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Neoadjuvant chemoradiotherapy in rectal cancer

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https://www.readbyqxmd.com/read/28177997/outcome-and-salvage-surgery-following-watch-and-wait-for-rectal-cancer-after-neoadjuvant-therapy-a-systematic-review
#1
REVIEW
Joseph C Kong, Glen R Guerra, Satish K Warrier, Robert G Ramsay, Alexander G Heriot
BACKGROUND: Currently there is no reliable test to predict pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer. However, there is increasing interest in using clinical complete response as a surrogate marker, allowing a subset of patients with locally advanced rectal cancer to be allocated into a "watch and wait" pathway. Little is known about the oncological safety of the "watch and wait" approach or the rate of salvage surgery in cases of tumor regrowth...
March 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28177891/tumour-infiltrating-regulatory-t-cell-density-before-neoadjuvant-chemoradiotherapy-for-rectal-cancer-does-not-predict-treatment-response
#2
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/28159930/compared-planning-dosimetry-of-tomo-vmat-and-imrt-in-rectal-cancer-with-different-simulated-positions
#3
Jang-Chun Lin, Jo-Ting Tsai, Li-Jhen Chen, Ming-Hsien Li, Wei-Hsiu Liu
OBJECTIVES: To compare treatment plans for helical tomotherapy (TOMO), volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for locally advanced rectal cancer (LARC). MATERIALS AND METHODS: This retrospective study from December 2010 to June 2013 included 20 patients with LARC who received neoadjuvant concurrent chemoradiotherapy (CCRT) with radiation doses of greater than 50.4 Gy. Dosimetric quality was evaluated based on doses to organs at risk (OARs), including small bowel, urinary bladder and bilateral femoral head, over the same coverage of the clinical target volume (CTV)...
January 31, 2017: Oncotarget
https://www.readbyqxmd.com/read/28157723/integrated-care-pathway-for-rectal-cancer-treatment-health-care-resource-utilization-costs-and-outcomes
#4
Silvia T Kobayashi, Maria D P E Diz, Alessandro G Campolina, Patricia C De Soárez, Ulysses Ribeiro, Sergio C Nahas, Karina G M C Vasconcelos, Fernanda Capareli, Ivan Cecconello, Paulo M Hoff
AIM: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. METHODS: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group)...
February 2, 2017: International Journal of Evidence-based Healthcare
https://www.readbyqxmd.com/read/28149883/focusing-the-management-of-rectal-cancer
#5
COMMENT
Rachel Dbeis, Neil J Smart, Ian R Daniels
Rectal cancer treatment has undergone major changes over the last 15 years with a focus on individualized care based around MRI assessment of the relationship of the tumour to the mesorectal fascia, improved surgical techniques and targeted use of pre-operative oncological therapies in patients with locally advanced disease. The recognition that some tumours responded completely to pre-operative chemoradiotherapy, and the selective use of a non-operative policy has led to a quest to further identify those patients and their tumour in whom this approach could be used, irrespective of MRI stage...
December 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28133017/-the-local-control-effect-of-surgical-treatment-after-neoadjuvant-chemoradiotherapy-for-rectal-adenocarcinoma-with-inguinal-lymph-node-metastasis
#6
Koji Ueta, Kimihiro Yamashita, Yasuo Sumi, Kiyonori Kanemitsu, Masashi Yamamoto, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji
No consensus has been reached with regard to the optimal treatment strategy and the prognosis of patients with advanced rectal cancer and inguinal lymph node metastasis. We, therefore, retrospectively analyzed the outcomes of 41 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant chemoradiotherapy(NACRT). Six patients, with clinical inguinal lymph node metastasis determined by pretreatment imaging, underwent inguinal lymph node dissections after NACRT. Five patients survived without a relapse...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28130593/functional-outcome-following-rectal-surgery-predisposing-factors-for-low-anterior-resection-syndrome
#7
Daniel Ll Hughes, Julie Cornish, Chris Morris
PURPOSE: Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery. METHODS: Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre...
January 27, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28105657/a-nomogram-to-predict-distant-metastasis-after-neoadjuvant-chemoradiotherapy-and-radical-surgery-in-patients-with-locally-advanced-rectal-cancer
#8
Yanwu Sun, Huiming Lin, Xingrong Lu, Ying Huang, Zongbin Xu, Shenghui Huang, Xiaojie Wang, Pan Chi
PURPOSE: To compare distant metastasis (DM) in locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) and surgery alone, and to develop a predictive nomogram for DM following nCRT. METHODS: Propensity-scoring match analysis was performed to compare DM in LARC treated with nCRT (n = 375) and surgery alone (n = 375). Cox regression was performed to identify predictors of DM following nCRT. A nomogram was developed and validated by internal (n = 425) and external validation (n = 97)...
January 20, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28103579/the-combination-of-early-treatment-response-and-ypt-stage-is-a-novel-metric-to-stage-rectal-cancer-patients-treated-with-neoadjuvant-chemoradiotherapy
#9
Jian Cui, Lin Yang, Lei Guo, Yongfu Shao, Dongfeng Tan, Ni Li, Haizeng Zhang
Rectal cancer patients receiving neoadjuvant chemoradiotherapy (NCRT) are currently classified using the same Tumor-Node-Metastasis staging system as those patients without NCRT. We determined whether the combination of tumor treatment response (TRG) and ypT stage more accurately assesses primary tumors in rectal cancer after NCRT. We analyzed data from 329 rectal cancer patients treated with NCRT followed by radical resection. Cox proportional hazards models were used to evaluate the effects of different staging parameters on disease-free survival (DFS)...
January 17, 2017: Oncotarget
https://www.readbyqxmd.com/read/28100902/prognostic-role-of-neutrophil-to-lymphocyte-ratio-in-locally-advanced-rectal-cancer-treated-with-neoadjuvant-chemoradiotherapy
#10
Jinwen Shen, Yuan Zhu, Wei Wu, Lingnan Zhang, Haixing Ju, Yongtian Fan, Yuping Zhu, Jialin Luo, Peng Liu, Ning Zhou, Ke Lu, Na Zhang, Dechuan Li, Luying Liu
BACKGROUND Increasing evidence suggests that cancer-associated inflammation is associated with poorer outcomes. The neutrophil-to-lymphocyte ratio (NLR), considered as a systemic inflammation marker, is thought to predict prognoses in colorectal cancer. In this study, we explored the association between the NLR and prognoses following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). MATERIAL AND METHODS From February 2002 to December 2012, a group of 202 patients diagnosed with LARC and receiving neoadjuvant CRT followed by radical surgery was included in our retrospective study...
January 19, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28099070/laparoscopic-rectal-dissection-assisted-by-transanal-endoluminal-videoendoscopy-through-a-blunt-tip-trocar
#11
Emanuele Asti, Andrea Lovece, Luigi Bonavina
BACKGROUND AND AIMS: Laparoscopic resection is a well-established approach for colorectal cancer surgery. In patients with rectal cancer treated by neoadjuvant chemoradiotherapy, it may be difficult to identify a clear safety margin for endostapling and subsequent anastomosis. We designed an innovative technical approach to assist colorectal anastomosis in these patients. TECHNIQUE: A four-trocar laparoscopic approach is used. After exploration of the abdominal cavity, the left colic flexure is completely mobilized...
January 18, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28059920/local-excision-techniques-for-rectal-cancer-after-neoadjuvant-chemoradiotherapy-what-are-we-doing
#12
Fraser McLean Smith, Abdul Ahad, Rodrigo Oliva Perez, John Marks, Krzysztof Bujko, Richard J Heald
BACKGROUND: Recent evidence shows that the majority of rectal cancers demonstrate occult tumor scatter after neoadjuvant chemoradiotherapy that can extend for several centimeters under adjacent normal-appearing mucosa beside the residual mucosal abnormality or scar. OBJECTIVE: This systematic review aimed to determine all of the published selection criteria and technical descriptions for local excision to date with regard to this phenomenon. DATA SOURCES: PubMed, MEDLINE, and Embase were searched using the following key words: rectal cancer, local excision, radiotherapy, and neoadjuvant...
February 2017: Diseases of the Colon and Rectum
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
#13
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/28035459/understanding-the-factors-associated-with-reduction-in-the-number-of-lymph-nodes-in-rectal-cancer-patients-treated-by-neoadjuvant-treatment
#14
L Bustamante-Lopez, C S Nahas, S C Nahas, U Ribeiro, C F Marques, G Cotti, A Rocco, I Cecconello
INTRODUCTION: Rectal cancer patients frequently present with locally advanced disease for which the standard of care includes neoadjuvant chemoradiotherapy followed by total mesorectal excision. Positive lymph nodes are one of the most powerful risk factors for recurrence and survival in colorectal cancer. In the absence of specific rectal guidelines, the literature recommends to the pathologist to optimize the number of rectal lymph nodes (LN) retrieved. We made a literature review in order to identify factors that could potentially affect the number of LN retrieved in specimens of patients with rectal cancer treated by chemoradiotherapy (CRT) followed by total mesorectal excision (TME)...
December 29, 2016: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28027520/lymph-node-yield-after-rectal-resection-in-patients-treated-with-neoadjuvant-radiation-for-rectal-cancer-a-systematic-review-and-meta-analysis
#15
REVIEW
Robert Mechera, Tibor Schuster, Robert Rosenberg, Benjamin Speich
BACKGROUND: The lymph node status represents a major prognostic factor in colorectal cancer. However, it was demonstrated that neoadjuvant chemoradiotherapy (CRT) decreases the numbers of lymph nodes in the specimen. Several studies describe less than 12 lymph nodes in the resected specimen of rectal cancer patients after neoadjuvant radiation. This meta-analysis quantifies the influence of neoadjuvant CRT or radiotherapy (RT) only on the lymph node yield in rectal cancer patients. METHODS: We performed a systematic review and searched PubMed, EMBASE and the Cochrane Library without any language restriction from 1st of January 1980 until 31st March 2015...
February 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28011504/prognostic-and-therapeutic-potential-implications-of-genetic-variability-in-prostaglandin-e2-pathway-genes-in-rectal-cancer
#16
Marisa D Santos, Cristina Silva, Anabela Rocha, Carlos Nogueira, Fernando Castro-Poças, António Araujo, Eduarda Matos, Carina Pereira, Rui Medeiros, Carlos Lopes
AIM: To evaluate the prognostic significance and potential therapeutic implication of genetic variability in prostaglandin E2 pathway genes in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery. MATERIALS AND METHODS: This cohort study included 167 patients with LARC, treated with nCRT followed by surgery. A total of 61 single nucleotide polymorphisms (SNPs) were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation...
2017: Anticancer Research
https://www.readbyqxmd.com/read/27997526/organ-preservation-with-local-excision-or-active-surveillance-following-chemoradiotherapy-for-rectal-cancer
#17
B Creavin, E Ryan, S T Martin, A Hanly, P R O'Connell, K Sheahan, D C Winter
BACKGROUND: Organ preservation has been proposed as an alternative to radical surgery for rectal cancer to reduce morbidity and mortality, and to improve functional outcome. METHODS: Locally advanced non-metastatic rectal cancers were identified from a prospective database. Patients staged ⩾T3 or any stage N+ were referred for neoadjuvant chemoradiotherapy (CRT) (50-54 Gy and 5-fluorouracil), and were reassessed 6-8 weeks post treatment. An active surveillance programme ('watch and wait') was offered to patients who were found to have a complete endoluminal response...
January 17, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/27984651/neoadjuvant-long-course-chemoradiation-remains-strongly-favored-over-short-course-radiotherapy-by-radiation-oncologists-in-the-united-states
#18
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/27981667/assessment-of-pathological-complete-response-to-preoperative-chemoradiotherapy-by-means-of-multiple-mathematical-models-of-diffusion-weighted-mri-in-locally-advanced-rectal-cancer-a-prospective-single-center-study
#19
Hai-Bin Zhu, Xiao-Yan Zhang, Xiao-Hong Zhou, Xiao-Ting Li, Yu-Liang Liu, Shuai Wang, Ying-Shi Sun
PURPOSE: To assess stretched-exponential, mono-exponential and intravoxel incoherent motion (IVIM) models of diffusion-weighted MRI(DWI) in predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in rectal cancer patients. MATERIALS AND METHODS: This prospective study recruited 98 consecutive patients with locally advanced rectal cancer who underwent 3 Tesla MR examination before, during and after CRT. The apparent diffusion coefficient (ADC), IVIM-derived parameters (D, f, and D*), and stretched-exponential model-derived parameters (DDC and α) were measured...
December 16, 2016: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/27959450/chemoradiotherapy-and-concurrent-radiofrequency-thermal-therapy-to-treat-primary-rectal-cancer-and-prediction-of-treatment-responses
#20
Hisanori Shoji, Masahiko Motegi, Yosuke Takakusagi, Takayuki Asao, Hiroyuki Kuwano, Takeo Takahashi, Kyoji Ogoshi
The present study aimed to evaluate a previously reported predictive formula of output-limiting symptoms induced by radiofrequency (RF) to determine the efficacy of this neoadjuvant chemoradiation (NACR) and concurrent RF thermal therapy. The present study included 81 consecutive patients with confirmed diagnoses of rectal adenocarcinoma that was localized in the mid-low rectum (up to 12 cm from the anal verge) who received NACR [intensity-modulated radiotherapy (IMRT), 50 Gy/25 fractions, capecitabine 1,700 mg/m2/day for 5 days/week)] with concurrent thermal therapy (Thermotron-RF8, once a week for 5 weeks with 50 min irradiation)...
February 2017: Oncology Reports
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