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Neoadjuvant chemoradiation rectal cancer

Kazushi Yamashita, Tsuyoshi Chiku, Wataru Sano, Takahiro Hashiba, Kimio Shinoda, Yasuhiro Togawa
We reported 2 cases of colorectal cancer receiving neoadjuvant chemotherapy(NAC)with the aim of curative resection or anal preservation. Case 1: A 50-year-old man was diagnosed with locally advanced rectal cancer with sacral invasion. Because of the sacral invasion, we performed preoperative chemotherapy. He was treated with 12 courses of CapeOX plus Bmab and 3 courses of capecitabine plus radiation therapy(45 Gy in total). After chemoradiation therapy, a lower anterior resection was performed. The pathological finding was pT3pN0pM0, pStage Ⅱ...
January 2019: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Doenja M J Lambregts, Thierry N Boellaard, Regina G H Beets-Tan
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation...
February 13, 2019: Insights Into Imaging
Angelita Habr-Gama, Guilherme Pagin São Julião, Laura Melina Fernandez, Bruna Borba Vailati, Andres Andrade, Sérgio Eduardo Alonso Araújo, Joaquim Gama-Rodrigues, Rodrigo Oliva Perez
BACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed by organ-preserving strategies and acceptable long-term outcomes. Controversy still exists regarding optimal timing for the assessment of tumor response after neoadjuvant chemoradiation. OBJECTIVE: The purpose of this study was to estimate the time interval for achieving complete clinical response using strict endoscopic and clinical criteria after a single neoadjuvant chemoradiation regimen...
February 6, 2019: Diseases of the Colon and Rectum
Oliver S Chow, Sujata Patil, Metin Keskin, J Joshua Smith, Maria Widmar, David D Smith, Karin Avila, Jinru Shia, Peiguo Chu, Julio Garcia-Aguilar
BACKGROUND: Pathologic complete response (pCR) is associated with better prognosis and guides management for patients with advanced rectal cancer. Response rates vary between series for unclear reasons. We examine whether the thoroughness of pathologic assessment explains differences in pCR rates. METHODS: We retrospectively reviewed pathology reports from patients with stage II/III rectal cancer who underwent chemoradiation and resection in a prospective, multicenter trial...
February 4, 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Tao Wu, Long Wen, Jixin Zhang, Yingchao Wu, Yong Jiang, Guowei Chen, Xin Wang, Shanjun Huang, Yuanlian Wan
OBJECTIVE: To investigate the value of neoadjuvant chemoradiotherapy (nCRT) combined with total pelvic exenteration (TPE) in the treatment of primary T4b rectal cancer. METHODS: A retrospective cohort study was conducted to analyze the clinicopathological data of 31 patients with primary T4b rectal cancer who underwent TPE from January 2008 to December 2015 at Peking University First Hospital. INCLUSION CRITERIA: preoperative clinical stage (cTNM) was defined as cT4b primary rectal cancer with only front wall Invasion; the lower edge of tumor was within 10 cm from the anal margin; TPE was performed; R0 resection was confirmed by pathology...
January 25, 2019: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Min Chen, Liang-Zhou Chen, Lin Xu, Jin-Song Zhang, Xue Song
Background: Neoadjuvant chemoradiotherapy (CRT) prior to surgery is a standard therapy for locally advanced rectal cancer, but the optimum regime is not conclusive. This meta-analysis evaluated various CRT regimens with regard to the rate of pathologic complete response (pCR) and toxic effects of grade ≥3. Methods: The databases PubMed, Cochrane Library, and Embase were searched for randomized controlled trials (RCTs) that compared neoadjuvant CRT regimes for treating patients with locally advanced rectal cancer, published before 28 December 2017...
2019: Cancer Management and Research
Jun Seok Park, Soo Yeun Park, Hye Jin Kim, Seung Hyun Cho, Sang Gyu Kwak, Gyu-Seog Choi
BACKGROUND: To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors. OBJECTIVE: This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers. DESIGN: This was a retrospective analysis of prospectively collected departmental data...
January 23, 2019: Diseases of the Colon and Rectum
Deborah Schrag, Martin Weiser, Leonard Saltz, Harvey Mamon, Marc Gollub, Ethan Basch, Alan Venook, Qian Shi
BACKGROUND: More than half of the 40,000 incident rectal cancer patients in the United States each year are diagnosed at clinical stage II and III (locally advanced stage). For this group, high rates of cure can be achieved with the combination of pelvic radiation and sensitizing 5-fluorouracil (chemoradiation), surgery and chemotherapy, but treatment is long, arduous and toxicities are substantial. The PROSPECT trial (N1048, NCT01515787) was designed to determine whether neoadjuvant chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX) could be used as an alternative to neoadjuvant chemoradiation without compromising treatment outcomes and to spare these patients excess toxicity...
January 28, 2019: Clinical Trials: Journal of the Society for Clinical Trials
C Tyler Ellis, Ashley L Cole, Hanna K Sanoff, Sharon Hinton, Stacie B Dusetzina, Karyn B Stitzenberg
BACKGROUND: Upfront chemoradiation with omission of surgery (CR-only) is increasingly being used to treat rectal cancer. When CR-only is used with curative intent, intense surveillance is recommended. We hypothesize that in practice few patients treated with CR-only receive intensive post-treatment surveillance. STUDY DESIGN: Using SEER-Medicare, all non-metastatic rectal cancer patients (≥66 years old) diagnosed from 2004-2012 who received upfront chemoradiation were included...
January 24, 2019: Journal of the American College of Surgeons
Alberto Oldani, Giovanni Cesana, Matteo Uccelli, Francesca Ciccarese, Riccardo Giorgi, Stefano M De Carli, Roberta Villa, Stefano Olmi
BACKGROUND: Colorectal cancer, one of the most common tumor- and cancer-related deaths worldwide, requires a multidisciplinary management including neoadjuvant chemoradiotherapy and surgery. Laparoscopic surgery for rectal cancer is gaining popularity due to its safety profile and good oncological results, if performed by experienced surgeons in specialized centers. This study describes our 10 years experience in minimally invasive rectal cancer surgery. METHODS: We have retrospectively evaluated a series of 140 patients treated with laparoscopic approach for rectal malignant and benign diseases...
January 24, 2019: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Julia Schollbach, Stefan Kircher, Armin Wiegering, Florian Seyfried, Ingo Klein, Andreas Rosenwald, Christoph-Thomas Germer, Stefan Löb
The prognostic value of the local immune phenotype in patients with colorectal cancer has been extensively studied. Neoadjuvant radiotherapy and/or chemotherapy may potentially influence these immune responses. In this study, we examined the prognostic role of indoleamine-2,3-Dioxygenase (IDO1) and infiltrating cytotoxic T lymphocytes (CD8+) in locally advanced rectal carcinomas after neoadjuvant treatment. Expression of IDO1 and CD8 was evaluated by immunohistochemistry in 106 archival tumour tissue samples from patients following neoadjuvant chemoradiation and radical resection...
January 22, 2019: Cancer Immunology, Immunotherapy: CII
Arash Azin, Mohammadali Khorasani, Fayez A Quereshy
No abstract text is available yet for this article.
February 2019: Journal of Clinical Pathology
Alice M Couwenberg, Johannes P M Burbach, Martijn P W Intven, Esther C J Consten, Anandi H W Schiphorst, Anke B Smits, Niels A T Wijffels, Joost T Heikens, Miriam Koopman, Wilhemina M U van Grevenstein, Helena M Verkooijen
BACKGROUND: Neoadjuvant chemoradiation with delayed surgery (CRT-DS) and short-course radiotherapy with immediate surgery (SCRT-IS) are two commonly used treatment strategies for rectal cancer. However, the optimal treatment strategy for patients with intermediate-risk rectal cancer remains a discussion. This study compares quality of life (QOL) between SCRT-IS and CRT-DS from diagnosis until 24 months after treatment. METHODS: In a prospective colorectal cancer cohort, rectal cancer patients with clinical stage T2-3N0-2M0 undergoing SCRT-IS or CRT-DS between 2013 and 2017 were identified...
January 18, 2019: Acta Oncologica
Megan C Turner, Jeffrey E Keenan, Christel N Rushing, Brian C Gulack, Daniel P Nussbaum, Ehsan Benrashid, Terry Hyslop, John H Strickler, Christopher R Mantyh, John Migaly
BACKGROUND: Controversy exists over the use of adjuvant chemotherapy for locally advanced (stages II-III) rectal cancer (LARC) patients who demonstrate pathologic complete response (pCR) following neoadjuvant chemoradiation. We conducted a retrospective analysis to determine whether adjuvant chemotherapy imparts survival benefit among this population. METHODS: The National Cancer Database (NCDB) was queried to identify LARC patients with pCR following neoadjuvant chemoradiation...
January 11, 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Yugo Hirata, Hiroaki Nozawa, Kazushige Kawai, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Kensuke Otani, Kazuhito Sasaki, Manabu Kaneko, Shigenobu Emoto
BACKGROUND: It is unclear whether neoadjuvant chemoradiation for lower rectal cancer causes a deterioration in urinary function. This study aimed to prospectively compare the postoperative urinary function of patients with lower rectal cancer treated by surgery after neoadjuvant chemoradiation with that of patients treated with surgery alone. METHOD: Urinary function was assessed before treatment and 1, 3, and 6 months after surgery by calculating the changes in the scores of the seven items of the International Prostatic Symptom Score (incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia) and Quality of life index...
January 7, 2019: Asian Journal of Surgery
Rodney E Wegner, Stephen Abel, Richard J White, Zachary D Horne, Shaakir Hasan, Alexander V Kirichenko
PURPOSE: Traditionally, three-dimensional conformal radiation therapy (3D-CRT) is used for neoadjuvant chemoradiation in locally advanced rectal cancer. Intensity-modulated radiation therapy (IMRT) was later developed for more conformal dose distribution, with the potential for reduced toxicity across many disease sites. We sought to use the National Cancer Database (NCDB) to examine trends and predictors for IMRT use in rectal cancer. MATERIALS AND METHODS: We queried the NCDB from 2004 to 2015 for patients with rectal adenocarcinoma treated with neoadjuvant concurrent chemoradiation to standard doses followed by surgical resection...
December 2018: Radiation Oncology Journal
S L Liu, P O'Brien, Y Zhao, W M Hopman, N Lamond, R Ramjeesingh
Background: Little is known about the benefits of adjuvant chemotherapy (adj) in the older population with locally advanced rectal cancer (larc). We evaluated use of adj, survival outcomes, and adj-related toxicity in older patients with larc. Methods: Our retrospective review included 286 patients with larc (stages ii and iii) diagnosed between January 2010 and December 2013 in Nova Scotia who underwent curative-intent surgery. Baseline patient, tumour, and treatment characteristics were collected...
December 2018: Current Oncology
Jehan Yahya, Daniel Herzig, Matthew Farrell, Catherine Degnin, Yiyi Chen, John Holland, Simon Brown, Christina Binder, Jerry Jaboin, Vassiliki Liana Tsikitis, Nima Nabavizadeh, Charles R Thomas, Timur Mitin
Background: Watchful waiting in rectal cancer patients with a complete clinical response (cCR) to chemoradiation therapy (CRT) forgo upfront resection has been proposed. Growing evidence suggests that a watch-and-wait approach using resection for salvage of local recurrence may improve quality of life without jeopardizing outcomes. The current acceptance of watch-and-wait by US radiation oncologists (ROs) is unknown. Methods: US ROs completed our IRB-approved anonymous e-survey regarding non-surgical management of patients who achieved a cCR to neoadjuvant CRT...
December 2018: Journal of Gastrointestinal Oncology
Shenghui Huang, Ying Huang, Pan Chi, Huiming Lin, Xingrong Lu, Zongbin Xu, Yanwu Sun, Xiaojie Wang
PURPOSE: Traditional intersphincteric resection is a technically demanding procedure that required a perineal approach dissection and a handsewn coloanal anastomosis. Our study was to investigate the feasibility and the prognostic factors of completely abdominal approach partial intersphincteric resection (APISR) after neoadjuvant chemoradiotherapy (CRT) for low rectal cancer with initial stage cT3. METHODS: A total of 101 consecutive patients with initial stage cT3 juxta-anal rectal cancer who underwent APISR after neoadjuvant CRT between January 2010 and March 2015 were enrolled...
December 31, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Runjan Chetty, Aoife J McCarthy
Neoadjuvant chemoradiation (NACR) is now standard of care in stage II and III rectal cancer. The advent of this modality of treatment has impacted on the way the pathological evaluation of resection specimens that have been subjected to preoperative chemoradiation is conducted. The gross description, sectioning and microscopic examination have had to be adapted to accommodate the changes induced by NACR. Attempts at introducing a uniform approach to the gross triaging and reporting of these specimens have been met with muted response...
December 28, 2018: Journal of Clinical Pathology
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