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Neoadjuvant chemotherapy in rectal cancer

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https://www.readbyqxmd.com/read/28304150/additional-chemotherapy-and-salvage-surgery-for-poor-response-to-chemoradiotherapy-in-rectal-cancers
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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...
January 20, 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
#9
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...
February 3, 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
#10
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
#11
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
https://www.readbyqxmd.com/read/28133030/-evaluation-of-the-therapeutic-effect-of-using-dual-energy-ct-for-rectal-cancer-after-neoadjuvant-chemotherapy
#12
Hajime Morohashi, Yoshiyuki Sakamoto, Daichi Ichinohe, Hiroyuki Jin, Takuya Miura, Fumiyasu Tsushima, Shuichi Ono, Kenichi Hakamada
It is difficult to know the effects of preoperative treatment on advanced rectal cancer even if using a variety of diagnostic imaging modalities. We report the efficacy of evaluating the therapeutic effect of using dual-energy CT(DECT)against rectal cancer after neoadjuvant chemotherapy(NAC). The subject sample consisted of1 1 patients who underwent rectal cancer surgery after NAC from September 2015 to January 2016. The pathological effective grade was higher if the after/before ratio ofcontrast enhancement on DECT was small(Grade 1a: 1...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28120325/predictive-factors-for-survival-in-neoadjuvant-radiochemotherapy-for-advanced-rectal-cancer
#13
A Reig Castillejo, I Membrive, P Foro, J Quera, X Sanz, N Rodriguez, E Fernández-Velilla, O Pera, A Ortiz, M Algara
INTRODUCTION: Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. OBJECTIVE: To assess predictive factors for survival in 115 patients. PATIENTS AND METHOD: 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy...
January 24, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28078118/less-than-12-lymph-nodes-in-the-surgical-specimen-after-neoadjuvant-chemo-radiotherapy-an-indicator-of-tumor-regression-in-locally-advanced-rectal-cancer
#14
Jaiprakash Gurawalia, Kapil Dev, Sandeep P Nayak, Vishnu Kurpad, Arun Pandey
BACKGROUND: The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response...
December 2016: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28044949/sphincter-sparing-surgery-in-patients-with-mid-and-low-rectal-cancer-risk-factors-for-local-recurrence-and-anastomotic-leakage
#15
Denis Aslan, Florin Grama, Daniel Cristian, Adrian Bordea, Traean Burcoş
Background: Rectal cancer is a major health problem. The current treatment of distal rectal cancer involves a multimodality approach aimed at achieving an optimal oncologic control and an increased quality of life. PURPOSE: The purpose of this article is to identify the risk factors for local recurrence and anastomotic leakage after sphincter-sparing surgery for low and mid rectal cancer. Material and Methods: We prospectively analyzed a group of 38 patients with low and middle rectal cancer who underwent sphincter-sparing surgery...
November 2016: Chirurgia
https://www.readbyqxmd.com/read/27984651/neoadjuvant-long-course-chemoradiation-remains-strongly-favored-over-short-course-radiotherapy-by-radiation-oncologists-in-the-united-states
#16
Yvonne M Mowery, Joseph K Salama, S Yousuf Zafar, Harvey G Moore, Christopher G Willett, Brian G Czito, M Benjamin Hopkins, Manisha Palta
BACKGROUND: Short-course radiotherapy (SC-RT) and long-course chemoradiotherapy (LC-CRT) are accepted neoadjuvant treatments of rectal cancer. In the current study, the authors surveyed US radiation oncologists to assess practice patterns and attitudes regarding SC-RT and LC-CRT for patients with rectal cancer. METHODS: The authors distributed a survey to 1701 radiation oncologists regarding treatment of neoadjuvant rectal cancer. Respondents were asked questions regarding the number of patients with rectal cancer treated, preference for SC-RT versus LC-CRT, and factors influencing regimen choice...
December 16, 2016: Cancer
https://www.readbyqxmd.com/read/27978776/short-course-preoperative-radiotherapy-combined-with-chemotherapy-delayed-surgery-and-local-hyperthermia-for-rectal-cancer-a-phase-ii-study
#17
A O Rasulov, S S Gordeyev, Yu A Barsukov, S I Tkachev, A G Malikhov, S S Balyasnikova, M Yu Fedyanin
PURPOSE: The aim of this study was to investigate the feasibility of short-course radiotherapy with oral capecitabine, hyperthermia and delayed surgery for neoadjuvant treatment of rectal cancer. METHODS: Patients with clinically staged T2-3N0-2M0 primary rectal cancer were included. All patients received short-course 25 Gy in 5 Gy fractions radiotherapy with capecitabine, local hyperthermia and metronidazole. Capecitabine 1000 mg/m2 twice a day was given on days 1-14...
December 15, 2016: International Journal of Hyperthermia
https://www.readbyqxmd.com/read/27956537/neoadjuvant-therapy-for-rectal-cancer-affects-lymph-node-yield-and-status-without-clear-implications-on-outcome-the-case-for-eliminating-a-metric-and-using-preoperative-staging-to-guide-therapy
#18
Sherif R Z Abdel-Misih, Lai Wei, Al B Benson, Steven Cohen, Lily Lai, John Skibber, Neal Wilkinson, Martin Weiser, Deborah Schrag, Tanios Bekaii-Saab
BACKGROUND: Nodal status has long been considered pivotal to oncologic care, staging, and management. This has resulted in the establishment of rudimentary metrics regarding adequate lymph node yield in colon and rectal cancers for accurate cancer staging. In the era of neoadjuvant treatment, the implications of lymph node yield and status on patient outcomes remains unclear. PATIENT AND METHODS: This study included 1,680 patients with locally advanced rectal cancer from the NCCN prospective oncology database stratified into 3 groups based on preoperative therapy received: no neoadjuvant therapy, neoadjuvant chemoradiation, and neoadjuvant chemotherapy...
December 2016: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/27939008/is-routine-use-of-adjuvant-chemotherapy-for-rectal-cancer-with-complete-pathological-response-justified
#19
Maysoon Gamaleldin, James M Church, Luca Stocchi, Mathew Kalady, David Liska, Emre Gorgun
BACKGROUND: Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT). METHODS: A prospectively maintained outcomes database was queried for patients who had pCR to nCRT for LARC from 2000 to 2012. Local recurrence and survival were analyzed according to whether patients received ACT. RESULTS: We identified 139 patients and excluded 9 due to lack of follow-up...
November 19, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27935051/the-survival-impact-of-delayed-surgery-and-adjuvant-chemotherapy-on-stage-ii-iii-rectal-cancer-with-pathological-complete-response-after-neoadjuvant-chemoradiation
#20
Feng-Che Kuan, Chia-Hsuan Lai, Hsiu-Ying Ku, Chun-Feng Wu, Meng-Chiao Hsieh, Tsang-Wu Liu, Chien-Yuh Yeh, Kuan-Der Lee
Neoadjuvant concurrent chemoradiation (CCRT) is standard treatment for clinical stage II/III rectal cancers. However, whether patients with pathological complete response (pT0N0, pCR) should receive adjuvant chemotherapy and whether delayed surgery will influence the pCR rate remains controversial. A nationwide population study was conducted using the Taiwan Cancer Registry Database from January 2007 to December 2013. Kaplan-Meier survival analysis was performed. Cox proportional hazards models were used to estimate multivariate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI)...
April 1, 2017: International Journal of Cancer. Journal International du Cancer
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