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Neoadjuvant chemotherapy in local advanced rectal cancer

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https://www.readbyqxmd.com/read/28803718/total-neoadjuvant-therapy-a-shifting-paradigm-in-locally-advanced-rectal-cancer-management
#1
REVIEW
Aaron J Franke, Hiral Parekh, Jason S Starr, Sanda A Tan, Atif Iqbal, Thomas J George
Colorectal carcinoma is the second leading cause of cancer-related deaths in the United States, with rectal cancer accounting for approximately one-third of newly diagnosed cases, thus representing a major socioeconomic health burden. Although minimally invasive procedures (ie, transanal excision) may be appropriate for a subset of patients with small, superficially invasive tumors, a more comprehensive trimodality approach with neoadjuvant chemoradiotherapy, total mesorectal excision, and systemic chemotherapy is recommended for medically operable patients with nonmetastatic, locally advanced rectal cancer (LARC)...
June 27, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/28756493/impact-of-adjuvant-chemotherapy-after-neoadjuvant-radio-or-radiochemotherapy-for-patients-with-locally-advanced-rectal-cancer
#2
Sven Lichthardt, Lisa Zenorini, Johanna Wagner, Johannes Baur, Alexander Kerscher, Niels Matthes, Caroline Kastner, Jörg Pelz, Volker Kunzmann, Christoph-Thomas Germer, Armin Wiegering
BACKGROUND: Due to its primarily extraperitoneal location, potential affection of the anorectal continence and different metastatic behavior the rectal carcinoma (RC) is classified and treated as an independent disease. Over the past few decades various trials have led to improved multimodal therapies (including radiation, chemotherapy and surgery) for locally advanced rectal cancer and significant changes in the management of this disease whereas the benefit of adjuvant chemotherapy remains unclear...
July 29, 2017: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/28728302/-clinical-efficacy-of-ladder-neoadjuvant-therapy-in-treatment-of-advanced-mid-low-rectal-cancer
#3
Y X Zhang, H B Wang, Y J Lu, H Y Liu
Objective: To explore the clinical efficacy of ladder neoadjuvant therapy in treatment of advanced mid-low rectal cancer. Methods: We performed a retrospective study of one hundred and eighty mid and low rectal cancer patients who underwent ladder neoadjuvant therapy(neoadjuvant chemotherapy followed by surgery if neoadjuvant chemotherapy was effective; neoadjuvant chemotherapy followed by neoadjuvant chemoradiotherapy if neoadjuvant chemotherapy was ineffective)(n=90) or neoadjuvant chemoradiotherapy (n=90)...
July 23, 2017: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
https://www.readbyqxmd.com/read/28685354/a-multicenter-phase-2-study-on-the-feasibility-and-efficacy-of-neoadjuvant-chemotherapy-without-radiotherapy-for-locally-advanced-rectal-cancer
#4
Suguru Hasegawa, Saori Goto, Takuya Matsumoto, Koya Hida, Kenji Kawada, Ryo Matsusue, Takashi Yamaguchi, Ryuta Nishitai, Dai Manaka, Shigeru Kato, Yoshio Kadokawa, Satoshi Yamanokuchi, Junichiro Kawamura, Masazumi Zaima, Takahisa Kyogoku, Akiyoshi Kanazawa, Yukiko Mori, Masashi Kanai, Shigemi Matsumoto, Yoshiharu Sakai
BACKGROUND: This prospective multicenter phase 2 study aimed to evaluate the feasibility and efficacy of neoadjuvant chemotherapy (NAC) without radiotherapy for locally advanced rectal cancer (LARC). METHODS: Patients with LARC (cStage II and III) were included in the study. Those with cT4b tumor were excluded. Six cycles of modified FOLFOX6 (mFOLFOX6) plus either bevacizumab or cetuximab, depending on KRAS status, were administered before surgery. The primary end point of the study was the R0 resection rate...
July 6, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28655079/-pathological-insights-of-radiotherapy-related-damage-to-surgical-margin-after-preoperative-radiotherapy-in-patients-with-rectal-cancer
#5
RANDOMIZED CONTROLLED TRIAL
Q H Zhong, P H Wu, Q Y Qin, Y Y Kuang, T H Ma, H M Wang, Y X Zhu, D C Chen, J P Wang, L Wang
Objective: To investigate the effect of irradiation to anastomosis from preoperative radiotherapy for patients with rectal cancer by studying the pathological changes. Methods: In this retrospective study, patients enrolled in the FOWARC study from January 2011 to July 2014 in the Sixth Affiliated Hospital of Sun Yat-Sen University were included. In the FOWARC study, enrolled patients with local advanced rectal cancer were randomly assigned to receive either neoadjuvant chemo-radiotherapy or chemotherapy. Among these patients, 23 patients were selected as radiation proctitis (RP)group, who fulfilled these conditions: (1) received neoadjuvant chemo-radiotherapy followed by sphincter-preserving surgery; (2) developed radiation proctitis as confirmed by preoperative imaging diagnosis; (3) had intact clinical samples of surgical margins...
July 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28637039/different-impacts-of-preoperative-radiotherapy-and-chemoradiotherapy-on-oncological-outcomes-in-patients-with-stages-ii-and-iii-lower-rectal-cancer-a-propensity-score-analysis
#6
Hirotoshi Takiyama, Kazushige Kawai, Soichiro Ishihara, Koji Yasuda, Kensuke Otani, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Hiroaki Nozawa, Teppei Morikawa, Toshiaki Watanabe
BACKGROUND/AIMS: The neoadjuvant therapy for locally advanced rectal cancer has been changed from radiotherapy (RT) to chemoradiotherapy (CRT). This study is aimed at evaluating the benefit of CRT in patients with stage II or III lower rectal cancer, with regard to the impact on recurrence. METHODS: A total of 474 patients with clinical stage II or III lower rectal cancer who received either preoperative RT (n = 221) or CRT (n = 253) followed by total mesorectal excision were identified from our institutional database...
June 21, 2017: Digestive Surgery
https://www.readbyqxmd.com/read/28594719/bowel-dysfunction-after-low-anterior-resection-with-neoadjuvant-chemoradiotherapy-or-chemotherapy-alone-for-rectal-cancer-a-cross-sectional-study-from-china
#7
Qiyuan Qin, Binjie Huang, Wuteng Cao, Jie Zhou, Tenghui Ma, Zhiyang Zhou, Jianping Wang, Lei Wang
BACKGROUND: Neoadjuvant therapy plays a vital role in the treatment of locally advanced rectal cancer but impairs bowel function after restorative surgery. Optimal decision making requires adequate information of functional outcomes. OBJECTIVE: This study aimed to assess postoperative bowel function and to identify predictors for severe dysfunction. DESIGN: The study included a cross-sectional cohort and retrospective assessments of pelvic anatomic features...
July 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28586509/association-between-neoadjuvant-chemoradiation-and-survival-for-patients-with-locally-advanced-rectal-cancer
#8
Zhifei Sun, Mohamed A Adam, Jina Kim, Megan C Turner, Deborah A Fisher, Kingshuk Roy Choudhury, Brian G Czito, John Migaly, Christopher R Mantyh
AIM: To examine the overall survival differences of neoadjuvant therapy modalities: no therapy, chemotherapy alone, radiation alone, and chemoradiation in a large cohort of patients with locally advanced rectal cancer. METHOD: Adults with clinical stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapies received: no therapy, chemotherapy only, radiotherapy only, or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival...
June 6, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28583790/transanal-endoscopic-microsurgery-after-neoadjuvant-radiochemotherapy-for-locally-advanced-extraperitoneal-rectal-cancer
#9
G Rizzo, G Zaccone, M Magnocavallo, C Mattana, D P Pafundi, M A Gambacorta, V Valentini, C Coco
PURPOSE: The aim of this study is to provide a prospective analysis of post-operative and oncological outcomes in patients affected by locally advanced rectal cancer (LARC), who obtained a major/complete clinical response after pre-operative radio-chemotherapy (RCT) and were treated with local excision (LE) by trans-anal endoscopic microsurgery (TEM) to confirm a pathological complete response (pCR) after to neo-adjuvant RCT. METHODS: All patients with LARC treated by pre-operative RCT and full-thickness LE by TEM (2000-2014) were included in the study...
May 25, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28576182/evolving-role-of-radiotherapy-in-the-management-of-rectal-carcinoma
#10
REVIEW
Clayton A Smith, Lisa A Kachnic
Management of locally advanced rectal cancer has evolved over time from surgical resection alone to multimodality therapy with preoperative radiation, chemotherapy, and total mesorectal excision resulting in excellent local control rates. Refinements in neoadjuvant therapies and their sequencing have improved pathologic complete response rates such that consideration of selective radiation and nonoperative management are now active clinical trial questions. Advances in radiation treatment planning and delivery techniques may allow for further reduction in acute treatment-related toxicity in select patient populations...
July 2017: Surgical Oncology Clinics of North America
https://www.readbyqxmd.com/read/28551665/the-role-of-concomitant-radiation-boost-in-neoadjuvant-chemoradiotherapy-for-locally-advanced-rectal-cancer
#11
Harun Badakhshi, Mahmoud Ismail, Christos Boskos, Kuaile Zhao, David Kaul
BACKGROUND/AIM: This study analyzed the impact of concomitant boost on long-term clinical outcomes in locally advanced rectal cancer. PATIENTS AND METHODS: A total of 141 patients (median age=61 years) were treated with neoadjuvant chemoradiotherapy. Median total dose was 50.4 Gy. Forty-three patients received a concomitant boost. Concurrent chemotherapy consisted of 5-fluorouracil (5-FU), given as a 24-h continuous infusion. Mean follow-up was 83.7 months. RESULTS: The 3, 5-, and 10-year overall survival (OS) rates were 91...
June 2017: Anticancer Research
https://www.readbyqxmd.com/read/28537875/n-myc-downstream-regulated-gene-1-promotes-oxaliplatin-triggered-apoptosis-in-colorectal-cancer-cells-via-enhancing-the-ubiquitination-of-bcl-2
#12
Xiao Yang, Fan Zhu, Chaoran Yu, Jiaoyang Lu, Luyang Zhang, Yanfeng Lv, Jing Sun, Minhua Zheng
N-myc downstream-regulated gene1 (NDRG1) has been identified as a potent tumor suppressor gene. The molecular mechanisms of anti-tumor activity of NDRG1 involve its suppressive effects on a variety of tumorigenic signaling pathways. The purpose of this study was to investigate the role of NDRG1 in the apoptosis of colorectal cancer (CRC) cells. We first collected the clinical data of locally advanced rectal cancer (LARC) patients receiving oxaliplatin-based neoadjuvant chemotherapy in our medical center. Correlation analysis revealed that NDRG1 positively associated with the downstaging rates and prognosis of patients...
July 18, 2017: Oncotarget
https://www.readbyqxmd.com/read/28503826/prospective-randomised-trial-of-neoadjuvant-chemotherapy-during-the-wait-period-following-pre-operative-chemoradiotherapy-for-rectal-cancer-results-of-the-wait-trial
#13
James Moore, Tim Price, Scott Carruthers, Sudarsha Selva-Nayagam, Andrew Luck, Michelle Thomas, Peter Hewett
AIMS: To determine whether the addition of additional cycles of chemotherapy during the "wait "period following neoadjuvant chemo-radiotherapy for rectal cancer improves the pathologic complete response rate (pCR). METHODS: Rectal cancer patients were randomly allocated to either a standard 10 week wait period before surgery (standard chemo-radiotherapy, SCRT) or to receive 3 cycles of 5FU based chemotherapy following chemo-radiotherapy during a similar 10 week wait (extended chemo-radiotherapy, XCRT)...
May 15, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28501970/cancer-center-volume-and-type-impact-stage-specific-utilization-of-neoadjuvant-therapy-in-rectal-cancer
#14
Emily F Midura, Andrew D Jung, Meghan C Daly, Dennis J Hanseman, Bradley R Davis, Shimul A Shah, Ian M Paquette
BACKGROUND: Neoadjuvant chemoradiation reduces local recurrence in locally advanced rectal cancer, and adherence to national and societal recommendations remains unknown. OBJECTIVE: To determine variability in guideline adherence in rectal cancer treatment and investigate whether hospital volume correlated with variability seen. DESIGN: We performed a retrospective analysis using the National Cancer Database rectal cancer participant user files from 2005 to 2010...
August 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28497757/safety-and-tolerability-of-veliparib-combined-with-capecitabine-plus-radiotherapy-in-patients-with-locally-advanced-rectal-cancer-a-phase-1b-study
#15
Brian G Czito, Dustin A Deming, Gayle S Jameson, Mary F Mulcahy, Houman Vaghefi, Matthew W Dudley, Kyle D Holen, Angela DeLuca, Rajendar K Mittapalli, Wijith Munasinghe, Lei He, John R Zalcberg, Samuel Y Ngan, Philip Komarnitsky, Michael Michael
BACKGROUND: Further optimisation of present standard chemoradiation is needed in patients with locally advanced rectal cancer. Veliparib, an oral poly(ADP-ribose) polymerase inhibitor, has been shown to enhance the antitumour activity of chemotherapy and radiotherapy in preclinical models. We aimed to establish the maximum tolerated dose and establish the recommended phase 2 dose of veliparib combined with neoadjuvant capecitabine and radiotherapy. METHODS: This phase 1b, open-label, multicentre, dose-escalation study was done at six hospitals (one in Australia and five in the USA)...
June 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28476941/systemic-chemotherapy-as-salvage-treatment-for-locally-advanced-rectal-cancer-patients-who-fail-to-respond-to-standard-neoadjuvant-chemoradiotherapy
#16
Francesco Sclafani, Gina Brown, David Cunningham, Sheela Rao, Paris Tekkis, Diana Tait, Federica Morano, Chiara Baratelli, Eleftheria Kalaitzaki, Shahnawaz Rasheed, David Watkins, Naureen Starling, Andrew Wotherspoon, Ian Chau
BACKGROUND: The potential of chemotherapy as salvage treatment after failure of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC) has never been explored. We conducted a single-center, retrospective analysis to address this question. PATIENTS AND METHODS: Patients with newly diagnosed LARC who were inoperable or candidates for extensive (i.e., beyond total mesorectal excision [TME]) surgery after long-course chemoradiotherapy and who received salvage chemotherapy were included...
June 2017: Oncologist
https://www.readbyqxmd.com/read/28464745/diffusion-weighted-magnetic-resonance-imaging-of-rectal-cancer-tumour-volume-and-perfusion-fraction-predict-chemoradiotherapy-response-and-survival
#17
Kine Mari Bakke, Knut Håkon Hole, Svein Dueland, Krystyna Kotanska Grøholt, Kjersti Flatmark, Anne Hansen Ree, Therese Seierstad, Kathrine Røe Redalen
BACKGROUND: In locally advanced rectal cancer (LARC), responses to preoperative treatment are highly heterogeneous and more accurate diagnostics are likely to enable more individualised treatment approaches with improved responses. We investigated the potential of diffusion-weighted magnetic resonance imaging (DW MRI), with quantification of the apparent diffusion coefficient (ADC) and perfusion fraction (F), as well as volumetry from T2-weighted (T2W) MRI, for prediction of therapeutic outcome...
June 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28439842/controversies-in-the-multimodality-management-of-locally-advanced-rectal-cancer
#18
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/28423720/meta-analysis-of-oxaliplatin-based-versus-fluorouracil-based-neoadjuvant-chemoradiotherapy-and-adjuvant-chemotherapy-for-locally-advanced-rectal-cancer
#19
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...
May 23, 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
#20
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
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