgery were included. NAR scores were calculated using the equation [5pN-3(cT-pT) + 12]^2/9.61, and classified as low (<8), intermediate (8-16), and high (>16). Clinicopathological and survival outcomes were compared...
December 11, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29225479/density-of-cd8-lymphocytes-in-biopsy-samples-combined-with-the-circulating-lymphocyte-ratio-predicts-pathologic-complete-response-to-chemoradiotherapy-for-rectal-cancer
#10
Binyi Xiao, Jianhong Peng, Rongxin Zhang, Jing Xu, Yongchun Wang, Yujing Fang, Junzhong Lin, Zhizhong Pan, Xiaojun Wu
Objectives: The systemic status and local immune status, as determined by the neutrophil-lymphocyte ratio (NLR) or the lymphocyte ratio (LYMR) and tumor-infiltrating lymphocyte (TIL) count, respectively, have been suggested as predictors of the tumor response to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer, although the utility of these measures remains controversial. We aimed to investigate the values of the LYMR, NLR and TIL count and their combinations (TIL-LYMR/TIL-NLR) in predicting pathologic complete response (pCR) after nCRT...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/29223019/are-pathological-high-risk-features-in-locally-advanced-rectal-cancer-a-useful-selection-tool-for-adjuvant-chemotherapy
#11
Marloes Swets, Peter J K Kuppen, Erik J Blok, Hans Gelderblom, Cornelis J H van de Velde, Iris D Nagtegaal
BACKGROUND: Several histological high-risk factors are used as an indication for adjuvant therapy in stage II colon cancer. Those and other factors, including lymphatic invasion, perineural invasion (PNI), venous invasion and tumour budding are associated with decreased outcome. In this study, we evaluated the prognostic and predictive values of these biomarkers in a cohort of rectal cancer patients. MATERIALS AND METHODS: The trial-based cohort consisted of 221npTNM stage II-III rectal cancer patients, included in the PROCTOR/SCRIPT trial, a multicentre randomised phase III trial...
December 6, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/29218690/neoadjuvant-volumetric-modulated-arc-therapy-in-rectal-cancer-and-the-correlation-of-pathological-response-with-diffusion-weighted-mri-and-apoptotic-markers
#12
Necla Gurdal, Merdan Fayda, Nijat Alishev, Baris Bakir, Didem Tastekin, Faruk Aykan, Ugur Gezer, Emre Balik, Esra Kaytan Saglam, Ethem Nezih Oral, Mine Gulluoglu, Ahmet Kizir
PURPOSE: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. METHODS: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy...
December 6, 2017: Tumori
https://www.readbyqxmd.com/read/29217764/radiotherapy-activated-cancer-associated-fibroblasts-promote-tumor-progression-through-paracrine-igf-1r-activation
#13
Joke Tommelein, Elly De Vlieghere, Laurine Verset, Elodie Melsens, Justine Leenders, Benedicte Descamps, Annelies Debucquoy, Christian Vanhove, Patrick Pauwels, Christian P Gespach, Anne Vral, Astrid De Boeck, Karin Haustermans, Pascal de Tullio, Wim Ceelen, Pieter Demetter, Tom Boterberg, Marc Bracke, Olivier De Wever
Preoperative radiotherapy (RT) is a mainstay in the management of rectal cancer (RC), a tumor characterized by desmoplastic stroma containing cancer-associated fibroblasts (CAF). Although CAF are abundantly present, the effects of RT to CAF and its impact on cancer cells are unknown. We evaluated the damage responses of CAF to RT and investigated changes in colorectal cancer (CRC) cell growth, transcriptome, metabolome, and kinome in response to paracrine signals emerging from irradiated CAF. RT to CAF induced DNA damage, p53 activation, cell cycle arrest, and secretion of paracrine mediators including insulin-like growth factor-1 (IGF-1)...
December 7, 2017: Cancer Research
https://www.readbyqxmd.com/read/29217398/is-neoadjuvant-chemoradiation-with-dose-escalation-and%C3%A2-consolidation-chemotherapy-sufficient-to-increase-surgery-free-and-distant-metastases-free-survival-in-baseline%C3%A2-ct3-rectal-cancer
#14
Guilherme Pagin São Julião, Angelita Habr-Gama, Bruna Borba Vailati, Patricia Bailão Aguilar, Jorge Sabbaga, Sérgio Eduardo Alonso Araújo, Adrian Mattacheo, Flavia Andrea Alexandre, Laura Melina Fernandez, Diogo Bugano Gomes, Joaquim Gama-Rodrigues, Rodrigo Oliva Perez
Patients with cT3 rectal cancer are less likely to develop complete response to neoadjuvant chemoradiation (nCRT) and still face significant risk for systemic relapse. In this setting, radiation (RT) dose-escalation and consolidation chemotherapy in "extended" nCRT regimens have been suggested to improve primary tumor response and decrease the risks of systemic recurrences. For these reasons we compared surgery-free and distant-metastases free survival among cT3 patients undergoing standard or extended nCRT...
November 26, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29208445/optimal-interval-for-18f-fdg-pet-after-chemoradiotherapy-for-rectal-cancer
#15
Kazushige Kawai, Hiroaki Nozawa, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Koji Oba, Toshiaki Watanabe
INTRODUCTION: Although 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) has been increasingly used to evaluate the response to preoperative chemoradiotherapy (CRT) in patients with rectal cancer, the optimal intervals between completion of CRT, PET, and surgery have not been fully investigated. PATIENTS AND METHODS: A total of 148 consecutive patients with rectal adenocarcinoma who received CRT followed by FDG-PET and radical surgery were retrospectively analyzed...
November 21, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29205364/effects-of-local-multivisceral-resection-for-clinically-locally-advanced-rectal-cancer-on-long-term-outcomes
#16
Anne M Dinaux, Lieve G J Leijssen, Liliana G Bordeianou, Hiroko Kunitake, David L Berger
INTRODUCTION: Multivisceral resection is occasionally needed to obtain clear margins in patients with transmural rectal cancer. Most series demonstrate equivalent outcomes between those patients who undergo multivisceral resections and those who do not, provided an R0-resection is achieved. This study focuses solely on patients who received neoadjuvant treatment for clinically transmural rectal cancers and underwent a local multivisceral R0-resection. METHODS: A retrospective, single center analysis of consecutive series of patients who received a surgical R0-resection after neoadjuvant treatment for a clinically transmural, non-metastatic, primary rectal cancer...
December 4, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29203981/triple-test-a-predictor-of-anastomotic-integrity-in-patients-undergoing-low-anterior-resection-after-neoadjuvant-chemoradiotherapy
#17
Madhu Muralee, Nithish R Acharya, Wagh Mira Sudham, Arun Peter Mathew, Kurian Cherian, K Chandramohan, Paul Augustine, M Iqbal Ahamed
Anastomotic leak after low anterior resection for rectal cancer is a dreaded complication. Diversion stoma helps tiding over this crisis and it is routinely practised in most centres, especially in post chemoradiotherapy setting. But a diversion stoma has got its own problems. In this study, we attempt to use the triple test as a predictor of anastomotic integrity and thereby avoid a diverting stoma, and patients undergoing low anterior resection after neoadjuvant chemoradiotherapy were spared the trouble of a diverting stoma if the on table triple test was negative...
December 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29203979/young-vs-old-colorectal-cancer-in-indian-subcontinent-a-tertiary-care-center-experience
#18
Ashish B Pokharkar, Manish Bhandare, Prachi Patil, Shaesta Mehta, Reena Engineer, Avanish P Saklani
This study aims to compare patient, tumor, treatment-related factors and survival between young (<45 years) and old (>45 years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73 months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45 years) and old (>45 years) age groups...
December 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29203977/radical-treatment-of-rectal-cancer-in-elderly-is-feasible-than-feared-results-from-a-tertiary-care-centre
#19
Madhu Muralee, Rajesh Singh, Arun Peter Mathew, Kurian Cherian, K Chandramohan, Paul Augustine, S Roshni, Iqbal Ahamed
The thought of subjecting an elderly patient with rectal cancer to protocol-based neoadjuvant chemoradiation (NACTRT), surgery and adjuvant chemotherapy is sought with fear due to their multiple comorbidities and impaired functional status associated with the process of ageing. Hence, many a times the treatment is compromised and it is a fact that this subgroup of patients is underrepresented in most of the clinical trials. This study was aimed at analysing the perioperative and oncologic outcomes after protocol-based treatment of rectal cancer in the elderly patients, defined here as those with age ≥70 years...
December 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29203975/a-prospective-study-of-distal-microscopic-spread-in-rectal-cancer-after-neoadjuvant-chemoradiation-in-pinned-and-unpinned-specimen
#20
Aravind S Kapali, K Chandramohan, A V Jayasudha
The most important margin in determining the prognosis of rectal cancer is circumferential resection margin (CRM). But, the type of surgery is determined by distal rectal margin (DRM), whether sphincter saving procedure is possible or patient needs an abdominoperineal resection. There are no standardized uniform guidelines for measurement of DRM. The purpose of this study is to assess the distal microscopic spread beyond gross margin after neoadjuvant concurrent chemoradiation (CCRT) in rectal cancers, the factors influencing the distal microscopic spread, the shrinkage of the distal margin in pinned and unpinned fresh and fixed specimen, and to find out the best method of measurement of distal rectal margin...
December 2017: Indian Journal of Surgical Oncology
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