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Neoadjuvant chemotherapy in rectal cancer

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https://www.readbyqxmd.com/read/27872117/protocol-for-a-multicentre-randomised-feasibility-trial-evaluating-early-surgery-alone-in-low-rectal-cancer-sailor
#1
Dean A Harris, Kymberley Thorne, Hayley Hutchings, Saiful Islam, Gail Holland, Olivia Hatcher, Sarah Gwynne, Ian Jenkins, Peter Coyne, Michael Duff, Melanie Feldman, Des C Winter, Simon Gollins, Phil Quirke, Nick West, Gina Brown, Deborah Fitzsimmons, Alan Brown, John Beynon
INTRODUCTION: There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT...
November 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27864695/adjuvant-chemotherapy-improves-overall-survival-of-rectal-cancer-patients-treated-with-neoadjuvant-chemoradiotherapy-regardless-of-pathologic-nodal-status
#2
Audrey S Kulaylat, Christopher S Hollenbeak, David B Stewart
BACKGROUND: After neoadjuvant chemoradiotherapy for rectal cancer, the interpretation of surgical pathology poses difficulties in deciding the need for adjuvant chemotherapy (AC). The aim of this study was to determine whether there is a survival benefit to providing AC in patients with node-negative disease on surgical pathology. METHODS: Patients with clinical stage II and III rectal adenocarcinoma who received neoadjuvant chemoradiation and definitive surgical resection from 2006 to 2012 were identified in the National Cancer Data Base...
November 18, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27837319/functional-outcomes-after-tem-in-patients-with-complete-clinical-response-after-neoadjuvant-chemoradiotherapy
#3
Roberto Ghiselli, Monica Ortenzi, Luca Cardinali, Edlira Skrami, Rosaria Gesuita, Mario Guerrieri
BACKGROUND: In patients who exhibit a complete clinical response after radio-chemotherapy for rectal cancer, the standard surgical approach might constitute overtreatment. The aim of this study is to analyse the outcomes of anorectal function and quality of life after transanal endoscopic microsurgery (TEM) in irradiated patients with complete clinical response. PATIENTS AND METHODS: Between 2007 and 2014, 84 patients who were diagnosed with stage T2-T3-T4 N0 rectal cancer before chemoradiotherapy showed a complete clinical response to neoadjuvant therapy and underwent TEM...
November 11, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27830368/adjuvant-treatment-for-resected-rectal-cancer-impact-of-standard-and-intensified-postoperative-chemotherapy-on-disease-free-survival-in-patients-undergoing-preoperative-chemoradiation-a-propensity-score-matched-analysis-of-an-observational-database
#4
Benjamin Garlipp, Henry Ptok, Frank Benedix, Ronny Otto, Felix Popp, Karsten Ridwelski, Ingo Gastinger, Christoph Benckert, Hans Lippert, Christiane Bruns
AIMS: Adjuvant chemotherapy for resected rectal cancer is widely used. However, studies on adjuvant treatment following neoadjuvant chemoradiotherapy (CRT) and total mesorectal excision (TME) have yielded conflicting results. Recent studies have focused on adding oxaliplatin to both preoperative and postoperative therapy, making it difficult to assess the impact of adjuvant oxaliplatin alone. This study was aimed at determining the impact of (i) any adjuvant treatment and (ii) oxaliplatin-containing adjuvant treatment on disease-free survival in CRT-pretreated, R0-resected rectal cancer patients...
November 9, 2016: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/27819876/impact-of-postoperative-adjuvant-chemotherapy-following-long-course-chemoradiotherapy-in-stage-ii-rectal-cancer
#5
Jonathan M Loree, Hagen F Kennecke, Richard M Lee-Ying, Rachel A Goodwin, Erin D Powell, Patricia A Tang, Julie A Price Hiller, Michael M Vickers, Winson Y Cheung
OBJECTIVES: Use of adjuvant chemotherapy (AC) following neoadjuvant chemoradiation (nCRT) is controversial in rectal cancer (RC). We assessed a multi-institutional database to determine if there was benefit from AC for pathologic stage II RC patients and whether the addition of oxaliplatin to fluoropyrimidine (OXAC) therapy impacted outcomes. MATERIALS AND METHODS: We included patients who underwent nCRT and had pathologic stage II (ypT3/4 ypN0) tumors. Disease-free survival and overall survival were assessed...
November 4, 2016: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/27819639/therapy-of-stenosing-rectal-cancer
#6
Violeta Deaconescu, Eugen Brătucu, Bogdan Mastalier, Cristian Botezatu, Marian Marincaş
Develop a rectal cancer management aims to establish an algorithm diagnostic, surgical treatment strategy implementation, strategy and neoadjuvant and adjuvant treatment response and optimal methods for assessing response to specific treatment. In trying to track this management, we studied the issues listed above, we conducted a retrospective clinical study, descriptive and included the analysis of data obtained on a sample selected 90 patients diagnosed with stenosing rectal cancer between January 2008 and December 2012 treated on the General Surgery Clinic I of "Prof...
2016: Chirurgia
https://www.readbyqxmd.com/read/27796635/clinically-node-negative-pathologically-node-positive-rectal-cancer-patients-who-did-not-receive-neoadjuvant-therapy
#7
Nouf Akeel, Nan Lan, Luca Stocchi, Meagan M Costedio, David W Dietz, Emre Gorgun, Matthew F Kalady, Georgios Karagkounis, Hermann Kessler, Feza H Remzi
PURPOSE: Neoadjuvant chemoradiotherapy is the preferred standard of care for clinical stages II-III rectal cancer. It is uncertain whether clinically node negative (cN-) tumors found to be pathologically stage III could be optimally treated with surgery alone and avoid adjuvant treatments. The aim of our study was to define the outcomes of such patients. METHODS: Patients undergoing radical surgery using total mesorectal excision (TME) techniques for rectal cancer (≤12 cm from the anal verge) with curative intent during 2000-2012 and found to have stage III disease on final pathology were identified from a prospectively maintained database...
October 27, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27795447/clinical-outcome-of-neoadjuvant-chemoradiation-in-locally-advanced-rectal-cancer-at-a-tertiary-hospital
#8
W Wk Yeung, B By Ma, J Fy Lee, S Sm Ng, M Hy Cheung, W M Ho, M Wk Tsang, S Chu, D Cm Lam, F Kf Mo
OBJECTIVES: To review the clinical outcome of locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by definitive surgery with or without adjuvant chemotherapy and to elucidate the prognostic factors for treatment outcome. METHODS: This historical cohort study was conducted at a tertiary public hospital in Hong Kong. All patients who had undergone neoadjuvant chemoradiation for locally advanced rectal cancer in our department from November 2005 to October 2014 were recruited...
October 31, 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/27793945/a-comparative-effectiveness-study-of-two-oral-chemotherapy-drugs-uft-vs-capecitabine-in-neoadjuvant-concurrent-chemoradiotherapy-for-patients-with-locally-advanced-rectal-cancer
#9
Chun-Ru Chien, William Tzu-Liang Chen, Hwei-Min Wang, Tao-Wei Ke, Hua-Che Chiang, Sheng-Chi Chang, Yu-Chun Huang, Che-Hung Lin, Chun-Lin Huang, Ying-Chun Lin, Tsung-Wei Chen, Chia-Chin Li, K S Clifford Chao
BACKGROUND/AIM: Capecitabine is the current standard oral chemotherapy used in neoadjuvant concurrent chemoradiotherapy (NCCRT) for locally advanced rectal cancer (LARC) in North America. We compared the effectiveness of another oral chemotherapy agent, UFT (an oral combination of uracil and tegafur), to that of capecitabine. MATERIALS AND METHODS: We identified LARC patients diagnosed from 2007 to 2011 using a population-based registry in Taiwan (Health and Welfare Data Science Center, HWDC) and constructed a propensity score matched cohort to balance observable potential confounders...
November 2016: Anticancer Research
https://www.readbyqxmd.com/read/27784746/crlx101-a-nanoparticle-drug-conjugate-containing-camptothecin-improves-rectal-cancer-chemoradiotherapy-by-inhibiting-dna-repair-and-hif-1%C3%AE
#10
Xi Tian, Minh Nguyen, Henry Putnam Foote, Joseph M Caster, Kyle C Roche, Christian G Peters, Pauline Wu, Lata Jayaraman, Edward G Garmey, Joel E Tepper, Scott Eliasof, Andrew Z Wang
Novel agents are needed to improve chemoradiotherapy for locally advanced rectal cancer. In this study, we assessed the ability of CRLX101, an investigational nanoparticle-drug conjugate containing the payload camptothecin (CPT), to improve therapeutic responses as compared to standard chemotherapy. CRLX101 was evaluated as a radiosensitizer in colorectal cancer cell lines and murine xenograft models. CRLX101 was as potent as CPT in vitro in its ability to radiosensitize cancer cells. Evaluations in vivo demonstrated that the addition of CRLX101 to standard chemoradiotherapy significantly increased therapeutic efficacy by inhibiting DNA repair and HIF-1α pathway activation in tumor cells...
October 26, 2016: Cancer Research
https://www.readbyqxmd.com/read/27780316/can-we-eliminate-neoadjuvant-chemoradiotherapy-in-favor-of-neoadjuvant-multiagent-chemotherapy-for-select-stage-ii-iii-rectal-adenocarcinomas-analysis-of-the-national-cancer-database
#11
Richard J Cassidy, Yuan Liu, Kirtesh Patel, Jim Zhong, Conor E Steuer, David A Kooby, Maria C Russell, Theresa W Gillespie, Jerome C Landry
BACKGROUND: Stage II and III rectal cancers have been effectively treated with neoadjuvant chemoradiotherapy (NCRT) followed by definitive resection. Advancements in surgical technique and systemic therapy have prompted investigation of neoadjuvant multiagent chemotherapy (NMAC) regimens with the elimination of radiation (RT). The objective of the current study was to investigate factors that predict for the use of NCRT versus NMAC and compare outcomes using the National Cancer Data Base (NCDB) for select stage II and III rectal cancers...
October 25, 2016: Cancer
https://www.readbyqxmd.com/read/27766558/racial-and-socioeconomic-treatment-disparities-in-adolescents-and-young-adults-with-stage-ii-iii-rectal-cancer
#12
David Y Lee, Annabelle Teng, Rose C Pedersen, Farees R Tavangari, Vikram Attaluri, Elisabeth C McLemore, Stacey L Stern, Anton J Bilchik, Melanie R Goldfarb
INTRODUCTION: Stage II-III rectal cancer requires multidisciplinary cancer care, and adolescents and young adults (AYA, ages 15-39 years) often do not receive optimal cancer therapy. METHODS: Overall, 3295 AYAs with clinical stage II-III rectal cancer were identified in the National Cancer Database. Factors associated with the receipt of adjuvant and surgical therapies, as well as overall survival (OS), were examined. RESULTS: The majority of patients were non-Hispanic White (72...
October 20, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27762654/effect-of-increasing-radiation-dose-on-pathologic-complete-response-in-rectal-cancer-patients-treated-with-neoadjuvant-chemoradiation-therapy
#13
Matthew D Hall, Timothy E Schultheiss, David D Smith, Marwan G Fakih, Jeffrey Y C Wong, Yi-Jen Chen
BACKGROUND: Neoadjuvant chemoradiation therapy (CRT) increases pathological complete response (pCR) rates compared to radiotherapy alone in patients with stage II-III rectal cancer. Limited evidence addresses whether radiotherapy dose escalation further improves pCR rates. Our purpose is to measure the effects of radiotherapy dose and other factors on post-therapy pathologic tumor (ypT) and nodal stage in rectal cancer patients treated with neoadjuvant CRT followed by mesorectal excision...
October 20, 2016: Acta Oncologica
https://www.readbyqxmd.com/read/27752409/the-first-case-of-severe-takotsubo-cardiomyopathy-associated-with-5-fluorouracil-in-a-patient-with-abnormalities-of-both-dihydropyrimidine-dehydrogenase-dpyd-and-thymidylate-synthase-tyms-genes
#14
Muhammad W Saif, Melissa Smith, Antonio Maloney
5-Fluorouracil (5-FU) is the backbone of the chemotherapy regimens approved for treatment of many malignancies, especially colorectal cancer (CRC). The incidence of cardiotoxicity associated with 5-FU ranges between 1.5% to 18% and is most commonly manifested as anginal symptoms. Cardiomyopathy is very rarely reported with 5-FU and capecitabine. A 35-year-old Caucasian male with T3, N1, M0 rectal cancer after the initial neoadjuvant chemoradiation with 5FU/LV followed by surgical abdominoperineal resection (APR), began mFOLFOX6 in the adjuvant setting...
September 14, 2016: Curēus
https://www.readbyqxmd.com/read/27748153/rectal-cancer-treatment-in-a-teaching-hospital
#15
Vanessa Verdin, Joseph Weerts, David Francart, Constant Jehaes, David Magis, Paul Magotteaux, Laurine Mattart, Benoit Monami, Christian Wahlen, Serge Markiewicz
BACKGROUND: Rectal adenocarcinomas surgery morbidity and mortality might be impaired by neoadjuvant therapy. We performed this retropsective study to be compared with the PROCARE study running afterwards. METHODS: We performed a retrospective study of 95 patients operated on for rectal adenocarcinoma in a single institution during the period of 2007-2009. We used logistic regression to estimate the relationship between possible predictive parameters of anastomotic leakage (AL)...
October 17, 2016: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/27721486/pathological-assessment-of-rectal-cancer-after-neoadjuvant-chemoradiotherapy-distribution-of-residual-cancer-cells-and-accuracy-of-biopsy
#16
Lin Xiao, Xin Yu, Wenjing Deng, Huixia Feng, Hui Chang, Weiwei Xiao, Huizhong Zhang, Shaoyan Xi, Mengzhong Liu, Yujia Zhu, Yuanhong Gao
We investigated the distribution of residual cancer cells (RCCs) within different layers of the bowel wall in surgical specimens and the value of biopsies of primary rectal lesion after preoperative volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients with rectal cancer. Between April 2011 and April 2013, 178 patients with rectal cancer who received preoperative VMAT, concurrent chemotherapy, and surgery were evaluated; 79 of the patients received a biopsy of the primary lesion after chemoradiotherapy and prior to surgery...
October 10, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27717529/individualizing-surgical-treatment-based-on-tumour-response-following-neoadjuvant-therapy-in-t4-primary-rectal-cancer
#17
Q Denost, C Kontovounisios, S Rasheed, R Chevalier, R Brasio, M Capdepont, E Rullier, P P Tekkis
BACKGROUND: Rectal cancer involving at least one adjacent organ (mrT4b) requires multi-visceral resection to achieve clear resection margin (R0). Performing pelvic compartment preservation according to the tumour response has not been considered. This study assesses the impact of changing the surgical strategy according to tumour response in rectal cancer mrT4b. METHODS: Patients with non-metastatic T4b rectal cancer at two tertiary referral centres between 2008 and 2013 were grouped as "Responders" ypT0-3abNx versus "Non-responders" ypT3cd-4Nx and divided into three surgical procedures: total mesorectal excision (TME), extended-TME (eTME) and beyond-TME (b-TME)...
September 17, 2016: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27697137/cancer-of-the-upper-rectum
#18
Peter Bondeven
Rectal cancer constitutes one-third of all colorectal cancers, and the incidence in Denmark increasing. In 2012, 1.400 cases were registered, and of these 38% were located in the upper rectum. There have been several key advances in the optimal management of rectal cancer during the past decades, primarily by standardisation and improvement of the surgical procedure. There is now general agreement that the optimal surgical treatment involves the concept of total mesorectal excision and that a resection with tumour-free margins is crucial...
October 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27695932/the-significance-of-extramural-venous-invasion-in-r1-positive-rectal-cancer
#19
N M Ormsby, H N Bermingham, H M Joshi, M Chadwick, A Samad, D Maitra, M Scott, S Kelly, K Whitmarsh, R Rajaganeshan
BACKGROUND AND AIMS: Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer. MATERIAL AND METHODS: Retrospective study of all patients operatively managed within our institution between April 2008 and April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded...
October 1, 2016: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/27686666/pathological-complete-response-after-neoadjuvant-chemotherapy-for-rectal-cancer-with-synchronous-multiple-liver-metastases-a-report-of-an-unusual-case
#20
Ryosuke Arata, Toshiyuki Itamoto, Satoshi Ikeda, Hideki Nakahara, Akihiko Oshita, Katsunori Shinozaki, Takashi Nishisaka
BACKGROUND: Systemic chemotherapy for stage IV colorectal cancer has advanced markedly in the recent years. We report an unusual case of 13 synchronous liver metastases for which a pathological complete response was achieved with neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluorouracil (5-FU), oxaliplatin, leucovorin (mFOLFOX6), and bevacizumab. CASE PRESENTATION: A 44-year-old man was diagnosed with colorectal cancer with synchronous liver metastases...
December 2016: Surgical Case Reports
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