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Neoadjuvant chemotherapy in rectal cancer

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https://www.readbyqxmd.com/read/28439842/controversies-in-the-multimodality-management-of-locally-advanced-rectal-cancer
#1
REVIEW
Robert Díaz Beveridge, Dilara Akhoundova, Gema Bruixola, Jorge Aparicio
Neoadjuvant radiotherapy previous to radical surgery, both as short-course radiotherapy and as long-course radiotherapy combined with 5-FU-based chemotherapy (LCRCT), is routinely used in the management of locally advanced rectal cancer, with consistent benefits in the reduction in the local relapse risk. Unfortunately, survival benefits have been elusive to demonstrate with this approach, especially in the setting of radical surgery in the form of total mesorectal excision (TME). Concerns about over-treating early-stage patients and about the possible long-term side effects have also cast more doubts in a blanket approach of treating all patients with neoadjuvant radiotherapy, especially with LCRCT...
June 2017: Medical Oncology
https://www.readbyqxmd.com/read/28434582/effectiveness-between-early-and-late-temporary-ileostomy-closure-in-patients-with-rectal-cancer-a-prospective-study
#2
Li Zhen, Yanan Wang, Ze Zhang, Tongwei Wu, Ruoyan Liu, Tingting Li, Liying Zhao, Haijun Deng, Xiaolong Qi, Guoxin Li
A temporary stoma is often used in rectal cancer surgery to protect a distal anastomosis, which remains a major concern after rectal cancer surgery, particularly after low anterior resection. The temporary stoma is scheduled for closure. However, the optimal time of closure of the protecting stoma remains unclear because of sparse studies and data. We aimed to detect the efficacy between early and late temporary ileostomy closure in patients with rectal cancer during or after neoadjuvant chemoradiotherapy. We conducted a prospective, 2-group design between early and late ileostomy closure group in patients after rectal cancer surgery with temporary stoma...
March 2, 2017: Current Problems in Cancer
https://www.readbyqxmd.com/read/28426108/mri-assessment-and-outcomes-in-patients-receiving-neoadjuvant-chemotherapy-only-for-primary-rectal-cancer-long-term-results-from-the-gemcad-0801-trial
#3
U B Patel, G Brown, I Machado, J Santos-Cores, C Pericay, E Ballesteros, A Salud, M Isabel-Gil, C Montagut, J Maurel, J Ramón-Ayuso, N Martin, R Estevan, C Fernandez-Martos
Background: Primary chemotherapy has been tested as a possible approach for patients with high risk features but predicted clear mesorectal margins on preoperative MRI assessment. This study investigates the prognostic relevance of baseline and post-treatment MRI and pathology staging in rectal cancer patients undergoing primary chemotherapy. Patients and methods: Forty-six patients with T3 tumour > =2 mm from the mesorectal fascia were prospectively treated with Neoadjuvant Capecitabine, Oxaliplatin and Bevacizumab prior to surgery between 2009 and 2011...
February 1, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28423720/meta-analysis-of-oxaliplatin-based-versus-fluorouracil-based-neoadjuvant-chemoradiotherapy-and-adjuvant-chemotherapy-for-locally-advanced-rectal-cancer
#4
Xing-Li Fu, Zheng Fang, Liang-Hui Shu, Guo-Qing Tao, Jian-Qiang Wang, Zhi-Lian Rui, Yong-Jie Zhang, Zhi-Qiang Tian
A meta-analysis was conducted to compare oxaliplatin-based with fluorouracil-based neoadjuvant chemoradiotherapy and adjuvant chemotherapy for locally advanced rectal cancer. MEDLINE, EMBASE and CENTRAL were systematically searched for relevant randomized controlled trials (RCTs) until January 31 2017. Review Manager (version 5.3) was used to analyze the data. Dichotomous data were calculated by odds ratio (OR) with 95% confidence intervals (CI). A total of 8 RCTs with 6103 stage II or III rectal cancer patients were analyzed, including 2887 patients with oxaliplatin+fluorouracil regimen and 3216 patients with fluorouracil alone regimen...
March 11, 2017: Oncotarget
https://www.readbyqxmd.com/read/28420585/adjuvant-chemotherapy-is-associated-with-improved-overall-survival-in-locally-advanced-rectal-cancer-after-achievement-of-a-pathologic-complete-response-to-chemoradiation
#5
Danish Shahab, Emmanuel Gabriel, Kristopher Attwood, Wen Wee Ma, Valerie Francescutti, Steven Nurkin, Patrick M Boland
BACKGROUND: In locally advanced rectal adenocarcinoma, 15% to 20% of patients treated with neoadjuvant chemoradiation (nCRT) achieve a pathologic complete response (pCR). The benefit of adjuvant chemotherapy is controversial in rectal cancer. Our objective was to evaluate the effect of clinical risk factors and adjuvant chemotherapy usage on the outcomes of the pCR patient population. PATIENTS AND METHODS: We performed a retrospective study using the National Cancer Data Base from 2006 to 2013...
March 18, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/28411888/neoadjuvant-therapy-and-transanal-endoscopic-surgery-in-t2-t3-superficial-n0-m0-rectal-tumors-local-recurrence-complete-clinical-and-pathological-response
#6
Xavier Serra-Aracil, Carlos Pericay, Laura Mora-Lopez, Juan Carlos Garcia Pacheco, José Isaac Latorraca, Julio Ocaña-Rojas, Alex Casalots, Eva Ballesteros, Salvador Navarro-Soto
INTRODUCTION: The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. METHODS: This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016)...
April 12, 2017: Cirugía Española
https://www.readbyqxmd.com/read/28391777/remarkable-response-to-fluorouracil-leucovorin-oxaliplatin-and-irinotecan-therapy-in-urothelial-cancer-of-the-renal-pelvis-a-case-report
#7
Takuya Tsujino, Kiyoshi Takahara, Tomohisa Matsunaga, Yuki Yoshikawa, Tomoaki Takai, Taizo Uchimoto, Kenkichi Saito, Naoki Tanda, Hajime Hirano, Hayahito Nomi, Naokazu Ibuki, Teruo Inamoto, Haruhito Azuma
BACKGROUND: No standard chemotherapy regimen for advanced urothelial cancer has been established, except for cisplatin-based regimens. We report the case of a patient with double primary cancer, urothelial carcinoma of the upper urinary tract and colorectal cancer, who underwent oxaliplatin-based chemotherapies. CASE PRESENTATION: A 56-year-old Japanese man presented to our hospital with the diagnosis of a left renal pelvic tumor and rectal cancer. Several examinations including ureteroscopic biopsy and computed tomography-guided biopsy were performed; however, the diagnosis of renal pelvic cancer could not be made...
April 10, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28386670/the-impact-of-pathologic-complete-response-in-patients-with-neoadjuvantly-treated-locally-advanced-rectal-cancer-a-large-single-center-experience
#8
A M Dinaux, R Amri, L G Bordeianou, T S Hong, J Y Wo, L S Blaszkowsky, J N Allen, J E Murphy, H Kunitake, D L Berger
Small cohort studies demonstrated better oncologic outcomes for patients with pathologic complete response (PathCR) after neoadjuvant treatment for locally advanced rectal cancer. This study reviews long-term outcomes of a large cohort of clinically stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery. This is a retrospective analysis of a single-center cohort, including all clinical stage II/III rectal cancer patients who received neoadjuvant chemoradiation and surgery between 2004 and 2014 (n = 271)...
April 6, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28333014/single-nucleotide-polymorphism-tgf%C3%AE-1-r25p-correlates-with-acute-toxicity-during-neoadjuvant-chemoradiotherapy-in-rectal-cancer-patients
#9
J Joshua Smith, Isaac Wasserman, Sarah A Milgrom, Oliver S Chow, Chin-Tung Chen, Sujata Patil, Karyn A Goodman, Julio Garcia-Aguilar
PURPOSE: To validate the finding of an association between single nucleotide polymorphisms (SNPs) and toxicity during chemoradiotherapy (CRT) in rectal cancer patients, in an independent population. METHODS AND MATERIALS: The cohort consisted of 165 patients who received CRT for rectal cancer from 2006 to 2012. Prospectively recorded toxicity information, graded according to the Common Terminology Criteria for Adverse Events version 3.0, was retrieved from the medical record...
April 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28304150/additional-chemotherapy-and-salvage-surgery-for-poor-response-to-chemoradiotherapy-in-rectal-cancers
#10
Reena Engineer, Vikas Ostwal, Supreeta Arya, Priyamvada Gupta, Supriya Chopra, Prachi Patil, Sudhir Jatal, Avanish Saklani
AIM: A proportion of locally advanced rectal cancer patients who receive neoadjuvant chemoradiotherapy (NACRT) are still unresectable. This study was undertaken to assess the outcomes of giving additional chemotherapy to rectal cancer patients with unresectable disease after NACRT. METHODS: Patients with poor response to NACRT where mesorectal fascia was still involved on MRI and R0 resection was doubtful, received additional four cycles of chemotherapy with either CAPOX or FOLFIRINOX regimen, and the response was reevaluated with MRI and reassessed for surgical resection...
March 17, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28295220/total-neoadjuvant-therapy-for-rectal-cancer-an-emerging-option
#11
REVIEW
Ethan B Ludmir, Manisha Palta, Christopher G Willett, Brian G Czito
The treatment of locally advanced rectal cancer (LARC) has benefited from improved surgical techniques and from the implementation of neoadjuvant chemoradiotherapy (CRT), which have markedly decreased the rates of local recurrence. However, distant metastatic disease remains the most significant cause of death for these patients. Although adjuvant chemotherapy (ChT) after neoadjuvant CRT and definitive surgery is commonly recommended, the value of adjuvant systemic therapy remains less clear. Trials evaluating adjuvant ChT for rectal cancer have been handicapped by poor compliance rates and inconsistent survival results...
March 10, 2017: Cancer
https://www.readbyqxmd.com/read/28281215/neoadjuvant-treatment-for-locally-advanced-rectal-cancer-new-concepts-in-clinical-trial-design
#12
REVIEW
Nitesh Rana, A Bapsi Chakravarthy, Lisa A Kachnic
Treatment for locally advanced rectal cancer has evolved from surgery alone to surgery plus adjuvant therapy. Preoperative 5-fluorouracil- or capecitabine-based chemoradiation with standard fractionated radiation, surgery utilizing total mesorectal excision, and further chemotherapy has become the standard of care in the USA. Preoperative adjuvant chemoradiation treatment sequencing has allowed for decreased toxicity, more sphincter-sparing surgery, and improved local control rates as compared to delivering the chemoradiation postoperatively...
February 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28273303/association-between-incomplete-neoadjuvant-radiotherapy-and-survival-for-patients-with-locally-advanced-rectal-cancer
#13
Kyle Freischlag, Zhifei Sun, Mohamed A Adam, Jina Kim, Manisha Palta, Brian G Czito, John Migaly, Christopher R Mantyh
Importance: Failing to complete chemotherapy adversely affects survival in patients with colorectal cancer. However, the effect of incomplete delivery of neoadjuvant radiotherapy is unclear. Objective: To determine whether incomplete radiotherapy delivery is associated with worse clinical outcomes and survival. Design, Setting, and Participants: Data on 17 600 patients with stage II to III rectal adenocarcinoma from the 2006-2012 National Cancer Database who received neoadjuvant chemoradiotherapy followed by surgical resection were included...
March 8, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28270729/pre-and-post-surgery-treatments-in-rectal-cancer-a-long-term-single-centre-experience
#14
H Ozyurt, A S Ozden, Z Ozgen, C Gemici, G Yaprak
BACKGROUND: Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. METHODS: The study included 196 patients [median age: 58 years (range: 20-86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined...
February 2017: Current Oncology
https://www.readbyqxmd.com/read/28200088/mri-assessment-and-outcomes-in-patients-receiving-neoadjuvant-chemotherapy-only-for-primary-rectal-cancer-longterm-results-from-the-gemcad-0801-trial
#15
U B Patel, G Brown, I Machado, J Santos-Cores, C Pericay, E Ballesteros, A Salud, M Isabel-Gil, C Montagut, J Maurel, J Ramón-Ayuso, C Fernandez-Martos
No abstract text is available yet for this article.
February 14, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28181384/resection-of-synchronous-liver-metastases-between-radiotherapy-and-definitive-surgery-for-locally-advanced-rectal-cancer-short-term-surgical-outcomes-overall-and-recurrence-free-survivals
#16
K J Labori, M G Guren, K W Brudvik, B I Røsok, A Waage, A Nesbakken, S Larsen, S Dueland, B Edwin, B A Bjørnbeth
AIM: There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability, and survival after a modified "liver-first" approach. METHOD: This was retrospective study of patients undergoing preoperative adjuvant radiotherapy for the primary rectal tumour, followed by liver resection and finally, resection of the primary tumour. Short-term surgical outcome, overall survival (OS) and recurrence-free survival (RFS) are reported...
February 9, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28179091/rectal-cancer-french-intergroup-clinical-practice-guidelines-for-diagnosis-treatments-and-follow-up-snfge-ffcd-gercor-unicancer-sfcd-sfed-sfro
#17
Jean-Pierre Gérard, Thierry André, Frédéric Bibeau, Thierry Conroy, Jean-Louis Legoux, Guillaume Portier, Jean-François Bosset, Guillaume Cadiot, Olivier Bouché, Laurent Bedenne
INTRODUCTION: This document is a summary of the French Intergroup guidelines regarding the management of rectal adenocarcinoma published in February 2016. METHOD: This collaborative work, under the auspices of most of the French medical societies involved in the management of rectal cancer, is based on the previous guidelines published in 2013. Recommendations are graded into 3 categories according to the level of evidence of data found in the literature. RESULTS: In agreement with the ESMO guidelines (2013), non-metastatic rectal cancers have been stratified in 4 risk groups according to endoscopy, MRI or endorectal-ultrasonography...
April 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28177891/tumour-infiltrating-regulatory-t-cell-density-before-neoadjuvant-chemoradiotherapy-for-rectal-cancer-does-not-predict-treatment-response
#18
Melanie J McCoy, Chris Hemmings, Chidozie C Anyaegbu, Stephanie J Austin, Tracey F Lee-Pullen, Timothy J Miller, Max K Bulsara, Nikolajs Zeps, Anna K Nowak, Richard A Lake, Cameron F Platell
Neoadjuvant (preoperative) chemoradiotherapy (CRT) decreases the risk of rectal cancer recurrence and reduces tumour volume prior to surgery. However, response to CRT varies considerably between individuals and factors associated with response are poorly understood. Foxp3+ regulatory T cells (Tregs) inhibit anti-tumour immunity and may limit any response to chemotherapy and radiotherapy. We have previously reported that a low density of Tregs in the tumour stroma following neoadjuvant CRT for rectal cancer is associated with improved tumour regression...
March 21, 2017: Oncotarget
https://www.readbyqxmd.com/read/28150022/efficacy-and-safety-of-neoadjuvant-chemotherapy-with-oxaliplatin-5-fluorouracil-and-levofolinate-for-t3-or-t4-stage-ii-iii-rectal-cancer-the-fact-trial
#19
Junichi Koike, Kimihiko Funahashi, Kazuhiko Yoshimatsu, Hajime Yokomizo, Hayato Kan, Takeshi Yamada, Hideyuki Ishida, Keiichiro Ishibashi, Yoshihisa Saida, Toshiyuki Enomoto, Kenji Katsumata, Masayuki Hisada, Hirotoshi Hasegawa, Keiji Koda, Takumi Ochiai, Kazuhiro Sakamoto, Hiroyuki Shiokawa, Shimpei Ogawa, Michio Itabashi, Shingo Kameoka
PURPOSE: A multicenter phase II clinical study was performed in patients with T3 or T4 stage II/III rectal cancer to evaluate the efficacy and safety of neoadjuvant chemotherapy with 5-fluorouracil, levofolinate, and oxaliplatin (mFOLFOX6). METHODS: Patients received four 2-week cycles of mFOLFOX6 therapy (oxaliplatin at 85 mg/m(2) + leucovorin at 200 mg/m(2) + fluorouracil as a 400 mg/m(2) bolus followed by infusion of 2400 mg/m(2) over 46 h, all on Day 1)...
February 1, 2017: Cancer Chemotherapy and Pharmacology
https://www.readbyqxmd.com/read/28133313/-a-case-of-advanced-rectal-cancer-resulting-in-a-pathologically-complete-response-after-neoadjuvant-chemotherapy
#20
Takayuki Minoji, Kohei Murata, Tomohiro Kitahara, Shu Okamura, Yoichiro Nushijima, Rie Hamano, Tetsu Yanagisawa, Nariaki Fukuchi, Chikara Ebisui, Hideoki Yokouchi, Masakatsu Kinuta, Kazuhito Ohishi
A 61-years-old man was admitted to our hospital because of abdominal pain. Colonoscopy revealed a type 2 tumor in the rectum, which was diagnosed as low differentiated adenocarcinoma. At least 8 abdominal lymph adenopathies were enhanced on contrast-enhanced CT. We diagnosed stage cT3N2H0M0P0, cStage III b. Because of the risk of a poor prognosis, we tried neoadjuvant chemotherapy for the purpose of down staging. A CRT was prevented by Clostridium difficile enteritis, but we completed 80% of the regimen. Laparoscopic abdominoperineal resection was performed after 4 months of chemotherapy...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
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