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Neoadjuvant chemotherapy in local advanced rectal cancer

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
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
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...
December 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
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
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
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
Nikhil Suresh Ghadyalpatil, Chopra Supriya, Patil Prachi, Dsouza Ashwin, Saklani Avanish
GI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist, these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes...
July 2016: South Asian Journal of Cancer
Murtaza Jamnagerwalla, Rebecca Tay, Malcolm Steel, Jamie Keck, Ian Jones, Ian Faragher, Peter Gibbs, Rachel Wong
BACKGROUND: Surgical complications after resection for locally advanced rectal cancer may influence adjuvant treatment outcomes and survival. Few studies have examined this effect. OBJECTIVE: This study aimed to examine the impact of surgical complications on adjuvant therapy delivery and survival in patients with locally advanced rectal cancer treated with long-course chemoradiation followed by surgery. DESIGN: This is a retrospective analysis of a prospectively collected multicenter colorectal cancer database...
October 2016: Diseases of the Colon and Rectum
Zhaomin Xu, Supriya Gupta Mohile, Mohamedtaki Abdulaziz Tejani, Adan Z Becerra, Christian P Probst, Christopher T Aquina, Bradley J Hensley, Reza Arsalanizadeh, Katia Noyes, John R T Monson, Fergal J Fleming
BACKGROUND: National Comprehensive Cancer Network treatment guidelines for patients with locally advanced rectal cancer include neoadjuvant chemoradiation followed by total mesorectal excision and adjuvant chemotherapy. The objective of the current study was to examine the rate of adjuvant chemotherapy and associated survival in patients with stage II/III rectal cancer. METHODS: The 2006 to 2011 National Cancer Data Base was queried for patients with AJCC clinical stage II/III rectal cancer who underwent neoadjuvant chemoradiation and surgical resection...
August 25, 2016: Cancer
Seraina Faes, Olivier Gié, Nicolas Demartines, Dieter Hahnloser
Treatment of patients with locally advanced rectal cancer remains challenging. Preoperative imaging with pelvic MRI allows to identify patients for multimodal treatment including induction chemothe- rapy or neoadjuvant radio-chemotherapy and an extended surgical resection. With multidisciplinary approach and an experienced team, excellent oncologic results may be achieved, as well as a good function and quality of life, even with preservation of the anus in the majority of patients.
June 15, 2016: Revue Médicale Suisse
Erta Kalanxhi, Helga Helseth Hektoen, Sebastian Meltzer, Svein Dueland, Kjersti Flatmark, Anne Hansen Ree
BACKGROUND: The increasingly complex programs of contemporary cancer therapy emphasize the need for biological indicators of both therapeutic response and adverse effects. One example is combined-modality treatment aimed at improving long-term outcome in patients with locally advanced rectal cancer, which commonly comes at the price of extended limits of patient tolerance. METHODS: In a prospective study with intensified neoadjuvant treatment of rectal cancer patients, using an antibody array, the profiling of approximately 500 proteins was performed in serial serum samples collected at different stages of the treatment course...
July 26, 2016: BMC Cancer
Francesco Sclafani, Ian Chau, David Cunningham, Andrea Lampis, Jens Claus Hahne, Michele Ghidini, Hazel Lote, Domenico Zito, Josep Tabernero, Bengt Glimelius, Andres Cervantes, Ruwaida Begum, David Gonzalez De Castro, Sanna Hulkki Wilson, Clare Peckitt, Zakaria Eltahir, Andrew Wotherspoon, Diana Tait, Gina Brown, Jacqueline Oates, Chiara Braconi, Nicola Valeri
Single nucleotide polymorphisms (SNPs) in microRNA genes have been associated with colorectal cancer (CRC) risk, survival and response to treatment. Conflicting results are available on the association between rs4919510, a SNP in mature miR-608 and clinical outcome in CRC. Here, we analyzed the association between rs4919510 and benefit from perioperative treatment in a randomised phase II trial of neoadjuvant Capecitabine and Oxaliplatin (CAPOX) followed by chemo-radiotherapy, surgery and adjuvant CAPOX ± Cetuximab in high-risk locally advanced rectal cancer (LARC)...
September 2016: Carcinogenesis
Dongmei Li, Huanwen Wu, Ruie Feng, Dingrong Zhong, Yufeng Luo, Yi Xiao
OBJECTIVE: To investigate the association of CD133 expression in rectal cancer tissues with neoadjuvant chemoradiotherapy (nCRT) and tumor regression grading (TRG) after nCRT. METHODS: Radical resected rectal cancer specimens and clinicopathological data of 105 patients, including 60 men and 45 women with median age of 59 years, diagnosed as locally advanced rectal cancer in Peking Union Medical College Hospital from January 2008 to December 2014 were collected retrospectively...
June 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Lijun Shen, Zhen Zhang
Recently, treatment strategy optimization for neoadjuvant therapy of rectal cancer includes two aspects: (1) Increasing treatment intensity may improve pathological complete response rate, including increasing radiation dose or concurrent chemotherapy intensity, or shifting adjuvant chemotherapy; (2) Short-course radiotherapy or neoadjuvant chemotherapy which can promise treatment efficacy will decrease toxicity and lead to better tolerance. Long-course chemoradiotherapy is the recent treatment standard for locally advanced rectal cancer...
June 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Guoxiang Cai, Weixing Dai, Sanjun Cai
Multi-disciplinary treatment (MDT) is an effective pattern to implement the standardized and individualized treatment for cancer. Under the pattern of MDT which integrates the surgery, chemotherapy, radiotherapy, interventional therapy, targeted therapy and immune therapy, there has been a landmark progress in the diagnosis and treatment of colorectal cancer. Curative resection followed by adjuvant chemotherapy has been established as a standard treatment for stage III( colon cancer, but it is still controversial about whether patients with stage II( colon cancer should receive adjuvant chemotherapy and which regimen is preferred...
June 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Mohamed E Salem, Marion Hartley, Keith Unger, John L Marshall
Rectal cancer treatment presents a challenge, and its optimal management requires a multidisciplinary approach involving surgical, medical, and radiation oncologists. Advances in surgical techniques, radiotherapy, and medical imaging technology have transformed the therapeutic landscape and have led to substantial improvements in both local disease control and patient survival. The currently established standard of care for patients with locally advanced rectal cancer involves preoperative (neoadjuvant) concurrent radiotherapy and infusional fluorouracil-based or oral capecitabine-based chemotherapy, also known as chemoradiotherapy (CRT), followed by surgery...
June 2016: Oncology (Williston Park, NY)
V Bencova, I Krajcovicova, J Svec
Patients with cancer experience stress-determined psychosocial comorbidities and behavioural alterations. Patients expectation to be cured by the first line surgery and their emotional status can be negatively influenced by the decision to include neoadjuvant long-course radiotherapy prior to surgical intervention. From the patient's perspective such treatment algorithmindicates incurability of the disease. The aim of this study was to analyse the extent and dynamics of stress and related psychosocial disturbances among patients with resectable rectal cancer to whom the neoadjuvant radiochemotherapy before surgery has been indicated...
2016: Neoplasma
Manfred P Lutz, John R Zalcberg, Rob Glynne-Jones, Theo Ruers, Michel Ducreux, Dirk Arnold, Daniela Aust, Gina Brown, Krzysztof Bujko, Christopher Cunningham, Serge Evrard, Gunnar Folprecht, Jean-Pierre Gerard, Angelita Habr-Gama, Karin Haustermans, Torbjörn Holm, Koert F Kuhlmann, Florian Lordick, Gilles Mentha, Markus Moehler, Iris D Nagtegaal, Alessio Pigazzi, Salvatore Puciarelli, Arnaud Roth, Harm Rutten, Hans-Joachim Schmoll, Halfdan Sorbye, Eric Van Cutsem, Jürgen Weitz, Florian Otto
Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence...
August 2016: European Journal of Cancer
Ivana M Blazic, Gordana B Lilic, Milan M Gajic
Purpose To determine the impact of three different methods of region of interest (ROI) positioning for apparent diffusion coefficient (ADC) measurements on the assessment of complete response (CR) to neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with rectal cancer. Materials and Methods Institutional review board approval was obtained for this study; all patients gave written informed consent. ADCs were measured by two radiologists using three circular ROIs (three-ROIs), single-section (SS), and whole-tumor volume (WTV) methods in 62 patients with locally advanced rectal cancer on pre- and post-CRT images...
June 2, 2016: Radiology
Francesco Sclafani, Ian Chau
A multimodality disciplinary approach is paramount for the management of locally advanced rectal cancer. Over the last decade, (chemo)radiotherapy followed by surgery plus or minus adjuvant chemotherapy has represented the mainstay of treatment for this disease. Nevertheless, robust evidence suggesting the optimal timing and sequence of therapies in this setting has been overall limited. A number of questions are still unsolved including the length of the interval between neoadjuvant radiotherapy and surgery or the timing of systemic chemotherapy...
July 2016: Seminars in Radiation Oncology
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