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Neoadjuvant chemoradiotherapy in rectal cancer

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https://www.readbyqxmd.com/read/28059920/local-excision-techniques-for-rectal-cancer-after-neoadjuvant-chemoradiotherapy-what-are-we-doing
#1
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
#2
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
#3
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
#4
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...
December 24, 2016: 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
#5
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...
January 2017: Anticancer Research
https://www.readbyqxmd.com/read/27997526/organ-preservation-with-local-excision-or-active-surveillance-following-chemoradiotherapy-for-rectal-cancer
#6
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...
December 20, 2016: 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
#7
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
#8
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
#9
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)...
December 7, 2016: Oncology Reports
https://www.readbyqxmd.com/read/27940290/the-relationship-between-systemic-inflammation-and-stoma-formation-following-anterior-resection-for-rectal-cancer-a-cross-sectional-study
#10
Bo Y Khor, Stephen T McSorley, Paul G Horgan, Donald C McMillan
INTRODUCTION: There is evidence that temporary defunctioning stoma formation in patients undergoing anterior resection reduces the risk of anastomotic leakage. The aim of the present study was to investigate the relationship between stoma formation, the postoperative systemic inflammatory response and complications following anterior resection for rectal cancer. METHODS: Data was recorded prospectively for patients who underwent anterior resection for histologically proven rectal cancer, from 2008 to 2015 at a single centre, n = 167...
January 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/27938574/-effects-of-neoadjuvant-chemoradiotherapy-on-the-rates-of-sphincter-preserving-surgery-in-lower-rectal-cancer-and-analysis-of-their-prognostic-factors
#11
X J Wang, P Chi, H M Lin, X R Lu, Y Huang, Z B Xu, S H Huang, Y W Sun, D X Ye
Objectives: To identify independent factors of sphincter preserving surgery, and to evaluated whether preoperative chemoradiotherapy (CRT) improves the sphincter preservation rate for lower rectal cancers. Methods: A total of 541 consecutive patients who underwent curative surgery for locally advanced rectal cancer (cT3-4Nx or cTxN+ ) within 6 cm of the anal verge with or without neoadjuvant CRT in Department of Colorectal Surgery, Union Hospital, Fujian Medical University between September 2000 and September 2013 were reviewed...
1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/27934790/abdomino-endoscopic-perineal-excision-of-the-rectum-for-benign-and-malignant-pathology-technique-considerations-for-true-transperineal-verus-transanal-total-mesorectal-excision-endoscopic-proctectomy
#12
Hazar Al Furajii, Niall Kennedy, Ronan A Cahill
PURPOSE: Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature. METHODS: Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed...
January 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/27926555/avoiding-radical-surgery-in-elderly-patients-with-rectal-cancer-is-cost-effective
#13
Christopher Rao, Arthur Sun Myint, Thanos Athanasiou, Omar Faiz, Antony Paul Martin, Brendan Collins, Fraser McLean Smith
BACKGROUND: Radical surgery is associated with significant perioperative mortality in elderly and comorbid populations. Emerging data suggest for patients with a clinical complete response after neoadjuvant chemoradiotherapy that a watch-and-wait approach may provide equivalent survival and oncological outcomes. OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of watch and wait and radical surgery for patients with rectal cancer after a clinical complete response following chemoradiotherapy...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27917208/histologic-response-after-neoadjuvant-chemoradiotherapy-in-locally-advanced-rectal-adenocarcinoma-experience-from-sudan
#14
Ahmed Abd Elrahman Abdalla, Awad Ali M Alawad, Hussein Abdalla M Ali
BACKGROUND: Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. PATIENTS AND METHODS: A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed...
September 2016: African Health Sciences
https://www.readbyqxmd.com/read/27903247/preoperative-conventional-chemoradiotherapy-versus-short-course-radiotherapy-with-delayed-surgery-for-rectal-cancer-results-of-a-randomized-controlled-trial
#15
Tadas Latkauskas, Henrikas Pauzas, Laura Kairevice, Aleksandras Petrauskas, Zilvinas Saladzinskas, Rasa Janciauskiene, Jurate Gudaityte, Paulius Lizdenis, Saulius Svagzdys, Algimantas Tamelis, Dainius Pavalkis
BACKGROUND: There still is no evidence which neoadjuvant therapy regimen for stage II-III rectal cancer is superior. The aim of this study was to compare results achieved after long-course chemoradiotherapy (CRT) with short-term radiotherapy (RT) followed by delayed surgery. METHODS: A randomized trial was carried out between 2007-2013. One hundred fifty patients diagnosed with stage II-III rectal cancer were randomized into one of two neoadjuvant treatment arms: conventional chemoradiotherapy (CRT) and short-term radiotherapy (RT) followed by surgery after 6-8 weeks...
December 1, 2016: BMC Cancer
https://www.readbyqxmd.com/read/27891147/effect-of-neoadjuvant-chemoradiotherapy-with-capecitabine-versus-fluorouracil-for-locally-advanced-rectal-cancer-a-meta-analysis
#16
REVIEW
Guo-Chen Liu, Jun-Ping Yan, Qing He, Xin An, Zhi-Zhong Pan, Pei-Rong Ding
A meta-analysis was carried out to compare the efficacy and safety of capecitabine plus radiation with 5-fluorouracil (5-FU) plus radiotherapy (RT) as neoadjuvant treatment in locally advanced rectal cancer (LARC). We searched the Cochrane database, Ovid, Medline, Embase, ISI databases, and Chinese Biomedical Literature Database between January 1998 and October 2014. Trials of capecitabine compared with 5-FU plus RT as neoadjuvant treatment for LARC were considered for inclusion. RevMan software was used to analyze these data...
2016: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/27885479/wait-and-see-approach-for-rectal-cancer-with-a-clinically-complete-response-after-neoadjuvant-concurrent-chemoradiotherapy
#17
Hyun Jung Kim, Jin Ho Song, Hyeong Sik Ahn, Bong-Hoi Choi, Hojin Jeong, Hoon Sik Choi, Yun Hee Lee, Ki Mun Kang, Bae Kwon Jeong
PURPOSE: Rectal cancer patients with a pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) have a better prognosis compared to those without a pCR. Therefore, the "Wait and See" (W&S) approach in those who achieved clinically complete response (cCR) after CCRT was introduced as an alternative modality to the total mesorectal excision (TME). The aim of this study was to compare the oncological outcomes between W&S and TME via meta-analysis. METHODS: We performed a comprehensive literature search on January 14, 2016, using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus...
November 24, 2016: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/27873100/the-pretreatment-systemic-inflammatory-response-is-an-important-determinant-of-poor-pathologic-response-for-patients-undergoing-neoadjuvant-therapy-for-rectal-cancer
#18
Stephan B Dreyer, Arfon G M T Powell, Stephen T McSorley, Ashita Waterston, James J Going, Joanne Edwards, Donald C McMillan, Paul G Horgan
BACKGROUND: Not all patients respond equally to neoadjuvant chemoradiotherapy (nCRT), with subsequent effects on survival. The systemic inflammatory response has been shown to predict long-term outcomes in colorectal cancer. The current study examined the association between systemic inflammation and nCRT in patients with rectal cancer. METHODS: Between 1999 and 2010, patients who underwent nCRT were identified. Serum measurements of hemoglobin, C-reactive protein, albumin, modified Glasgow prognostic score (mGPS), and differential white cell counts were obtained before and after nCRT...
November 21, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27864695/adjuvant-chemotherapy-improves-overall-survival-of-rectal-cancer-patients-treated-with-neoadjuvant-chemoradiotherapy-regardless-of-pathologic-nodal-status
#19
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
#20
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
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