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Sample records for preoperative rectal cancer

  1. Preoperative staging of rectal cancer.

    Science.gov (United States)

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  2. Preoperative rectal cancer staging with phased-array MR

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    Giusti Sabina

    2012-03-01

    Full Text Available Abstract Background We retrospectively reviewed magnetic resonance (MR images of 96 patients with diagnosis of rectal cancer to evaluate tumour stage (T stage, involvement of mesorectal fascia (MRF, and nodal metastasis (N stage. Our gold standard was histopathology. Methods All studies were performed with 1.5-T MR system (Symphony; Siemens Medical System, Erlangen, Germany by using a phased-array coil. Our population was subdivided into two groups: the first one, formed by patients at T1-T2-T3, N0, M0 stage, whose underwent MR before surgery; the second group included patients at Tx N1 M0 and T3-T4 Nx M0 stage, whose underwent preoperative MR before neoadjuvant chemoradiation therapy and again 4-6 wks after the end of the treatment for the re-staging of disease. Our gold standard was histopathology. Results MR showed 81% overall agreement with histological findings for T and N stage prediction; for T stage, this rate increased up to 95% for pts of group I (48/96, while for group II (48/96 it decreased to 75%. Preoperative MR prediction of histologically involved MRF resulted very accurate (sensitivity 100%; specificity 100% also after chemoradiation (sensitivity 100%; specificity 67%. Conclusions Phased-array MRI was able to clearly estimate the entire mesorectal fat and surrounding pelvic structures resulting the ideal technique for local preoperative rectal cancer staging.

  3. Combined modality preoperative therapy for unresectable rectal cancer.

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    Percarpio, B; Bitterman, J; Sabbath, K; Alfano, F; Ruszkowski, R; Bowen, J

    1992-01-01

    Locally advanced rectal cancer has been a surgical challenge because of fixation of the primary tumor to the boney pelvis or to other pelvic soft tissues. During a 12-month period seven patients with locally advanced adenocarcinoma of the rectum were treated preoperatively with simultaneous pelvic irradiation (4500-5040 cGy) and infusion chemotherapy (5-fluorouracil 1000 mg per m2 per day over 96 hours and mitomycin 10 mg per m2. Tolerance was reasonable and all patients underwent successful resection of the primary lesion. Two patients had a complete response to preoperative combined modality therapy with no cancer found in the surgical specimen. With a short follow-up period, all patients have experienced satisfactory healing and none have suffered local or distant recurrence. The results of this limited series are encouraging for future clinical trials.

  4. Clinicopathological studies on three preoperative combined treatments for rectal cancer

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    Yoshioka, Yuji; Ichikawa, Daisuke; Iizuka, Ryouji; Hagiwara, Akeo; Sawai, Kiyoshi; Yamaguchi, Toshiharu; Takahashi, Toshio [Kyoto Prefectural Univ. of Medicine (Japan)

    1995-09-01

    To prevent postoperative local recurrence of rectal cancer, we treated patients using preoperative hyperthermia (5-6 times), irradiation (total 30 Gy) and 5-fluorouracil suppository (2,000-2,500 mg). The subjects were 31 patients given combined treatments and 28 patients given surgery alone. The results were as follows: Histologically, therapeutic effects were recognized in 80.6% of patients receiving combined treatments. The mean distance from the adventitia to the site of cancer infiltration was 6.54 mm in the combined treatments group and 3.35 mm in the surgery alone group. The difference between the two was significant (p<0.05). The rate of local recurrence in the combined treatments group was less than that in the surgery alone group. No systemic side effects nor severe complications were observed during hospitalization in the combined treatments group. The survival rate of the combined treatments group was higher than that of the surgery alone group. It was considered that combined preoperative treatments for rectal cancer were beneficial to survival and local control. (author).

  5. Effect of Suboptimal Chemotherapy on Preoperative Chemoradiation in Rectal Cancer

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    Lee, Ji Hye; Kang, Hyun Cheol; Chie, Eui Kyu; Kang, Gyeong Hoon; Park, Jae Gahb; Oh, Do Youn; Im, Seock Ah; Kim, Tae You; Bang, Yung Jue; Ha, Sung Whan [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2009-06-15

    To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer. The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients. No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients. Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.

  6. Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer

    Directory of Open Access Journals (Sweden)

    Silva José Hyppolito da

    2002-01-01

    Full Text Available PURPOSE: Preservation of the anal sphincter in surgery for cancer of the distal rectum in an attempt to avoid colostomy has been a main concern of colorectal surgeons. Various proposed procedures contradict oncological principles, especially with respect to pelvic lymphadenectomy. Therefore, prior knowledge of pelvic lymph node involvement is an important factor in choosing the operative technique, i.e., radical or conservative resection. Introduction of ultrasound, computerized tomography, and magnetic resonance have made preoperative study of the area possible. Nevertheless, these resources offer information of an anatomical nature only. Lymphoscintigraphy enables the morphological and functional evaluation of the pelvic area and contributes toward complementing the data obtained with the other imaging techniques. The objective of this prospective study is twofold: to standardize the lymphoscintigraphy technique and to use it to differentiate patients with rectal cancer from those with other coloproctologic diseases. CASUISTIC AND METHODS: Sixty patients with various coloproctologic diseases were studied prospectively. Ages ranged from 21 to 96 years (average, 51 and median, 55 years. Twenty-six patients were male and 34 were female. Thirty patients had carcinoma of the distal rectum as diagnosed by proctologic and anatomic-pathologic examinations, 20 patients had hemorrhoids, 5 had chagasic megacolon, 2 had diverticular disease, 2 had neoplasm of the right colon, and 1 had ulcerative colitis as diagnosed by proctologic exam and/or enema. The lymphoscintigraphy method consisted of injecting 0.25 mL of a dextran solution marked with radioactive technetium-99m into the right and left sides of the perianal region and obtaining images with a gamma camera. The results were analyzed statistically with a confidence level of 95% (P < .05 using the following statistical techniques: arithmetic and medium average, Fisher exact test, chi-square test

  7. International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams.

    LENUS (Irish Health Repository)

    Augestad, Knut M

    2010-11-01

    Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates.

  8. Preoperative hyperthermo-chemo-radiotherapy for patients with rectal cancer

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    Matsuda, Hiroyuki; Shimono, Reishi; Inoue, Tetsuya; Mori, Masaki; Kuwano, Hiroyuki; Sugimachi, Keizo

    1989-04-01

    Between April 1986 and February 1988, 17 patients with rectal cancer were treated with preoperative hyperthermo-chemo-radiotherapy (HCR). Hyperthermia was given 4 or 5 times over a 2-week period before irradiation. X-ray irradiation was given 20 times in 1.5 Gy x 2/day to a total dose of 30 Gy. Two hundred and fifty milligrams of 5 FU was intravenously injected or 400-600 mg of HCFU was orally administered. Of evaluable 16 patients, 6 were roentgenologically evaluated as partial response, 3 as moderate response, and 7 as non-response. Histological examination revealed complete response in 9 (53%), moderate response in 4 (24%), and slight response in 4 (24%). In 9 patients seropositive for CEA, CEA tended to decrease after HCR. Early side effects of HCR was not encountered. Although some of the patients complained of fever in the anal site, defecation desire, and micturition desire attributable to hyperthermia, these complaints were not so severe as to discontinue the treatment. (Namekawa, K).

  9. Preoperative radiation therapy for upper rectal cancer T3,T4/Nx: selectivity essential.

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    Popek, Sarah; Tsikitis, Vassiliki Liana; Hazard, Lisa; Cohen, Alfred M

    2012-06-01

    This review explores the current available literature regarding the role of neoadjuvant therapy for upper locally advanced rectal cancers (≥10 cm-15 cm). Although there is a paucity of data evaluating the outcomes of preoperative chemoradiation for upper rectal cancers the authors suggest that T3N0 tumors will not likely benefit from radiation and that treatment of T4N0 should be individualized. Copyright © 2012. Published by Elsevier Inc.

  10. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer.

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    Taylor, Fiona G M; Swift, Robert I; Blomqvist, Lennart; Brown, Gina

    2008-12-01

    The purpose of this article is to provide an aid to the systematic evaluation of MRI in staging rectal cancer. MRI has been shown to be an effective tool for the accurate preoperative staging of rectal cancer. In the Magnetic Resonance Imaging and Rectal Cancer European Equivalence Study (MERCURY), imaging workshops were held for participating radiologists to ensure standardization of scan acquisition techniques and interpretation of the images. In this article, we report how the information was obtained and give examples of the images and how they are interpreted, with the aim of providing a systematic approach to the reporting process.

  11. Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer

    DEFF Research Database (Denmark)

    Achiam, Michael P; Løgager, Vibeke B; Skjoldbye, Bjørn;

    2016-01-01

    Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis....... The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT. Methods. Consecutive patients diagnosed with rectal cancers were....... The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time....

  12. Comparison of hydrocolonic sonograpy accuracy in preoperative staging between colon and rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Hye Won Chung; Jae Bock Chung; Seung Woo Park; Si Young Song; Jin Kyung Kang; Chan Il Park

    2004-01-01

    AIM: To compare the accuracy of hydrocolonic sonography (HUS) in determining the depth of invasion (T stage) in colon and rectal cancer.METHODS: A total of 1 000-2 000 mL of saline was instilled per rectum using a system for barium enemas, and then ultrasonography was conducted by a SSA-270A (Toshiba Co, Japan) sonolayer unit with a 3.75 MHz for 17 patients with colon cancer and 13 patients with rectal cancer before operation. After operation, T stage in HUS was compared with postoperative histological findings.RESULTS: Overall, the accuracy of T stage was 70%. It was 88% in colon cancer and 46% in rectal cancer. In evaluating nodal state, the accuracy of HUS was low in both colon (71%) and rectal cancers (46%) compared with conventional CT or MRI. The overall accuracy of N staging was 60%.CONCLUSION: HUS is valuable to evaluate the depth of invasion in colon cancer, but is less valuable in rectal cancer. Because HUS is low-cost, noninvasive, and readily available at any place, this technique seems to be useful to determine the preoperative staging in colon cancer, but not in rectal cancer.

  13. Effect of Tumor Infiltrating Lymphocyte on Local Control of Rectal Cancer after Preoperative Radiotherapy

    Institute of Scientific and Technical Information of China (English)

    XU Gang; XU Bo; ZHANG Shan-wen

    2008-01-01

    Objective:To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy.Methods:From Jan.1999 to Oct.2007,a total of 107 patients with rectal cancer were reviewed.They were treated by preoperative radiotherapy,30 Gy/10 fractions/12 days.Two weeks later,the patient underwent a surgical operation.Their pathological samples were kept in our hospital before and after radiotherapy.Lymphocyte infiltration(LI)degree,pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope.Results:After followed-up of 21 months(2-86 months),a total of 107 patients were reviewed.Univariate analysis showed that lymphocyte infiltration(LI),fibrosis and pathologic changes after radiotherapy were significant factors on local control.Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control.Conclusion:LI,fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy.LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.

  14. Results of a selective policy for preoperative radiotherapy in rectal cancer surgery.

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    Gandy; O'Leary; Falk; Roe

    2000-01-01

    Preoperative radiotherapy (pRT) for rectal cancer may reduce local recurrence and improve survival. This study was undertaken to assess a selective policy of pRT in rectal cancer. The aim was to determine whether patients likely to have involved circumferential margins (CRM) could be reliably selected for pRT using clinical criteria. We have used CRM and delay in surgery as outcome measures. Seventy-nine patients with rectal cancer were assessed for preoperative radiotherapy using clinical criteria. Twelve of 26 (46%) pRT patients had positive CRM compared with three of 53 (5.6%) who did not receive pRT (P benefit from radiotherapy and has avoided excessive delays prior to surgery. However, almost half of the pRT patients did not have involved CRM. With improved imaging techniques we may be able to refine our selection criteria further.

  15. Preoperative staging of rectal cancer by MRI; results of a UK survey

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    Taylor, A. [Department of Radiology, Royal Lancaster Infirmary, Lancaster (United Kingdom)]. E-mail: alasdair.taylor@rli.mbht.nhs.uk; Sheridan, M. [Department of Radiology, St James' Hospital, Leeds (United Kingdom); McGee, S. [Department of Radiology, Salisbury Hospitals NHS Trust, Salisbury (United Kingdom); Halligan, S. [Department of Radiology, Intestinal Imaging Centre, St Mark' s Hospital, Harrow (United Kingdom)

    2005-05-01

    AIM: To determine current day-to-day practice of and access to preoperative MRI for patients with rectal cancer in the UK, with the aim of identifying constraining factors. MATERIALS AND METHODS: A questionnaire asking for details of rectal cancer workload, multidisciplinary team (MDT) practice, preoperative MRI, the use of alternative imaging methods where appropriate, and an assessment of local access to MRI, was mailed to 283 UK departments of radiology. Replies were received from 142 departments (50.2% response rate). These were collated and response frequencies were determined. RESULTS: According to their replies, 135 (95%) of respondents always discussed rectal cancer cases within the context of an MDT, usually including a radiologist. Only 49% of respondents attempted to offer preoperative MRI to all rectal cancer patients, and 35% of respondents used MRI in less than 25% of cases. Of the 142 respondents, 73 (51%) felt their practice was currently constrained by lack of MR resources. The most frequently cited constraint was an available but over-subscribed MRI scanner. Limited radiology manpower was the next most frequently cited constraint. A significant minority stated that no MRI scanner was available. CONCLUSIONS: The MDT is a well established forum for the discussion of patients with rectal cancer, and a radiologist is usually involved. However, in the face of current guidelines, less than 50% of the units studied were able to offer preoperative MRI to all of their rectal cancer cases. Improved access to MRI and increased radiological manpower are necessary if current management guidelines are to be observed.

  16. Molecular prognostic factors in locally irresectable rectal cancer treated preoperatively by chemo-radiotherapy

    NARCIS (Netherlands)

    Reerink, O; Karrenbeld, Arend; Plukker, JTM; Verschueren, Rene; Szabo, BG; Sluiter, WJ; Hospers, GAP; Mulder, NH

    2004-01-01

    PURPOSE: The aim of this study was to determine the relationship between survival and value of molecular markers in the primary tumour in a group of patients with irresectable rectal cancer, treated with preoperative chemo-radiotherapy. MATERIALS AND METHODS: Immunohistochemistry for p53, p21, bcl-2

  17. PET/CT and histopathologic response to preoperative chemoradiation therapy in locally advanced rectal cancer

    DEFF Research Database (Denmark)

    Kristiansen, C.; Loft, A.; Berthelsen, Anne Kiil;

    2008-01-01

    PURPOSE: The objective of this study was to investigate the possibility of using positron emission tomography/computer tomography to predict the histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiation. METHODS: The study included 30 patients with locall...

  18. Livin expression is an independent factor in rectal cancer patients with or without preoperative radiotherapy.

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    Ding, Zhen-Yu; Zhang, Hong; Adell, Gunnar; Olsson, Birgit; Sun, Xiao-Feng

    2013-12-02

    This study was aimed to investigate the expression significance of Livin in relation to radiotherapy (RT), clinicopathological and biological factors of rectal cancer patients. This study included 144 primary rectal cancer patients who participated in a Swedish clinical trial of preoperative radiotherapy. Tissue microarray samples from the excised primary rectal cancers, normal mucosa and lymph node metastases were immunostained with Livin antibody. The proliferation of colon cancer cell lines SW620 and RKO was assayed after Livin knock-down. The expression of Livin was significantly increased from adjacent (P = 0.051) or distant (P = 0.028) normal mucosa to primary tumors. 15.4% (2/13) and 39.7% (52/131) patients with Livin-negative and positive tumors died at 180 months after surgery, and the difference tended to be statistically significant (P = 0.091). In multivariate analyses, the difference achieved statistical significance, independent of TNM stage, local and distant recurrence, grade of differentiation, gender, and age (odds ratio = 5.09, 95% CI: 1.01-25.64, P = 0.048). The in vitro study indicated colon cancer cells with Livin knock-down exhibited decreased proliferation compared with controls after RT. The expression of Livin was was independently related to survival in rectal cancer patients, suggesting Livin as a useful prognostic factor for rectal cancer patients.

  19. PET/CT and Histopathologic Response to Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer

    DEFF Research Database (Denmark)

    Kristiansen, Charlotte; Loft, Annika; Berthelsen, Anne K

    2008-01-01

    PURPOSE: The objective of this study was to investigate the possibility of using positron emission tomography/computer tomography to predict the histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiation. METHODS: The study included 30 patients with locally...... advanced rectal adenocarcinoma treated with a combination of radiotherapy and concurrent Uftoral(R) (uracil, tegafur) and leucovorine. All patients were evaluated by positron emission tomography/computer tomography scan seven weeks after end of chemoradiation, and the results were compared...... of chemoradiation is not able to predict the histopathologic response in locally advanced rectal cancer. There is an obvious need for other complementary methods especially with respect to the low sensitivity of positron emission tomography/computer tomography....

  20. Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: An institutional analysis

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    Le, Jeong Won; Lee, Jong Hoon; Kim, Jun Gi; Oh, Seong Taek; Chung, Hyuk Jun; Lee, Myung Ah; Chun, Hoo Geun; Jeong, Song Mi; Yoon, Sel Chul; Jang, Hong Seok [Seoul St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2013-09-15

    To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p = 0.10 and p = 0.62, respectively). The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.

  1. Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer.

    Science.gov (United States)

    Olagne, E; Baulieux, J; de la Roche, E; Adham, M; Berthoux, N; Bourdeix, O; Gerard, J P; Ducerf, C

    2000-12-01

    The aim of this study was to assess functional outcomes of patients who had a delayed coloanal anastomosis for a lower third rectal cancer after preoperative radiotherapy. From January 1988 to December 1997, 35 patients with an adenocarcinoma of the lower third of the rectum received preoperative radiotherapy (45Gy) followed by a rectal resection, combining an abdominal and transanal approach. Colorectal resection was performed about 32 days after the end of the radiotherapy. The distal colon stump was pulled through the anal canal. On postoperative day 5 the colonic stump was resected and a direct coloanal anastomosis performed without colostomia diversion. There was no mortality. There was no leakage. One patient had a pelvic abscess. One patient had a necrosis of the left colon requiring reoperation. Another delayed coloanal anastomosis could be performed. Median followup was 43 months (range 6 to 113 months). Functional results were evaluated with a new scoring system including 13 items. Function was considered good in 59% and 70% at 1 and 2 years, respectively. This new procedure is a safe and effective sphincter-preserving operation that avoids a diverting stoma for patients with rectal cancer of the lower third of the rectum. This technique is well adapted for patients receiving preoperative radiotherapy, with low local morbidity and good functional results. Further adaptation could be imagined for a coelioscopic approach.

  2. Preoperative staging of rectal cancer: the MERCURY research project.

    Science.gov (United States)

    Brown, G; Daniels, I R

    2005-01-01

    The development of a surgical technique that removes the tumour and all local draining nodes in an intact package, namely total mesorectal excision (TME) surgery, has provided the impetus for a more selective approach to the administration of preoperative therapy. One of the most important factors that governs the success of TME surgery is the relationship of tumour to the circumferential resection margin (CRM). Tumour involves the CRM in up to 20% of patients undergoing TME surgery, and results in both poor survival and local recurrence. It is therefore clear that the importance of the decision regarding the use of pre-operative therapy lies with the relationship of the tumour to the mesorectal fascia. In addition, a high-spatial-resolution MRI technique will identify tumours exhibiting other poor prognostic features, namely, extramural spread >5 mm, extramural venous invasion by tumour, nodal involvement, and peritoneal infiltration. The potential benefits of a selective approach using MRI-based selection criteria are evident. That is, over 50% of patients can be treated successfully with primary surgery alone without significant risk of local recurrence or systemic failure. Of the remainder, potentially dramatic improvements may be achieved through the use of intensive and targeted preoperative therapy aimed not only at reducing the size of the primary tumour and rendering potentially irresectable tumour resectable with tumour-free circumferential margins, but also at enabling patients at high risk of systemic failure to benefit from intensive combined modality therapy aimed at eliminating micrometastatic disease.

  3. Preoperative radiotherapy in rectal cancer treatment -- is it really a gold standard?

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    Pătraşcu, Tr; Doran, H; Mihalache, O

    2014-01-01

    Preoperative radiotherapy in the treatment of rectal cancer was thought to be an achievement of similar importance to total mesorectal excision (TME), for the therapeutic management of rectal malignancies. However, numerous criticisms have been discussed in this field lately. We have analysed the two main purposes of preoperative radiation: possible sphincter preservation and the conversion of a non-resectable tumor into a resectable one in a series of 31 consecutive patients, operated in our clinic. In 20 of them, preoperative radio chemoradiotherapy was applied, while 11 patients were firstly operated and then irradiated. The surgical procedure included total mesorectal excision in 30 patients, as part of a low anterior resection,in 13 cases and of an abdominal perineal resection, in the other 17 cases. We have found that preoperative radiotherapy improves the local recurrence rate but has no influence on the overall survival rate. However, we should not overlook the adverse effects of this method: toxicity of radiotherapy on the small bowel and the urinary bladder, the healing of the perineal wounds and the risk of anastomotic leaks. We concluded in favor of elective preoperative radiotherapy in selected cases: any T4 tumors, T3 tumors which threaten the mesorectal fascia on MRI, whenever there is a suspicion of nodal involvement and also for very low tumors. Celsius.

  4. Preoperative concurrent chemo-radiation in rectal cancer; Radiochimiotherapie concomitante preoperatoire pour cancer du rectum

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    Berger, C.; Kirscher, S.; Felix-Faure, C.; Chauvet, B.; Vincent, P.; Brewer, Y.; Reboul, F. [Clinique Sainte-Catherine, 84 - Avignon (France)

    1998-05-01

    To evaluate retrospectively treatment-related morbidity of concurrent radiotherapy and chemotherapy for rectal cancer. Between 1992 and 1995, 38 patients (median age: 60) were treated for locally advanced resectable rectal cancer. Median dose of radiotherapy was 45 Gy/25 fractions/5 weeks. Chemotherapy consisted of two courses of 5-fluorouracil and leucovorin administered during the first and the fifth weeks of radiotherapy. Median dose of 5-fluorouracil was 350 mg/m{sup 2}/day, and median dose of leucovorin was 350 mg/m{sup 2}/day, day 1 to day 5. Surgery was performed 5 weeks after completion of radiotherapy. Before surgery, one patient died of febrile neutropenia and sepsis after two cycles of chemotherapy and 45 Gy. Main pre-operative grade 3-4 toxicities were respectively: neutropenia: 3% ; nausea/vomiting: 3%; diarrhea: 3%; proctitis: 5%; radiation dermatitis: 8%. Twenty-six patients underwent a low anterior resection and 11 an abdomino-perineal resection. A temporary colostomy was performed in 12 patients. Pathologic complete response rate was 27 %. There was one post-operative death due to thrombo-embolic disease. Major post-operative grade 3-4 complications were: pelvic infection: 14 %; abdominal infection : 5%; perineal sepsis: 8%; anastomotic dehiscence: 8%; cardiac failure: 5%. Delayed perineal wound healing was observed in six patients. No significant prognostic factor of post-operative complications has been observed. Median duration of hospitalization was 22 days. With a median follow-up of 24 months, 2-year overall and disease-free survival rates were 82 and 64%. Tolerance of preoperative concurrent chemoradiotherapy was acceptable. Ongoing controlled studies will assess the impact of this combined treatment on survival. (authors)

  5. Clinicopathological studies on preoperative three combined treatments with hyperthermo-chemo-radiotherapy for rectal cancer

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    Yoshioka, Yuji [Kyoto Prefectural Univ. of Medicine (Japan)

    1995-08-01

    To prevent local recurrence of rectal cancer postoperatively, we treated patients using preoperative hyperthermia (5-6 times), irradiation (total 30 Gy) and a 5-Fluorouracil suppository (2000-2500 mg). The subjects were 31 patients given combined preoperative treatments and 28 patients given surgery alone. The results were as follows: Histologically, therapeutic effects were recognized in 80.6% of the combined treatments group. The mean distance from the adventitia to the site of cancer infiltration was 6.44 mm in the combined treatments group and 3.35 mm in the surgery alone group. The difference between the two was significant (p<0.05). The combined treatments produced a reduced tumor infiltration into the anal side, and resulted in making a safe margin for anastomosis. The rate of local recurrence in the combined treatments group was less than that of the surgery alone group. No systematic side effects or severe complications were observed during hospitalization in the combined treatments group. The survival rate of the combined treatments group was higher than that of the surgery alone group. It was considered that combined preoperative treatments for rectal cancer is beneficial to expand indications of super low anterior resection. (author).

  6. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Science.gov (United States)

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-08-01

    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  7. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Eun Cheol [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Kim, Jin Hee; Kim, Ok Bae; Kim, Mi Young; Oh, Young Ki; Baek, Sung Gyu [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.

  8. Preoperative chemoradiotherapy followed by local excision in clinical T2N0 rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Young Seob; Park, Jin Hong; Ahn, Seung Do [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); and others

    2016-09-15

    To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients' characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer.

  9. Preoperative chemoradiotherapy followed by local excision in clinical T2N0 rectal cancer

    Science.gov (United States)

    Shin, Young Seob; Yoon, Yong sik; Lim, Seok-Byung; Yu, Chang Sik; Kim, Tae Won; Chang, Heung Moon; Park, Jin-hong; Ahn, Seung Do; Lee, Sang-Wook; Choi, Eun Kyung; Kim, Jin Cheon; Kim, Jong Hoon

    2016-01-01

    Purpose To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Materials and Methods Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients’ characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. Results All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. Conclusion PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer. PMID:27730804

  10. Biological predictive factors in rectal cancer treated with preoperative radiotherapy or radiochemotherapy.

    Science.gov (United States)

    Negri, F V; Campanini, N; Camisa, R; Pucci, F; Bui, S; Ceccon, G; Martinelli, R; Fumagalli, M; Losardo, P L; Crafa, P; Bordi, C; Cascinu, S; Ardizzoni, A

    2008-01-15

    We analysed the expression of microsatellite instability, p53, p21, vascular endothelial growth factor and thymidylate synthase (TS) in pretreatment biopsy specimens from 57 locally advanced rectal cancers. The aim of the study was to correlate the expression of these markers with pathological response. Nineteen patients were treated with preoperative concomitant radiotherapy (RT) and fluorouracil/oxaliplatin-based chemotherapy (RCT), while 38 had RT alone. Pathological complete remission (pCR) and microfoci residual tumour (micR) occurred more frequently in patients treated with RCT (P=0.002) and in N0 tumours (P=0.004). Among patients treated with RCT, high TS levels were associated with a higher response rate (pCR+micR; P=0.015). No such correlation was found in the RT group. The other molecular factors were of no predictive value. Multivariate analysis confirmed a significant interaction between nodal status and the probability of achieving a pathological response (P=0.023) and between TS expression and treatment, indicating that a high TS level is predictive of a higher pathological response in the RCT subset (P=0.007). This study shows that lymph node status is the most important predictive factor of tumour response to preoperative treatment. Thymidylate synthase expression assessed immunohistochemically from pretreatment tumour biopsies may be a useful predictive marker of rectal tumour response to preoperative RCT.

  11. Biological predictive factors in rectal cancer treated with preoperative radiotherapy or radiochemotherapy

    Science.gov (United States)

    Negri, F V; Campanini, N; Camisa, R; Pucci, F; Bui, S; Ceccon, G; Martinelli, R; Fumagalli, M; Losardo, P L; Crafa, P; Bordi, C; Cascinu, S; Ardizzoni, A

    2007-01-01

    We analysed the expression of microsatellite instability, p53, p21, vascular endothelial growth factor and thymidylate synthase (TS) in pretreatment biopsy specimens from 57 locally advanced rectal cancers. The aim of the study was to correlate the expression of these markers with pathological response. Nineteen patients were treated with preoperative concomitant radiotherapy (RT) and fluorouracil/oxaliplatin-based chemotherapy (RCT), while 38 had RT alone. Pathological complete remission (pCR) and microfoci residual tumour (micR) occurred more frequently in patients treated with RCT (P=0.002) and in N0 tumours (P=0.004). Among patients treated with RCT, high TS levels were associated with a higher response rate (pCR+micR; P=0.015). No such correlation was found in the RT group. The other molecular factors were of no predictive value. Multivariate analysis confirmed a significant interaction between nodal status and the probability of achieving a pathological response (P=0.023) and between TS expression and treatment, indicating that a high TS level is predictive of a higher pathological response in the RCT subset (P=0.007). This study shows that lymph node status is the most important predictive factor of tumour response to preoperative treatment. Thymidylate synthase expression assessed immunohistochemically from pretreatment tumour biopsies may be a useful predictive marker of rectal tumour response to preoperative RCT. PMID:18087284

  12. Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy: A case report and literature review

    Science.gov (United States)

    Takase, Nobuhisa; Yamashita, Kimihiro; Sumi, Yasuo; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Matsuda, Yoshiko; Matsuda, Takeru; Oshikiri, Taro; Nakamura, Tetsu; Suzuki, Satoshi; Koma, Yu-Ichiro; Komatsu, Masato; Sasaki, Ryohei; Kakeji, Yoshihiro

    2017-01-01

    Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT. PMID:28138443

  13. Radiation Dose-Response Model for Locally Advanced Rectal Cancer After Preoperative Chemoradiation Therapy

    DEFF Research Database (Denmark)

    Appelt, A. L.; Ploen, J.; Vogelius, I. R.

    2013-01-01

    of external-beam radiation therapy and brachytherapy. Response at the time of operation was evaluated from the histopathologic specimen and graded on a 5-point scale (TRG1-5). The probability of achieving complete, major, and partial response was analyzed by ordinal logistic regression, and the effect......Purpose: Preoperative chemoradiation therapy (CRT) is part of the standard treatment of locally advanced rectal cancers. Tumor regression at the time of operation is desirable, but not much is known about the relationship between radiation dose and tumor regression. In the present study we...... estimated radiation dose-response curves for various grades of tumor regression after preoperative CRT. Methods and Materials: A total of 222 patients, treated with consistent chemotherapy and radiation therapy techniques, were considered for the analysis. Radiation therapy consisted of a combination...

  14. Response to treatment and interval to surgery after preoperative short-course radiotherapy in rectal cancer.

    Science.gov (United States)

    García-Cabezas, Sonia; Rodríguez-Liñán, Milagrosa; Otero-Romero, Ana M; Bueno-Serrano, Carmen M; Gómez-Barbadillo, José; Palacios-Eito, Amalia

    2016-10-01

    Preoperative short-course radiotherapy with immediate surgery improves local control in patients with rectal cancer. Tumor responses are smaller than those described with radiochemotherapy. Preliminary data associate this lower response to the short period until surgery. The aim of this study is to analyze the response to preoperative short-course radiotherapy and its correlation with the interval to surgery especially analyzing patients with mesorectal fascia involvement. A total of 155 patients with locally advanced rectal cancer treated with preoperative radiotherapy (5×5Gy) were retrospectively analyzed. Tumor response in terms of rates of complete pathological response, downstaging, tumor regression grading and status of the circumferential resection margin were quantified. The mean interval from radiotherapy to surgery was 23 days. The rate of complete pathological response was 2.2% and 28% experienced downstaging (stage decreased). No differences between these rates and interval to surgery were detected. Eighty-eight patients had magnetic resonance imaging for staging (in 31 patients the mesorectal fascia was involved).The mean time to surgery in patients with involvement of the fascia and R0 surgery was 27 days and 16 days if R1 (P=.016). The cutoff of 20 days reached the highest probability of achieving a free circumferential resection margin between patients with mesorectal fascia involvement, with no statistically significant differences: RR 3.036 95% CI=(0.691-13.328), P=.06. After preoperative short-course radiotherapy, an interval>20 days enhances the likelihood of achieving a free circumferential resection margin in patients with mesorectal fascia involvement. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Phase II Study of Preoperative Helical Tomotherapy With a Simultaneous Integrated Boost for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Engels, Benedikt; Tournel, Koen [Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium); Everaert, Hendrik [Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium); Hoorens, Anne [Department of Pathology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium); Sermeus, Alexandra [Department of Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium); Christian, Nicolas; Storme, Guy; Verellen, Dirk [Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium); De Ridder, Mark, E-mail: mark.deridder@uzbrussel.be [Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels (Belgium)

    2012-05-01

    Purpose: The addition of concomitant chemotherapy to preoperative radiotherapy is considered the standard of care for patients with cT3-4 rectal cancer. The combined treatment modality increases the complete response rate and local control (LC), but has no impact on survival or the incidence of distant metastases. In addition, it is associated with considerable toxicity. As an alternative strategy, we explored prospectively, preoperative helical tomotherapy with a simultaneous integrated boost (SIB). Methods and Materials: A total of 108 patients were treated with intensity-modulated and image-guided radiotherapy using the Tomotherapy Hi-Art II system. A dose of 46 Gy, in daily fractions of 2 Gy, was delivered to the mesorectum and draining lymph nodes, without concomitant chemotherapy. Patients with an anticipated circumferential resection margin (CRM) of less than 2 mm, based on magnetic resonance imaging, received a SIB to the tumor up to a total dose of 55.2 Gy. Acute and late side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: A total of 102 patients presented with cT3-4 tumors; 57 patients entered the boost group and 51 the no-boost group. One patient in the no-boost group developed a radio-hypersensitivity reaction, resulting in a complete tumor remission, a Grade 3 acute and Grade 5 late enteritis. No other Grade {>=}3 acute toxicities occurred. With a median follow-up of 32 months, Grade {>=}3 late gastrointestinal and urinary toxicity were observed in 6% and 4% of the patients, respectively. The actuarial 2-year LC, progression-free survival and overall survival were 98%, 79%, and 93%. Conclusions: Preoperative helical tomotherapy displays a favorable acute toxicity profile in patients with cT3-4 rectal cancer. A SIB can be safely administered in patients with a narrow CRM and resulted in a promising LC.

  16. Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision After Preoperative Chemoradiation.

    Science.gov (United States)

    Han, Yoon Dae; Kim, Woo Ram; Park, Seung Wan; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu

    2015-11-01

    Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR.This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10 cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4 Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors.Among the 332 patients, 27.4% (n = 91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61 ± 7.38 ng/mL in the pCR group and 10.49 ± 23.83 ng/mL in the non-pCR group (P = 0.035). Post-CRT CEA levels were 1.4 ± 1.07 ng/mL in the pCR group and 2.16 ± 2.8 ng/mL in the non-pCR group (P = 0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P = 0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P = 0.003) and low post-CRT CEA level (odds ratio 0.789; P = 0.04) were independent predictive factors for pCR.Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may

  17. Efficacy of High Resolution Magnetic Resonance Imaging in Preoperative Local Staging of Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Aysun Uçar

    2013-08-01

    Full Text Available Objective: To assess the efficacy of high-resolution magnetic resonance imaging (HRMRI for preoperative local staging in patients with rectal cancer who did not receive preoperative radiochemotherapy. Methods: In this retrospective study, 30 patients with biopsy proved primary rectal cancer were evaluated by HRMRI. Two observers independently scored the tumour and lymph node stages, and circumferential resection margin (CRM involvement. The sensitivity, specificity, the negative predictive value and the positive predictive value of HRMRI findings were calculated within the 95% confidence interval. The area under the curve was measured for each result. Agreement between two observers was assessed by means of the Kappa test. Results: In T staging the accuracy rate of HRMRI was 47-67%, overstaging was 10-21%, and understaging was 13-43%. In the prediction of extramural invasion with HRMRI, the sensitivity was 79-89%, the specificity was 72-100%, the PPV was 85-100%, the NPV was 73-86%, and the area under the curve was 0.81-0.89. In the prediction of lymph node metastasis, the sensitivity was 58-58%, the specificity was 50-55%, the PPV was 43-46%, and the NPV was 64-66%. The area under the curve was 0.54-0.57. When the cut off value was selected as 1 mm, the sensitivity of HRMRI was 38-42%, the specificity was 73-82%, the PPV was 33-42%, and NPV was 79-81% in the prediction of the CRM involvement. The correlation between the two observers was moderate for tumour staging, substantial for lymph node staging and predicting of CRM involvement. Conclusion: Preoperative HRMRI provides good predictive data for extramural invasion but poor prediction of lymph node status and CRM involvement.

  18. Preoperative chemoradiation for locally advanced rectal cancer: comparison of three radiation dose and fractionation schedules

    Energy Technology Data Exchange (ETDEWEB)

    Park, Shin Hyung; Kim, Jae Chul [Dept. of Radiation Oncology, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    The standard radiation dose for patients with locally rectal cancer treated with preoperative chemoradiotherapy is 45–50 Gy in 25–28 fractions. We aimed to assess whether a difference exists within this dose fractionation range. A retrospective analysis was performed to compare three dose fractionation schedules. Patients received 50 Gy in 25 fractions (group A), 50.4 Gy in 28 fractions (group B), or 45 Gy in 25 fractions (group C) to the whole pelvis, as well as concurrent 5-fluorouracil. Radical resection was scheduled for 8 weeks after concurrent chemoradiotherapy. Between September 2010 and August 2013, 175 patients were treated with preoperative chemoradiotherapy at our institution. Among those patients, 154 were eligible for analysis (55, 50, and 49 patients in groups A, B, and C, respectively). After the median follow-up period of 29 months (range, 5 to 48 months), no differences were found between the 3 groups regarding pathologic complete remission rate, tumor regression grade, treatment-related toxicity, 2-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, or overall survival. The circumferential resection margin width was a prognostic factor for 2-year locoregional recurrence-free survival, whereas ypN category was associated with distant metastasis-free survival, disease-free survival, and overall survival. High tumor regression grading score was correlated with 2-year distant metastasis-free survival and disease-free survival in univariate analysis. Three different radiation dose fractionation schedules, within the dose range recommended by the National Comprehensive Cancer Network, had no impact on pathologic tumor regression and early clinical outcome for locally advanced rectal cancer.

  19. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eng, Cathy [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Maru, Dipen M. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Clemons, Marilyn V. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  20. Preoperative treatment with capecitabine, cetuximab and radiotherapy for primary locally advanced rectal cancer : A phase II clinical trial

    NARCIS (Netherlands)

    Eisterer, Wolfgang; de Vries, Alexander; Öfner, Dietmar; Rabl, Hans; Koplmüller, Renate; Greil, Richard; Tschmelitsch, Jöerg; Schmid, Rainer; Kapp, Karin; Lukas, Peter; Sedlmayer, Felix; Höfler, Gerald; Gnant, Michael; Thaler, Josef; Widder, Joachim

    2014-01-01

    BACKGROUND/AIM: To investigate the feasibility and safety of preoperative capecitabine, cetuximab and radiation in patients with MRI-defined locally advanced rectal cancer (LARC, cT3/T4). PATIENTS AND METHODS: 31 patients with LARC were treated with cetuximab and capecitabine concomitantly with 45

  1. Preoperative treatment with capecitabine, cetuximab and radiotherapy for primary locally advanced rectal cancer : A phase II clinical trial

    NARCIS (Netherlands)

    Eisterer, Wolfgang; de Vries, Alexander; Öfner, Dietmar; Rabl, Hans; Koplmüller, Renate; Greil, Richard; Tschmelitsch, Jöerg; Schmid, Rainer; Kapp, Karin; Lukas, Peter; Sedlmayer, Felix; Höfler, Gerald; Gnant, Michael; Thaler, Josef; Widder, Joachim

    2014-01-01

    BACKGROUND/AIM: To investigate the feasibility and safety of preoperative capecitabine, cetuximab and radiation in patients with MRI-defined locally advanced rectal cancer (LARC, cT3/T4). PATIENTS AND METHODS: 31 patients with LARC were treated with cetuximab and capecitabine concomitantly with 45 G

  2. Acute toxicity and surgical complications after preoperative (chemo)radiation therapy for rectal cancer in patients with inflammatory bowel disease

    NARCIS (Netherlands)

    Bosch, S.L.; Rooijen, S.J. van; Bökkerink, G.M.J.; Braam, H.J.; Derikx, L.A.A.P.; Poortmans, P.M.P.; Marijnen, C.A.; Nagtegaal, I.D.; Wilt, J.H.W. de

    2017-01-01

    PURPOSE: Preoperative therapy reduces local recurrences and may facilitate surgery in rectal cancer patients. However, in patients with inflammatory bowel disease (IBD) this treatment is often withheld due to the perceived risk of excessive side-effects, even though evidence is limited. The purpose

  3. Quality assurance in preoperative radiotherapy of rectal cancer : evaluation of a pre-trial dummy-run

    NARCIS (Netherlands)

    Widder, J; Sedlmayer, F; Stanek, C; Potter, R

    2000-01-01

    Purpose: To assess inter-institution variability of treated volumes in preoperative radiotherapy for rectal cancer among Austrian radiotherapy institutions in the framework of a multi-centre phase-In clinical trial. Materials and,methods: All eleven Austrian radiotherapy departments were invited to

  4. Treatment of resectable distal rectal cancer with preoperative chemoradiation and sphincter saving surgery

    Directory of Open Access Journals (Sweden)

    Omrani Pour R

    2000-06-01

    Full Text Available To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66% and good in 3 patients (33%. There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10% and one case of partial rupture of anastomosis (10%. Complete pathologic response was achieved on one patient (6.6% and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.

  5. Significance of endoscopic biopsy after preoperative irradiation therapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Takiguchi, Nobuhiro; Sarashina, Hiromi; Saito, Norio; Nunomura, Masao; Kohda, Keishi; Nakajima, Nobuyuki (Chiba Univ. (Japan). School of Medicine)

    1994-05-01

    To evaluate the utility of endoscopic biopsy before and after preoperative irradiation therapy for rectal cancer, we examined histologically both biopsy specimens and resected materials of forty-three patients. Two pieces of biopsy materials were taken both before and after irradiation therapy (total dose 42.6 Gy) from the marginal wall of the tumor, cavity and transitional mucosa, respectively. In biopsy specimens, according to the degree of degeneration of cancer cells, cases with remarkable changes of nucleus, nucleolus, and cytoplasm due to irradiation were classified into the severely degenerated group. According to the histological examinations of resected materials, twenty-four cases were under Grade 1b (Gr I), and nineteen cases were over Grade 2 (Gr II). The rates of cancer cells found in biopsy materials after irradiation were 91.7% in Gr I and were 47.4% in Gr II, respectively (p<0.01). Among the cases, 54.5% in Gr I and 100% in Gr II belonged to the severely degenerated group (p<0.05). Transitional mucosas were not greatly damaged by irradiation. As a result, the greater the irradiation effect was, the fewer cancer cells were found and the more degenerated cancer cells were found in biopsy specimens. But the rate of severely degenerated cells found in the biopsy specimens of little effect cases was high. So it was thought to be too difficult to predict the histological radiation effect of resected specimens from only biopsy specimens. (author).

  6. Clinical and histopathological effect of combined preoperative radiation and intratumoral injections in rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sarashina, H.; Todoroki, T.; Orii, K.; Otsu, H.; Iwasaki, Y.

    1987-05-01

    Twenty-one surgical patients with carcinoma of the rectum (Group 3) were treated with preoperative radiotherapy and intratumoral injections of Pepleomycin and BUdR (5-bromo-2'-deoxyuridine). On the other hand, 25 patients (Group 1) were treated by surgery alone and 7 patients (Group 2) were treated with preoperative radiotherapy alone. The difference in the background factors of the patients for three groups was not significant. The total dose of preoperative radiation was 42.6 Gy., e.i., 30.6 Gy. (1.8 Gy./fr. x 5/wk) delivered to the entire pelvis plus an additional 12 Gy. (3.0 Gy./fr. x 4/wk) to the primary tumor. The reduction rates in tumor regression on roentgenogram for Groups 2 and 3 were 30.5 % and 46.5 %, respectively. The extent of cancer cell invasion in rectal wall of the surgical specimens was examined histopathologically. In the preoperative radiation group, especially in Group 3, it was indicated that the stage of the lesion had been reduced. The rates of patients with an ew of less than 2 mm were 64.0 % in Group 1, 28.6 % in Group 2 and 14.3 % in Group 3 (Group 1 - 3 : p = 0.02). The incidence of positive lymph nodes was higher in Group 1 than in Groups 2 and 3. In a histopathological investigation of the patients in Group 3, the degenerative changes were heavier than in Group 2. Scattered mucocele transformation from the submucosal layer through to the adventitial tissue was noted in Group 3. This study suggests that the clinical and pathological effect of this combination therapy is able to increase the local control and survival rate.

  7. Tumor Volume Reduction Rate After Preoperative Chemoradiotherapy as a Prognostic Factor in Locally Advanced Rectal Cancer

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    Yeo, Seung-Gu [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of); Kim, Dae Yong, E-mail: radiopiakim@hanmail.net [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Park, Ji Won; Oh, Jae Hwan; Kim, Sun Young; Chang, Hee Jin; Kim, Tae Hyun; Kim, Byung Chang; Sohn, Dae Kyung; Kim, Min Ju [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2012-02-01

    Purpose: To investigate the prognostic significance of tumor volume reduction rate (TVRR) after preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods and Materials: In total, 430 primary LARC (cT3-4) patients who were treated with preoperative CRT and curative radical surgery between May 2002 and March 2008 were analyzed retrospectively. Pre- and post-CRT tumor volumes were measured using three-dimensional region-of-interest MR volumetry. Tumor volume reduction rate was determined using the equation TVRR (%) = (pre-CRT tumor volume - post-CRT tumor volume) Multiplication-Sign 100/pre-CRT tumor volume. The median follow-up period was 64 months (range, 27-99 months) for survivors. Endpoints were disease-free survival (DFS) and overall survival (OS). Results: The median TVRR was 70.2% (mean, 64.7% {+-} 22.6%; range, 0-100%). Downstaging (ypT0-2N0M0) occurred in 183 patients (42.6%). The 5-year DFS and OS rates were 77.7% and 86.3%, respectively. In the analysis that included pre-CRT and post-CRT tumor volumes and TVRR as continuous variables, only TVRR was an independent prognostic factor. Tumor volume reduction rate was categorized according to a cutoff value of 45% and included with clinicopathologic factors in the multivariate analysis; ypN status, circumferential resection margin, and TVRR were significant prognostic factors for both DFS and OS. Conclusions: Tumor volume reduction rate was a significant prognostic factor in LARC patients receiving preoperative CRT. Tumor volume reduction rate data may be useful for tailoring surgery and postoperative adjuvant therapy after preoperative CRT.

  8. Optimal time intervals between preoperative radiotherapy or chemoradiotherapy and surgery in rectal cancer?

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    Bengt eGlimelius

    2014-04-01

    Full Text Available Background In rectal cancer therapy, radiotherapy or chemoradiotherapy (RT/CRT is extensively used preoperatively to (i decrease local recurrence risks, (ii allow radical surgery in non-resectable tumours and (iii increase the chances of sphincter-saving surgery or (iv organ preservation. There is a growing interest among clinicians and scientists to prolong the interval from the RT/CRT to surgery to achieve maximal tumour regression and to diminish complications during surgery.Methods The pros and cons of delaying surgery depending upon the aim of the preoperative RT/CRT are critically evaluated. Results Depending upon the clinical situation, the need for a time interval prior to surgery to allow tumour regression varies. In the first and most common situation (i, no regression is needed and any delay beyond what is needed for the acute radiation reaction in surrounding tissues to wash out can potentially only be deleterious. After short-course RT (5Gyx5 with immediate surgery, the ideal time between the last radiation fraction is 2-5 days since a slightly longer interval appears to increase surgical complications. A delay beyond 4 weeks appears safe; it results in tumour regression including pathologic complete responses, but is not yet fully evaluated concerning oncologic outcome. Surgical complications do not appear to be influenced by the CRT-surgery interval within reasonable limits (about 4-12 weeks, but this has not been sufficiently explored. Maximum tumour regression may not be seen in rectal adenocarcinomas until after several months; thus, a longer than usual delay may be of benefit in well responding tumours if limited or no surgery is planned, as in (iii or (iv, otherwise not.Conclusions A longer time interval is undoubtedly of benefit in some clinical situations but may be counterproductive in most situations.

  9. Clinical significance of thrombocytosis before preoperative chemoradiotherapy in rectal cancer: predicting pathologic tumor response and oncologic outcome.

    Science.gov (United States)

    Kim, Hye Jin; Choi, Gyu-Seog; Park, Jun Seok; Park, SooYeun; Kawai, Kazushige; Watanabe, Toshiaki

    2015-02-01

    Thrombocytosis is considered an adverse prognostic factor in various malignancies. However, the clinical significance of thrombocytosis in rectal cancer patients is unknown. We investigated the predictive value of thrombocytosis for pathologic tumor response to preoperative chemoradiotherapy (CRT) and oncologic outcomes in patients with rectal cancer. A total of 314 patients who underwent preoperative CRT and subsequent rectal resection for rectal cancer were retrospectively evaluated at two tertiary institutions. Univariate and multivariate analyses of the clinical parameters were performed to identify markers predictive of a pathologic complete response (pCR). The Kaplan-Meier method was used to estimate 3-year disease-free and overall survival rates. Sixty-nine patients (22 %) had thrombocytosis before CRT, which significantly correlated with a large tumor size and advanced tumor depth. Thirty-nine patients (12.4 %) achieved a pCR. In the multivariate analyses, a platelet count of thrombocytosis had lower 3-year disease-free (P = 0.037) and overall survival (P = 0.001) rates than patients with normal pretreatment platelet counts. Thrombocytosis is a negative predictive factor for a pCR and has an adverse impact on survival in rectal cancer. The predictive value of this easily available clinical factor should not be underestimated, and better therapeutic strategies for these tumors are required.

  10. Long-term results and complications of preoperative radiation in the treatment of rectal cancer

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    Reed, W.P.; Garb, J.L.; Park, W.C.; Stark, A.J.; Chabot, J.R.; Friedmann, P.

    1988-02-01

    A retrospective study of 149 patients with rectal cancer diagnosed between 1972 and 1979 was undertaken to compare survival, disease-free survival, recurrence sites, and long-term complications of 40 patients who received 4000 to 4500 rads of preoperative adjuvant radiotherapy (radiation group) with those of 109 patients treated by resection alone (control group). After a mean follow-up of 84 months and 99 months, respectively, survival of the irradiated patients was significantly better than that of controls (68% versus 52%, p less than 0.05). Disease-free survival of those patients rendered free of disease by treatment was also superior for the irradiated group (84% versus 57%, p less than 0.005). Local recurrence without signs of distant metastases developed only one-third as often in irradiated patients (6% versus 18%). Distant metastases, alone or in combination with local recurrence, were also less common after radiation (12% versus 27%). Second primary tumors developed in 15% and 10% of the respective groups, a difference that was not statistically significant. When we consider the survival benefit of preoperative radiation therapy, long-term complications were relatively mild. Delayed healing of the perineum was noted in two irradiated patients. Persistent diarrhea was severe enough to warrant treatment in only one case, and one patient required a colostomy for intestinal obstruction from pelvic fibrosis.

  11. Preoperative chemoradiation of locally advanced T3 rectal cancer combined with an endorectal boost

    DEFF Research Database (Denmark)

    Jakobsen, Anders; Mortensen, John P; Bisgaard, Claus

    2006-01-01

    PURPOSE: To investigate the effect and feasibility of concurrent radiation and chemotherapy combined with endorectal brachytherapy in T3 rectal cancer with complete pathologic remission as end point. METHODS AND MATERIALS: The study included 50 patients with rectal adenocarcinoma. All patients had...

  12. Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland.

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    Fundowicz, Magdalena; Macia, Miguel; Marin, Susanna; Bogusz-Czerniewicz, Marta; Konstanty, Ewelina; Modolel, Ignaci; Malicki, Julian; Guedea, Ferran

    2014-06-01

    We performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences. A total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radio-chemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment. Several differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines. An independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies.

  13. Helical Tomotherapy Combined with Capecitabine in the Preoperative Treatment of Locally Advanced Rectal Cancer

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    Ming-Yii Huang

    2014-01-01

    Full Text Available The aim of this study was to evaluate the efficacy of helical tomotherapy plus capecitabine as a preoperative chemoradiotherapy (CRT in patients with locally advanced rectal cancer (LARC. Thirty-six LARC patients receiving preoperative CRT were analyzed. Radiotherapy (RT consisted of 45 Gy to the regional lymph nodes and simultaneous-integrated boost (SIB 50.4 Gy to the tumor, 5 days/week for 5 weeks. Chemotherapy consisted of capecitabine 850 mg/m2, twice daily, during the RT days. Patients underwent surgery 6–8 weeks after completion of CRT. Information was collected for patient characteristics, treatment response, and acute and late toxicities. Grade 3/4 (G3+ toxicities occurred in 11.1% of patients (4/36. Sphincter preservation rate was 85.2% (23/27. Five patients (14.3% achieved pathological complete response. Tumor, nodal, and ypT0-2N0 downstaging were noted in 60% (21/35, 69.6% (16/23, and 57.1% (20/35. Tumor regression grade 2~4 was achieved in 28 patients (80%. After a median follow-up time of 35 months, the most common G3+ late morbidity was ileus and fistula (5.7%, 2/35. The study showed that capecitabine plus helical tomotherapy with an SIB is feasible in treatment of LARC. The treatment modality can achieve a very encouraging sphincter preservation rate and a favorable ypT0-2N0 downstaging rate without excessive toxicity.

  14. Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

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    Michael P. Achiam

    2016-01-01

    Full Text Available Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT.Methods. Consecutive patients diagnosed with rectal cancers were asked to participate in the study. Preoperative CT and diffusion weighted MR (DWMR were compared to contrast enhanced laparoscopic ultrasound (CELUS.Results. A total of 35 patients were included, 15 patients in Group-1 having the standard CT evaluation of the liver and 20 patients in Group-2 having the standard CT evaluation of the liver and DWMR of the liver. Compared with CELUS, the per-patient sensitivity/specificity was 50/100% for CT, and for DWMR: 100/94% and 100/100% for Reader 1 and 2, respectively. The per-lesion sensitivity of CT and DWMR were 17% and 89%, respectively compared with CELUS. Furthermore, one patient had non-resectable metastases after DWMR despite being diagnosed with resectable metastases after CT. Another patient was diagnosed with multiple liver metastases during CELUS, despite a negative CT-scan.Discussion. DWMR is feasible for preoperative evaluation of liver metastases. The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time.

  15. Accuracy of single phase contrast enhanced multidetector CT colonography in the preoperative staging of colo-rectal cancer

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    Mainenti, Pier Paolo [IBB CNR, Via Pansini 5, 80131 Naples (Italy) and Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy)]. E-mail: pierpamainenti@hotmail.com; Cirillo, Luigi Carlo [Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Hospital ' dei Pellegrini' , ASLNA 1, Via Portamedina 41, 80100 Naples (Italy); Camera, Luigi [Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Persico, Francesco [Department of General Surgery, Geriatry and Endoscopy, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Cantalupo, Teresa [Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Pace, Leonardo [Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Palma, Giovanni Domenico De [Department of General Surgery, Geriatry and Endoscopy, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Persico, Giovanni [Department of General Surgery, Geriatry and Endoscopy, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy); Salvatore, Marco [Department of Biomorphological and Functional Sciences, University of Naples ' Federico II' , Via Pansini 5, 80131 Naples (Italy)

    2006-12-15

    Aim: The optimal acquisition time for staging colo-rectal carcinoma with a contrast enhanced multidetector CT colonography (CE CTC) has not yet been established. A dual phase with both arterial and portal venous acquisition has been proposed. The purpose of our study is to assess the value of single portal venous phase CE CTC in the preoperative staging of colo-rectal carcinoma. Materials and methods: Fifty two (30 M, 22 F; aged 35-82 years) consecutive patients with a histologically proven diagnosis of colo-rectal adenocarcinoma or a highly suspected colo-rectal cancer on conventional colonoscopy underwent a four-slice CE CTC. The procedure was performed 70 s (portal phase) after the intravenous bolus (3 ml/s) administration of 120 ml iodinated non-ionic contrast agent (370 mg iodine/ml). Scans were performed using the following parameters: 2.5 mm beam collimation, pitch 1.25, 120 kV, 200 mAs, rotation time 0.75 s. Images were reconstructed with an effective thickness of 3.2 mm at intervals of 1.6 mm. Two radiologists independently evaluated the depth of tumour invasion into the colo-rectal wall (T), regional lymph node involvement (N), and extracolonic metastases (M). Disagreement was resolved by means of a consensus decision. The pathological results served as the standard of reference. Assessment was made of sensitivity, specificity and accuracy, as well as positive and negative predictive values were assessed. Results: CE CTC correctly staged the pT of 52/56 (93%) and the N of 40/56 (71%) lesions, as well as properly identifying 13/14 (93%) extracolonic findings. Conclusion: The single portal venous phase CE CTC scanning protocol enables satisfactory preoperative assessment of T, N and M staging in patients with colo-rectal cancer.

  16. Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II)

    NARCIS (Netherlands)

    Widder, J; Herbst, F; Dobrowsky, W; Schmid, R; Pokrajac, B; Jech, B; Chiari, C; Stift, A; Maier, A; Karner-Hanusch, J; Teleky, B; Wrba, F; Jakesz, R; Poetter, R

    2005-01-01

    To evaluate the feasibility, effectiveness, and long-term bowel function of preoperative hyperfractionated accelerated radiotherapy in primary resectable rectal cancer. A total of 184 consecutive patients ( median age 65 years, male : female = 2 : 1) with clinical T3Nx rectal adenocarcinoma received

  17. PINCH is an independent prognostic factor in rectal cancer patients without preoperative radiotherapy--a study in a Swedish rectal cancer trial of preoperative radiotherapy.

    Science.gov (United States)

    Holmqvist, Annica; Gao, Jingfang; Holmlund, Birgitta; Adell, Gunnar; Carstensen, John; Langford, Dianne; Sun, Xiao-Feng

    2012-02-10

    The clinical significance between particularly interesting new cysteine-histidine rich protein (PINCH) expression and radiotherapy (RT) in tumours is not known. In this study, the expression of PINCH and its relationship to RT, clinical, pathological and biological factors were studied in rectal cancer patients. PINCH expression determined by immunohistochemistry was analysed at the invasive margin and inner tumour area in 137 primary rectal adenocarcinomas (72 cases without RT and 65 cases with RT). PINCH expression in colon fibroblast cell line (CCD-18 Co) was determined by western blot. In patients without RT, strong PINCH expression at the invasive margin of primary tumours was related to worse survival, compared to patients with weak expression, independent of TNM stage and differentiation (P = 0.03). No survival relationship in patients with RT was observed (P = 0.64). Comparing the non-RT with RT subgroup, there was no difference in PINCH expression in primary tumours (invasive margin (P = 0.68)/inner tumour area (P = 0.49). In patients with RT, strong PINCH expression was related to a higher grade of LVD (lymphatic vessel density) (P = 0.01) PINCH expression at the invasive margin was an independent prognostic factor in patients without RT. RT does not seem to directly affect the PINCH expression.

  18. PINCH is an independent prognostic factor in rectal cancer patients without preoperative radiotherapy - a study in a Swedish rectal cancer trial of preoperative radiotherapy

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    Holmqvist Annica

    2012-02-01

    Full Text Available Abstract Background The clinical significance between particularly interesting new cysteine-histidine rich protein (PINCH expression and radiotherapy (RT in tumours is not known. In this study, the expression of PINCH and its relationship to RT, clinical, pathological and biological factors were studied in rectal cancer patients. Methods PINCH expression determined by immunohistochemistry was analysed at the invasive margin and inner tumour area in 137 primary rectal adenocarcinomas (72 cases without RT and 65 cases with RT. PINCH expression in colon fibroblast cell line (CCD-18 Co was determined by western blot. Results In patients without RT, strong PINCH expression at the invasive margin of primary tumours was related to worse survival, compared to patients with weak expression, independent of TNM stage and differentiation (P = 0.03. No survival relationship in patients with RT was observed (P = 0.64. Comparing the non-RT with RT subgroup, there was no difference in PINCH expression in primary tumours (invasive margin (P = 0.68/inner tumour area (P = 0.49. In patients with RT, strong PINCH expression was related to a higher grade of LVD (lymphatic vessel density (P = 0.01 Conclusions PINCH expression at the invasive margin was an independent prognostic factor in patients without RT. RT does not seem to directly affect the PINCH expression.

  19. The correlation between aldehyde dehydrogenase-1A1 level and tumor shrinkage after preoperative chemoradiation in locally advanced rectal cancer

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    Rhandyka Rafli

    2015-12-01

    Full Text Available This study was performed to determine the correlation between aldehyde dehydrogenase-1A1 (ALDH1A1 level and tumor shrinkage after chemoradiation in locally advanced rectal cancer. This is a retrospective study of 14 locally advanced rectal cancer patients with long course neoadjuvant chemoradiation. ALDH1A1 level was measured using ELISA from paraffin embedded tissue. Tumor shrinkage was measured from computed tomography (CT scan or magnetic resonance imaging (MRI based on Response Evaluation Criteria in Solid Tumor v1.1 (RECIST v1.1. The mean of ALDH1A1 level was 9.014 ± 3.3 pg/mL and the mean of tumor shrinkage was 7.89 ± 35.7%. Partial response proportion was 28.6%, stable disease proportion was 50% and progressive disease proportion was 21.4%. There was a significant strong negative correlation (r = –0.890, plt; 0.001 between ALDH1A1 and tumor shrinkage. In conclusion, tumor shrinkage in locally advanced rectal cancer after preoperative chemoradiation was influenced by ALDH1A1 level. Higher level of ALDH1A1 suggests decreased tumor shrinkage after preoperative chemoradiation.

  20. Results of Preoperative Concurrent Chemoradiotherapy for the Treatment of Rectal Cancer

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    Yoon, Mee Sun; Nam, Taek Keun; Kim, Hyeong Rok; Nah, Byung Sik; Chung, Woong Ki; Kim, Young Jin; Ahn, Sung Ja; Song, Ju Young; Jeong, Jae Uk [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2008-12-15

    The purpose of this study is to evaluate anal sphincter preservation rates, survival rates, and prognostic factors in patients with rectal cancer treated with preoperative chemoradiotherapy. Materials and Methods: One hundred fifty patients with pathologic confirmed rectal cancer and treated by preoperative chemoradiotherapy between January 1999 and June 2007. Of the 150 patients, the 82 who completed the scheduled chemoradiotherapy, received definitive surgery at our hospital, and did not have distant metastasis upon initial diagnosis were enrolled in this study. The radiation dose delivered to the whole pelvis ranged from 41.4 to 46.0 Gy (median 44.0 Gy) using daily fractions of 1.8-2.0 Gy at 5 days per week and a boost dose to the primary tumor and high risk area up to a total of 43.2-54 Gy (median 50.4 Gy). Sixty patients (80.5%) received 5-fluorouracil, leucovorin, and cisplatin, while 16 patients (19.5%) were administered 5-fluorouracil and leucovorin every 4 weeks concurrently during radiotherapy. Surgery was performed for 3 to 45 weeks (median 7 weeks) after completion of chemoradiotherapy. Results: The sphincter preservation rates for all patients were 73.2% (60/82). Of the 48 patients whose tumor was located at less than 5 cm away from the anal verge, 31 (64.6%) underwent sphincter-saving surgery. Moreover, of the 34 patients whose tumor was located at greater than or equal to 5 cm away from the anal verge, 29 (85.3%) were able to preserve their anal sphincter. A pathologic complete response was achieved in 14.6% (12/82) of all patients. The downstaging rates were 42.7% (35/82) for the T stage, 75.5% (37/49) for the N stage, and 67.1% (55/82) for the overall stages. The median follow-up period was 38 months (range 11 -107 months). The overall 5-year survival, disease-free survival, and locoregional control rates were 67.4%, 58.9% and 84.4%, respectively. The 5-year overall survival rates based on the pathologic stage were 100% for stage 0 (n=12), 59

  1. Phase II study of preoperative radiation plus concurrent daily tegafur-uracil (UFT with leucovorin for locally advanced rectal cancer

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    Calais Gilles

    2011-03-01

    Full Text Available Abstract Background Considerable variation in intravenous 5-fluorouracil (5-FU metabolism can occur due to the wide range of dihydropyrimidine dehydrogenase (DPD enzyme activity, which can affect both tolerability and efficacy. The oral fluoropyrimidine tegafur-uracil (UFT is an effective, well-tolerated and convenient alternative to intravenous 5-FU. We undertook this study in patients with locally advanced rectal cancer to evaluate the efficacy and tolerability of UFT with leucovorin (LV and preoperative radiotherapy and to evaluate the utility and limitations of multicenter staging using pre- and post-chemoradiotherapy ultrasound. We also performed a validated pretherapy assessment of DPD activity and assessed its potential influence on the tolerability of UFT treatment. Methods This phase II study assessed preoperative UFT with LV and radiotherapy in 85 patients with locally advanced T3 rectal cancer. Patients with potentially resectable tumors received UFT (300 mg/m/2/day, LV (75 mg/day, and pelvic radiotherapy (1.8 Gy/day, 45 Gy total 5 days/week for 5 weeks then surgery 4-6 weeks later. The primary endpoints included tumor downstaging and the pathologic complete response (pCR rate. Results Most adverse events were mild to moderate in nature. Preoperative grade 3/4 adverse events included diarrhea (n = 18, 21% and nausea/vomiting (n = 5, 6%. Two patients heterozygous for dihydropyrimidine dehydrogenase gene (DPYD experienced early grade 4 neutropenia (variant IVS14+1G > A and diarrhea (variant 2846A > T. Pretreatment ultrasound TNM staging was compared with postchemoradiotherapy pathology TN staging and a significant shift towards earlier TNM stages was observed (p Conclusion Preoperative chemoradiotherapy using UFT with LV plus radiotherapy was well tolerated and effective and represents a convenient alternative to 5-FU-based chemoradiotherapy for the treatment of resectable rectal cancer. Pretreatment detection of DPD deficiency should

  2. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

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    Becker Heinz

    2010-04-01

    Full Text Available Abstract Background Response to preoperative radiochemotherapy (RCT in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3, treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0 total mesorectal excision (TME in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS and overall survival (OS. Results Residual tumor transgression into the mesorectal compartment (ypT3 did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively. Nodal involvement after preoperative RCT (ypN1/2 turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively. Persistent tumor infiltration of the mesorectum (ypT3 and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0 resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters.

  3. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer.

    Science.gov (United States)

    Contin, Pietro; Kulu, Yakup; Bruckner, Thomas; Sturm, Martin; Welsch, Thilo; Müller-Stich, Beat P; Huber, Johannes; Büchler, Markus W; Ulrich, Alexis

    2014-02-01

    This study evaluates the anorectal and genitourinary function of patients treated by preoperative short-term radiotherapy (RT) or chemoradiotherapy (CRT) followed by surgery and surgery alone for rectal cancer. For this study, a total of 613 patients, who were identified from a prospective rectal cancer database, underwent anterior resection of the rectum between October 2001 and December 2007. Standardized questionnaires were used to determine fecal incontinence, urinary, and sexual function. Relevant clinical variables were evaluated using univariate and multivariate analyses. Independent predictors of functional outcome were identified by a binary logistic regression analysis. The data of 263 (43 %) patients were available for analysis. On multivariate analysis, neoadjuvant RT (P < 0.01) and low anterior resection (LAR) (P = 0.049) were associated with fecal incontinence. In univariate analysis, fecal incontinence was linked to preoperative neoadjuvant treatment (RT and/or CRT vs. LAR) (P < 0.01). The hazard ratio for developing fecal incontinence was 3.3 (1.6-6.8) for patients who received RT. One hundred twenty-five patients (51.2 %) experienced urinary incontinence following surgery, the majority of whom were female (P < 0.01). On univariate analysis, male sexual function was associated with age (P < 0.01), ASA class (P = 0.01) and LAR (P = 0.01). Multimodal therapy of low rectal cancer increases the incidence of fecal incontinence and negatively affects sexual function. The potential benefits of RT or CRT need to be balanced against the risk of increased bowel dysfunction when determining the appropriate treatment for individual patients with rectal cancer.

  4. Relationship of short-course preoperative radiotherapy and serum albumin level with postoperative complications in rectal cancer surgery

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    Trifunović Bratislav

    2015-01-01

    Full Text Available Background/Aim. The identification of risk factors could play a role in improving early postoperative outcome for rectal cancer surgery patients. The aim of this study was to determine the relationship between short-course preoperative radiotherapy (RT, serum albumin level and the development of postoperative complications in patients after anterior rectal resection due to rectal cancer without creation of diverting stoma. Methods. This retrospective study included patients with histopathologically confirmed adenocarcinoma of the rectum by and the clinical stage of T2-T4 operated on between 2007 and 2012. All the patients underwent open anterior rectal resection with no diverting stoma creation. Preoperative serum albumin was measured in each patient. Tumor location was noted intraoperatively as the distance from the inferior tumor margin to the anal verge. Tumor size was measured and noted by the pathologist who assessed specimens. Some of the patients received short-course preoperative RT, and some did not. The patients were divided into two groups (group 1 with short-course preoperative RT, group 2 with no short-course preoperative RT. Postoperative complications included clinically apparent anastomotic leakage, wound infection, diffuse peritonitis and pneumonia. They were compared between the groups, in relation to preoperative serum albumin level, patients age, tumor size and location. Results. The study included 107 patients (51 in the group 1 and 56 in the group 2. There were no significant difference in age (p = 0.95, and gender (p = 0.12 and tumor distance from anal verge (p = 0.53. The size of rectal carcinoma was significantly higher in the group 1 than in the group 2 (51.37 ± 12.04 mm vs 45.57 ± 9.81 mm, respectively; p = 0.007. The preoperative serum albumin level was significantly lower in the group 1 than in the group 2 (34.80 ± 2.85 g/L vs 37.55 ± 2.74 g/L, respectively; p < 0.001. A significant correlation between the tumor

  5. Correlation Between Preoperative Serum Carcinoembryonic Antigen Levels and Expression on Pancreatic and Rectal Cancer Tissue

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    LSF Boogerd

    2017-05-01

    Full Text Available Carcinoembryonic antigen (CEA–targeted imaging and therapeutic agents are being tested in clinical trials. If CEA overexpression in malignant tissue corresponds with elevated serum CEA, serum CEA could assist in selecting patients who may benefit from CEA-targeted agents. This study aims to assess the relationship between serum CEA and CEA expression in pancreatic (n = 20 and rectal cancer tissues (n = 35 using histopathology. According to local laboratory standards, a serum CEA >3 ng/mL was considered elevated. In pancreatic cancer patients a significant correlation between serum CEA and percentage of CEA-expressing tumor cells was observed ( P  = .04, ρ = .47. All 6 patients with homogeneous CEA expression in the tumor had a serum CEA >3 ng/mL. Most rectal cancer tissues (32/35 showed homogeneous CEA expression, independent of serum CEA levels. This study suggests that selection of pancreatic cancer patients for CEA-targeted agents via serum CEA appears adequate. For selection of rectal cancer patients, serum CEA levels are not informative.

  6. A national cohort study of long-course preoperative radiotherapy in primary fixed rectal cancer in Denmark

    DEFF Research Database (Denmark)

    Bulow, S.; Jensen, L.H.; Altaf, R.

    2010-01-01

    of radiotherapy concerning technique of radiotherapy, dose and fractionation and use of concomitant chemotherapy. Outcome was determined by actuarial analysis of local control, disease-free survival and overall survival. RESULTS: A total of 258 patients with fixed rectal cancer received long-course radiotherapy......-7%), and the actuarial distant recurrence rate was 41% (95% CI: 35-47%). The cumulative 5-year disease-free survival was 27% (95% CI: 22-32%) and overall 5-year survival was 34% (95% CI: 29-39%). CONCLUSIONS: This study is the first population-based report on outcome of preoperative long-course radiotherapy in a large...

  7. Expression of HER-2 in rectal cancers treated with preoperative radiotherapy: a potential biomarker predictive of metastasis.

    Science.gov (United States)

    Yao, Yun-Feng; Du, Chang-Zheng; Chen, Nan; Chen, Pengju; Gu, Jin

    2014-05-01

    Evidence suggests HER-2 overexpression may be predictive of prognosis in colorectal cancer patients, though this remains controversial. This study was performed to assess the prognostic value of HER-2 expression in locally advanced rectal cancer patients after preoperative radiotherapy. HER-2 expression was evaluated based on immunohistochemical (IHC) staining of resected specimens from 142 mid-to-low rectal cancer patients. Fluorescence in situ hybridization (FISH) was performed to confirm HER-2 overexpression in samples with an IHC score of 2+. Tumor regression grading (TRG) of the primary tumors was determined semiquantitatively using a tumor regression grading scheme advocated in the AJCC Cancer Staging Manual 7 edition. When the total staining intensity was evaluated, 106 samples (74.6%) showed barely-perceptible positivity (0-1+; HER-2--negative), 15 samples (10.6%) showed moderate positivity (2+) and 21 samples (14.8%) showed strong positivity (3+, HER-2 positive). FISH confirmed that 2 cases showing moderate HER-2 positivity (2+) overexpressed HER2. There was no significant difference between the HER-2 positive and -negative groups with respect to age, gender, TRG, TNM stage, downstaging status, lymphovascular invasion or tumor differentiation. A significant correlation was found between HER-2 overexpression and the incidence of distant metastasis (p = 0.005). Subgroup analysis revealed this correlation was not significant (p = 0.247) in the radiation-insensitive (TRG0-2) subgroup, whereas a significant correlation (p = 0.026) between HER-2 overexpression and distant metastasis was found in the radiation-resistant (TRG3) subgroup. Multivariate analysis identified ypN stage (OR = 0.473, p = 0.002)and overexpression of HER-2 (OR = 3.704, p = 0.008) as independent risk factors for distant metastasis. There was no correlation between HER-2 overexpression and disease-free survival or overall survival among the study population. We reported that HER-2

  8. Preoperative radiation with concurrent 5-fluorouracil for locally advanced T4-primary rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Roedel, C.; Grabenbauer, G.G.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Radiation Oncology; Schick, C.; Hohenberger, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Chirurgische Klinik mit Poliklinik; Papadopoulos, T. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Klinische Pathologie

    2000-04-01

    Herein we report on the curative resectability rate, acute toxicities, surgical complications, local control and 5-year survival rates achieved with a more aggressive multimodality regimen, including preoperative radiochemotherapy. Patients and Methods: Between 1/1990 and 12/1998, a total of 31 patients with cT4-rectal cancer were treated at our institution. All patients presented with tumor contiguous or adherent to adjacent pelvic organs. Eight patients had synchronous distant metastases. A total radiation dose of 50.4 Gy with a small-volume boost of 5.4 to 9 Gy was delivered (single dose: 1.8 Gy). 5-FU was scheduled as a continuous infusion of 1000 mg/m{sup 2} per 24 hours on days 1 to 5 and 29 to 33. Six weeks after completion of radiochemotherapy, patients were reassessed for resectability. Results: After preoperative radiochemotherapy, 29/31 patients (94%) underwent surgery with curative intent. Resection of the pelvic tumor with negative margins was achieved in 26/31 patients (84%), 3 patients had microscopic residual pelvic disease. In 3/8 patients with distant spread at presentation a complete resection of metastases was finally accomplished. Toxicity of radiochemotherapy occurred mainly as diarrhea (NCI-CTC Grade 3: 23%), dermatitis (Grade 3: 16%) and leucopenia (Grade 3: 10%). Surgical complications appeared as anastomotic leakage in 3, wound infection in 2, fistula, abscess and hemorrhage in 1 patient, respectively. With a median follow-up of 33 months, local failure after curative resection was observed in 4 patients (19%), 3 patients (14%) developed distant metastases. The 5-year overall survival rate for the entire group of 31 patients was 51%, following curative surgery 68%. (orig.) [German] Wir analysierten die Rate an kurativen (R0) Resektionen nach praeoperativer Radiochemotherapie, die Toxizitaet der Radiochemotherapie, die chirurgische Morbiditaet sowie die lokale Kontrolle und das Fuenf-Jahres-Gesamtueberleben nach multimodaler Therapie

  9. The Importance of Preoperative Staging of Rectal Cancer Using Multiparametric MRI. A Systematic Review

    Science.gov (United States)

    Bauer, Ferdinand

    2016-01-01

    A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an

  10. Prognostic impact of epidermal growth factor receptor (EGFR expression on loco-regional recurrence after preoperative radiotherapy in rectal cancer

    Directory of Open Access Journals (Sweden)

    Ychou Marc

    2005-06-01

    Full Text Available Abstract Background Epidermal growth factor receptor (EGFR represents a major target for current radiosensitizing strategies. We wished to ascertain whether a correlation exists between the expression of EGFR and treatment outcome in a group of patients with rectal adenocarcinoma who had undergone preoperative radiotherapy (RT. Methods Within a six-year period, 138 patients underwent preoperative radiotherapy and curative surgery for rectal cancer (UICC stages II-III at our institute. Among them, 77 pretherapeutic tumor biopsies were available for semi-quantitative immunohistochemical investigation evaluating the intensity and the number (extent of tumor stained cells. Statistical analyses included Cox regression for calculating risk ratios of survival endpoints and logistic regression for determining odds ratios for the development of loco-regional recurrences. Results Median age was 64 years (range: 30–88. Initial staging showed 75% and 25% stage II and III tumors, respectively. RT consisted of 44-Gy pelvic irradiation in 2-Gy fractions using 18-MV photons. In 25 very low-rectal-cancer patients the primary tumor received a boost dose of up to 16 Gy for a sphincter-preservation approach. Concomitant chemotherapy was used in 17% of the cases. All patients underwent complete total mesorectal resection. Positive staining (EGFR+ was observed in 43 patients (56%. Median follow-up was 36 months (range: 6–86. Locoregional recurrence rates were 7 and 20% for EGFR extent inferior and superior to 25%, respectively. The corresponding locoregional recurrence-free survival rate at two years was 94% (95% confidence interval, CI, 92–98% and 84% (CI 95%, 58–95%, respectively (P = 0.06. Multivariate analyses showed a significant correlation between the rate of loco-regional recurrence and three parameters: EGFR extent superior to 25% (hazard ratio = 7.18, CI 95%, 1.17–46, P = 0.037, rectal resection with microscopic residue (hazard ratio = 6.92, CI 95

  11. Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage.

    Science.gov (United States)

    Yamano, Tomoki; Yoshimura, Mie; Kobayashi, Masayoshi; Beppu, Naohito; Hamanaka, Michiko; Babaya, Akihito; Tsukamoto, Kiyoshi; Noda, Masafumi; Matsubara, Nagahide; Tomita, Naohiro

    2016-04-01

    This study assessed the incidence of malnutrition caused by preoperative chemoradiotherapy (CRT) in rectal cancer patients, which is seemingly underestimated; however, malnutrition affects treatment tolerability, postoperative complications, including anastomotic leakage (AL), and oncological outcomes. Between January 2008 and December 2014, 54 consecutive patients with T3-4, N0-2, M0-1 resectable rectal cancer received CRT comprising 45 Gy radiotherapy and S-1 alone or with irinotecan for 5 weeks and then underwent curative surgery with diverting or permanent stomas 6-8 weeks after CRT. We assessed malnutrition after completion of CRT (5-6 weeks after CRT start date) and at surgery (11-14 weeks after CRT start date), defining weight loss as ≥5 % of pre-CRT weight; this definition differs from commonly used criteria for adverse events. We evaluated the incidence of malnutrition associated with CRT and influence of malnutrition on treatment tolerability, AL, and disease-free survival (DFS). We also assessed the influence of CRT on the rate of postoperative complications by comparing the study group with 61 patients who had undergone excision with diverting or permanent stomas alone. Malnutrition was observed in 51 % of patients after CRT and in 29 % at surgery. Malnutrition after CRT was associated with treatment tolerability, and malnutrition at surgery was significantly associated with AL, which significantly influenced DFS in stage 1-3 patients. Malnutrition caused by CRT is common and is associated with treatment tolerability and AL. Nutritional assessment and support seem indispensable for the rectal cancer patients receiving CRT.

  12. Histopathological predictors for local recurrence in patients with T3 and T4 rectal cancers without preoperative chemoradiotherapy.

    Science.gov (United States)

    Akagi, Yoshito; Hisaka, Toru; Mizobe, Tomoaki; Kinugasa, Tetsushi; Ogata, Yutaka; Shirouzu, Kazuo

    2014-11-01

    Identification of suitable predictors of local recurrence (LR) in patients with rectal cancer would be of clinical benefit. The aim of this study was to identify histopathological factors that could predict LR. A total of 796 stage II/III patients with pT3 and pT4 rectal cancer who did not undergo preoperative chemoradiation were enrolled. LR was defined as intra-pelvic recurrence only. Histopathological factors related to LR were investigated. LR was found in 25 patients (6.1%) with stage II and 54 patients (13.9%) with stage IIIB/IIIC. In patients with stage II, distance of mesorectal extension (DME) >4 mm (P = 0.011) and positive venous invasion (P = 0.035) were independent factors that predicted LR. In patients with stage IIIB/IIIC, circumferential resection margin (CRM) ≤1 mm (P = 0.003) and positive lymphatic invasion (P = 0.006) were independent factors. The cumulative 5-year LR rate was higher (11.9%) in patients with a combination of DME > 4 mm and/or positive venous invasion for stage II (P CRM≤1 mm and/or positive lymphatic invasion for stage IIIB and IIIC (22.2%; P < 0.002, and 34.3%; P < 0.006, respectively). Important histopathological predictors for LR in patients with pT3 and pT4 rectal cancer were different at each stage. © 2014 Wiley Periodicals, Inc.

  13. Sphincter Preservation After Short-term Preoperative Radiotherapy for Low Rectal Cancer - Presentation of Own Data and a Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Bujko, Krzysztof; Nowacki, Marek P.; Oldzki, Janusz; Sopyo, Rafa; Skoczylas, Jerzy; Chwaliski, Maciej [The Maria Sklodowska-Curie Memorial Cancer Centre and Inst. of Oncology, Warsaw (Poland)

    2001-07-01

    This report is based on a series of 108 patients with clinically staged T2 (9), T3 (94) and T4 (5) rectal cancer treated with preoperative irradiation with 25 Gy, 5 Gy per fraction given for one week. In 77% of patients, the tumour was located within 7 cm of the anal verge and in 15% the anal canal was involved. Surgery was usually undertaken during the week after irradiation. For low tumours, total mesorectal excision was performed, and for middle and upper cancers, the whole circumference of the mesorectum was excised at least 2 cm below the lower pole of a tumour. Tumour was resected in 103 patients, and sphincter-preserving surgery was performed in 73% of them. In the subgroup where the tumour was located higher than 4 cm from the anal verge, sphincter-preserving surgery was performed in 95%. The follow-up period ranged from 10 to 49 months, with a median of 25 months. Local recurrences were observed in 4% of patients. Anorectal dysfunction caused impairment of social life in 40% of patients and 18% admitted that their quality of life was seriously affected - however, none of them stated that they would have preferred a colostomy. These preliminary data suggest that following high dose per fraction short-term preoperative radiotherapy a high rate of sphincter-preserving surgery can be reached, with acceptable anorectal function and an acceptable rate of local failure and late complications. The results of our own data and literature review indicate the need for a randomized clinical trial comparing high dose per fraction preoperative radiotherapy with immediate surgery with conventional preoperative radiochemotherapy with delayed surgery.

  14. Long-term outcomes of surgery alone versus surgery following preoperative chemoradiotherapy for early T3 rectal cancer

    Science.gov (United States)

    Cho, Seung Hyun; Choi, Gyu-Seog; Kim, Gab Chul; Seo, An Na; Kim, Hye Jung; Kim, Won Hwa; Shin, Kyung-Min; Lee, So Mi; Ryeom, Hunkyu; Kim, See Hyung

    2017-01-01

    Abstract Recently, a few studies have raised the question of whether preoperative chemoradiotherapy (PCRT) is essential for all T3 rectal cancers. This case-matched study aimed to compare the long-term outcomes of surgery alone with those of PCRT + surgery for magnetic resonance imaging (MRI)-assessed T3ab (extramural depth of invasion ≤5 mm) and absent mesorectal fascia invasion (clear MRF) in mid/lower rectal cancer patients. From January 2006 to November 2012, 203 patients who underwent curative surgery alone (n = 118) or PCRT + surgery (n = 85) were enrolled in this retrospective study. A 1:1 propensity score-matched analysis was performed to eliminate the inherent bias. Case-matching covariates included age, sex, body mass index, histologic grade, carcinoembryonic antigen, operation method, follow-up period, tumor height, and status of lymph node metastasis. The end-points were the 5-year local recurrence (LR) rate and disease-free-survival (DFS). After propensity score matching, 140 patients in 70 pairs were included. Neither the 5-year LR rate nor the DFS was significantly different between the 2 groups (the 5-year LR rate, P = 0.93; the 5-year DFS, P = 0.94). The 5-year LR rate of the surgery alone was 2% (95% confidence interval [CI] 0.2%–10.9%) versus 2% (95% CI 0.2%–10.1%) in the PCRT + surgery group. The 5-year DFS of the surgery alone was 87% (95% CI 74.6%–93.7%) versus 88% (95% CI 77.8%–93.9%) in the PCRT + surgery group. In patients with MRI-assessed T3ab and clear MRF mid/lower rectal cancer, the long-term outcomes of surgery alone were comparable with those of the PCRT + surgery. The suggested MRI-assessed T3ab and clear MRF can be used as a highly selective indication of surgery alone in mid/lower T3 rectal cancer. Additionally, in those patients, surgery alone can be tailored to the clinical situation. PMID:28328820

  15. Long-term results of preoperative 5-fluorouracil-oxaliplatin chemoradiation therapy in locally advanced rectal cancer.

    Science.gov (United States)

    Fontana, Elisa; Pucci, Francesca; Camisa, Roberta; Bui, Simona; Galdy, Salvatore; Leonardi, Francesco; Negri, Francesca Virginia; Anselmi, Elisa; Losardo, Pier Luigi; Roncoroni, Luigi; Dell'abate, Paolo; Crafa, Pellegrino; Cascinu, Stefano; Ardizzoni, Andrea

    2013-02-01

    To evaluate the activity, safety and long-term survival of patients after preoperative oxaliplatin and 5-fluorouracil chemoradiation therapy in locally advanced rectal cancer (LARC). Patients with resectable, T3-4 and/or nodal involvement rectal adenocarcinoma were treated with oxaliplatin 60 mg/m(2) weekly and 5-fluorouracil 200 mg/m(2)/d infused continuously for five days, over a period of five weeks, and radiotherapy (45 Gy/25 fractions). The primary end-point was pathological complete response (ypCR). Safety, overall survival (OS) and relapse-free survival (RFS) were secondary end-points. Sixty-six patients were treated. Grade 1-2 diarrhea was the most common adverse event. The ypCR rate was 16.7% (95% confidence interval=7.7-25.7%). After a median follow-up of 73.5 months, 23 patients (34.8%) had experienced relapse. Five-year actuarial RFS and OS rates were 64% and 73%, respectively. Five-year actuarial RFS was 91.7% in the ypCR group versus 57.8% in non-ypCR cases. Long-term local control and survival after this very well-tolerated regimen appear encouraging.

  16. Epigenetic Regulation of KLHL34 Predictive of Pathologic Response to Preoperative Chemoradiation Therapy in Rectal Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Ye J. [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Kim, Chan W. [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Roh, Seon A. [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Cho, Dong H. [Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Graduate School of East-West Medical Science, Kyung Hee University, Gyeonggi-do (Korea, Republic of); Park, Jong L.; Kim, Seon Y. [Medical Genomics Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon (Korea, Republic of); Kim, Jong H. [Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Choi, Eun K. [Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Kim, Yong S., E-mail: yongsung@kribb.re.kr [Medical Genomics Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Kim, Jin C., E-mail: jckim@amc.seoul.kr [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of)

    2015-03-01

    Purpose: Prediction of individual responsiveness to preoperative chemoradiation therapy (CRT) is urgently needed in patients with poorly responsive locally advanced rectal cancer (LARC). Methods and Materials: Candidate methylation genes associated with radiosensitivity were identified using a 3-step process. In the first step, genome-wide screening of methylation genes was performed in correlation with histopathologic tumor regression grade in 45 patients with LARC. In the second step, the methylation status of selected sites was analyzed by pyrosequencing in 67 LARC patients, including 24 patients analyzed in the first step. Finally, colorectal cancer cell clones with stable KLHL34 knockdown were generated and tested for cellular sensitivity to radiation. Results: Genome-wide screening identified 7 hypermethylated CpG sites (DZIP1 cg24107021, DZIP1 cg26886381, ZEB1 cg04430381, DKK3 cg041006961, STL cg00991794, KLHL34 cg01828474, and ARHGAP6 cg07828380) associated with preoperative CRT responses. Radiosensitivity in patients with hypermethylated KLHL34 cg14232291 was confirmed by pyrosequencing in additional cohorts. Knockdown of KLHL34 significantly reduced colony formation (KLHL34 sh#1: 20.1%, P=.0001 and KLHL34 sh#2: 15.8%, P=.0002), increased the cytotoxicity (KLHL34 sh#1: 14.8%, P=.019 and KLHL34 sh#2: 17.9%, P=.007) in LoVo cells, and increased radiation-induced caspase-3 activity and the sub-G1 population of cells. Conclusions: The methylation status of KLHL34 cg14232291 may be a predictive candidate of sensitivity to preoperative CRT, although further validation is needed in large cohorts using various cell types.

  17. Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Guckenberger, M.; Saur, G.; Wehner, D.; Sweeney, R.A.; Flentje, M. [Universitaetsklinikum Wuerzburg (Germany). Klinik und Poliklinik fuer Strahlentherapie; Thalheimer, A.; Germer, C.T. [Universitaetsklinikum Wuerzburg (Germany). Chirurgische Klinik I

    2012-07-15

    Background: The purpose of this work was to perform a single institution comparison between preoperative short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer. Methods: A total of 225 patients with clinical stage UICC II-III rectal cancer were treated with SC-RT (29 Gy in 10 twice daily fractions followed by immediate surgery; n = 108) or LC-RCHT (54 Gy in 28 fractions with simultaneous 5-fluorouracil (5-FU) {+-} oxaliplatin chemotherapy followed by delayed surgery; n = 117). All patients in the LC-RCHT cohort and patients in the SC-RT with pathological UICC stage {>=} II received adjuvant chemotherapy. Before 2004, the standard of care was SC-RT with LC-RCHT reserved for patients where downstaging was considered as required for sphincter preservation or curative resection. In the later period, SC-RT was practiced only for patients unfit for radiochemotherapy. Results: Patients in the LC-RCHT cohort had a significantly higher proportion of cT4 tumors, clinical node positivity, and lower tumor location. The 5-year local control (LC) and overall survival (OS) were 91% and 66% without differences between the SC-RT and LC-RCHT groups. Acute toxicity was increased during LC-RCHT (grade {>=} II 1% vs. 33%) and there were no differences in postoperative complications. Severe late toxicity grade {>=} III was increased after SC-RT (12% vs. 3%). Of patients aged > 80 years, 7 of 7 patients and 4 of 9 patients received curative surgery after SC-RT and LC-RCHT, respectively. Conclusion: Despite the fact that patients with worse prognostic factors were treated with LC-RCHT, there were no significant differences in LC and OS between the SC-RT and LC-RCHT group. Age > 80 years was identified as a significant risk factor for LC-RCHT and these patients could be treated preferably with SC-RT. (orig.)

  18. Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer; Linfocintilografia pelvica. Contribuicao ao estadiamento pre-operatorio do cancer retal

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Jose Hyppolito da

    1996-12-31

    Preservation of the lower rectal sphincters has been the main concern of colorectal surgeons in an attempt to avoid colostomy. Various proposed procedures contradict the oncological principles of the operation`s radicality, especially pelvic lymphadenectomy. Prior knowledge of this space is therefore, an important factor in choosing the operative technique: radical (amputation), or conservative. The introduction of ultrasound, computed tomography and magnetic resonance imaging, have provided preoperative information about the anatomic nature of the region. The morphological and functional study supplied by lymphoscintigraphy of this space supplements the data furnished by the other imaging techniques. The objective of this prospective of this prospective study was threefold: to standardize lymphoscintigraphy, to differentiate patients with rectal cancer from those with other coloproctological diseases and to asses the lymphonodal involvement in the former by utilizing the anatomopathological and surgical correlation. The study included 60 patients with various coloproctological diseases seen on the Department of Gastroentorology, Hospital da Clinicas, University of Sao Paulo School of Medicine, from September 1990 to August 1993. Thirty were cases of rectal cancer and the remainder were other colorectal diseases. The method consisted of injecting 0.5 of a dextran solution market with radioactive technetium in the perineal region and obtaining images by a gamma camera. In the rectal cancer patients, the tracer progresses unilaterally or is absent; in the others, it is bilateral and symmetrical, although its progress may be slow. The statistical data demonstrated that in rectal cancer, lymphoscintigraphy asseses the nodal involvement approximaltely as that obtained by the sun of the anatomapathological and surgical findings. Based on the results, the following conclusioons were possible: lymphoscintigraphy is a standardized, painless and harmless test that can be

  19. Preoperative radiotherapy for advanced lower rectal cancer. Combination of external and high-dose-rate intraluminal irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Horikawa, Noriko; Yoshimura, Hitoshi; Tamamoto, Tetsuro; Tsuji, Yoshihiko; Uto, Fumiaki; Ohishi, Hajime; Uchida, Hideo; Fujii, Hisao; Nakano, Hiroshige [Nara Medical Univ., Kashihara (Japan)

    1999-01-01

    This paper reports the therapeutic results of preoperative irradiation using a combination of external irradiation and high dose rate intraluminal irradiation using {sup 60}Co aimed at enhancing postoperative local control of advanced rectal cancer. The subjects comprised 38 patients (RT group) in whom {>=} A{sub 1}` lower rectal cancer was suspected and who underwent preoperative irradiation at this hospital. A control group (N-RT group) consisted of 16 patients subjected to operation alone in whom clinical {>=} A{sub 1}` and postoperative histological study revealed {>=} a{sub 1}. Intraluminal irradiation was performed using a balloon applicator. The external irradiation was performed with a 10 MVX delivering 30-40 Gy/15-20 Fr to the entire pelvic cavity. Using the criteria of Ohboshi and Shimozato to judge the histopathological effect, no cases showed Grade I, while of Grade II, 15 cases showed IIA and 19 cases IIB, Grade III in 4 cases. Grade IIB or above was noted in 23 of 38 (61%). Five and 8-year survival rates were 82.5 and 82.5% in the RT group, and were 79.5 and 79.5% in the N-RT group. Although these differences were not significant, a trend to better survival was found in the RT group. The local recurrence rate was 8% (3/38 cases) in the RT group in contrast to 25% (4/16 cases) in the N-RT group. The following complications developed during radiation therapy: diarrhea 19 (50%), anal pain 18 (47%), and others. Postoperative complications consisted of perineal fluid collection 4 (10%), bowel obstruction 3 cases (8%), an anastomotic insufficiency 3 (8%), fistula formation of bladder 2 (5%), ureteral narrowing 1 (3%), and thrombosis of vein 1 cases (3%) of the RT group, while perineal fluid collection 1 (6%), bowel obstruction 1 (6%), an anastomotic insufficiency 4 (25%) of the N-RT group, only one case of RT group (3%) required surgical treatment for the fistula formation of bladder. (K.H.)

  20. S-1-Based versus capecitabine-based preoperative chemoradiotherapy in the treatment of locally advanced rectal cancer: a matched-pair analysis.

    Directory of Open Access Journals (Sweden)

    Meng Su

    Full Text Available OBJECTIVE: The aim of this paper was to compare the efficacy and safety of S-1-based and capecitabine-based preoperative chemoradiotherapy regimens in patients with locally advanced rectal cancer through a retrospective matched-pair analysis. MATERIALS AND METHODS: Between Jan 2010 and Mar 2014, 24 patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with S-1 were individually matched with 24 contemporary patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with capecitabine according to clinical stage (as determined by pelvic magnetic resonance imaging and computed tomography and age (within five years. All these patients performed mesorectal excision 4-8 weeks after the completion of chemoradiotherapy. RESULTS: The tumor volume reduction rates were 55.9±15.1% in the S-1 group and 53.8±16.0% in the capecitabine group (p = 0.619. The overall downstaging, including both T downstaging and N downstaging, occurred in 83.3% of the S-1 group and 70.8% of the capecitabine group (p = 0.508. The significant tumor regression, including regression grade I and II, occurred in 33.3% of S-1 patients and 25.0% of capecitabine patients (p = 0.754. In the two groups, Grade 4 adverse events were not observed and Grade 3 consisted of only two cases of diarrhea, and no patient suffered hematologic adverse event of Grade 2 or higher. However, the incidence of diarrhea (62.5% vs 33.3%, p = 0.014 and hand-foot syndrome (29.2% vs 0%, p = 0.016 were higher in capecitabine group. Other adverse events did not differ significantly between two groups. CONCLUSIONS: The two preoperative chemoradiotherapy regimens were effective and safe for patients of locally advanced rectal cancer, but regimen with S-1 exhibited a lower incidence of adverse events.

  1. Tissue effects of glutamine in rectal cancer patients treated with preoperative chemoradiotherapy.

    Science.gov (United States)

    Vidal-Casariego, Alfonso; Hernando-Martín, Mercedes; Calleja-Fernández, Alicia; Cano-Rodríguez, Isidoro; Cordido, Fernando; Ballesteros-Pomar, María D

    2015-04-01

    Introducción: El objetivo fue evaluar los efectos de la administración de glutamina sobre la regresión tumoral y sobre el tejido sano en pacientes con cáncer rectal que recibieron quimiorradioterapia. Material y métodos: Se incluyó 10 pacientes con cáncer rectal operado después de quimiorradioterapia, un subgrupo de un ensayo clínico que comparó glutamina con placebo en la prevención de enteritis aguda. Un patólogo experto analizó las muestras de tumor y tejido sano, buscando datos de regresión tumoral, mucífagos y daño por radiación. Resultados: No hubo diferencias entre placebo y glutamina en el grado de regresión tumoral. Todos los pacientes con glutamina presentaron mucífagos, frente al 28,6% con placebo (p = 0,038). El daño sobre tejido sano fue similar en los pacientes con glutamina y placebo, y entre aquellos con y sin enteritis. Conclusión: La glutamina no ejerce un efecto protector frente a la quimiorradioterapia sobre el tumor o el tejido rectal sano.

  2. Anorectal and sexual functions after preoperative radiotherapy and full-thickness local excision of rectal cancer.

    Science.gov (United States)

    Gornicki, A; Richter, P; Polkowski, W; Szczepkowski, M; Pietrzak, L; Kepka, L; Rutkowski, A; Bujko, K

    2014-06-01

    Local excision with preoperative radiotherapy may be considered as alternative management to abdominal surgery alone for small cT2-3N0 tumours. However, little is known about anorectal and sexual functions after local excision with preoperative radiotherapy. Evaluation of this issue was a secondary aim of our previously published prospective multicentre study. Functional evaluation was based on a questionnaire completed by 44 of 64 eligible disease-free patients treated with preoperative radiotherapy and local excision. Additionally, ex post, these results were confronted with those recorded retrospectively in the control group treated with anterior resection alone (N = 38). In the preoperative radiotherapy and local excision group, the median number of bowel movements was two per day, incontinence of flatus occurred in 51% of patients, incontinence of loose stool in 46%, clustering of stools in 59%, and urgency in 49%; these symptoms occurred often or very often in 11%-21% of patients. Thirty-eight per cent of patients claimed that their quality of life was affected by anorectal dysfunction. Nineteen per cent of men and 20% of women claimed that the treatment negatively influenced their sexual life. The anorectal functions in the preoperative radiotherapy and local excision group were not much different from that observed in the anterior resection alone group. Our study suggests that anorectal functions after preoperative radiotherapy and local excision may be worse than expected and not much different from that recorded after anterior resection alone. It is possible that radiotherapy compromises the functional effects achieved by local excision. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Urinary function following resection for rectal cancer with preoperative radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Shirai, Yoshinori; Taniyama, Shinji; Arai, Tatsuo; Ono, Masato (National Cancer Center, Chiba (Japan). East Hospital); Nunomura, Masao; Sarashina, Hiromi; Saitoh, Norio; Nakajima, Nobuyuki

    1993-12-01

    Urinary function was evaluated after personal interview in 34 patients and after examination of the results of a urodynamic study in 15 of these, in whom resection for carcinoma of the rectum with preoperative irradiation therapy was performed. From the results of the personal interview, urinary urgency was found to have occurred in 19.2% when preoperative radiation was over. Urinary function after surgery was preserved in the group of patients who had undergone bilateral and unilateral pelvic plexus nerve preserving operations, whereas urinary dysfunction occurred in 66.7% of the group of patients who had undergone operations without pelvic plexus nerve preservation. Urinary dysfunction was recognized in 53.9% of the group of patients who had undergone abdominoperineal resection, but in none of the group of patients who had undergone low anterior resection. The urodynamic study showed that 21.4% had residual urinary output of more than 40 ml, 23.1% had the first desire to void at less than 100 ml, 15.4% had the maximum desire to void at less than 200 ml, 28.6% had compliance of the bladder at less than 20 ml/cmH[sub 2]O when preoperative irradiation was over, and these data became worse 1 month after surgery. However, these phenomena were improved 1 year after surgery. (author).

  4. Pretreatment HIF-1α and GLUT-1 expressions do not correlate with outcome after preoperative chemoradiotherapy in rectal cancer

    DEFF Research Database (Denmark)

    Havelund, Birgitte Mayland; Sørensen, Flemming Brandt; Lindebjerg, Jan

    2011-01-01

    The aim of the present study was to investigate hypoxia-inducible factor 1α (HIF-1α) and glucose transporter-1 (GLUT-1) expressions as predictors of response and survival after chemoradiotherapy in pretreatment biopsy specimens from patients with rectal cancer.......The aim of the present study was to investigate hypoxia-inducible factor 1α (HIF-1α) and glucose transporter-1 (GLUT-1) expressions as predictors of response and survival after chemoradiotherapy in pretreatment biopsy specimens from patients with rectal cancer....

  5. High-grade acute organ toxicity during preoperative radiochemotherapy as positive predictor for complete histopathologic tumor regression in multimodal treatment of locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Hendrik Andreas; Herrmann, Markus Karl Alfred; Hennies, Steffen; Rave-Fraenk, Margret; Hess, Clemens Friedrich; Christiansen, Hans [Dept. of Radiotherapy and Radiooncology, Univ. Medicine Goettingen (Germany); Gaedcke, Jochen; Liersch, Torsten [Dept. of Surgery, Univ. Medicine Goettingen (Germany); Jung, Klaus [Dept. of Medical Statistics, Univ. Medicine Goettingen (Germany); Hermann, Robert Michael [Dept. of Radiotherapy and Radiooncology, Univ. Medicine Goettingen (Germany); Dept. of Radiotherapy and Radiooncology, Aerztehaus am Diako, Bremen (Germany); Rothe, Hilka [Dept. of Pathology, Univ. Medicine Goettingen (Germany); Schirmer, Markus [Dept. of Clinical Pharmacology, Univ. Medicine Goettingen (Germany)

    2010-01-15

    Purpose: To test for a possible correlation between high-grade acute organ toxicity during preoperative radiochemotherapy and complete tumor regression after total mesorectal excision in multimodal treatment of locally advanced rectal cancer. Patients and Methods: From 2001 to 2008, 120 patients were treated. Preoperative treatment consisted of normofractionated radiotherapy at a total dose of 50.4 Gy, and either two cycles of 5-fluorouracil (5-FU) or two cycles of 5-FU and oxaliplatin. Toxicity during treatment was monitored weekly, and any toxicity CTC (Common Toxicity Criteria) {>=} grade 2 of enteritis, proctitis or cystitis was assessed as high-grade organ toxicity for later analysis. Complete histopathologic tumor regression (TRG4) was defined as the absence of any viable tumor cells. Results: A significant coherency between high-grade acute organ toxicity and complete histopathologic tumor regression was found, which was independent of other factors like the preoperative chemotherapy schedule. The probability of patients with acute organ toxicity {>=} grade 2 to achieve TRG4 after neoadjuvant treatment was more than three times higher than for patients without toxicity (odds ratio: 3.29, 95% confidence interval: [1.01, 10.96]). Conclusion: Acute organ toxicity during preoperative radiochemotherapy in rectal cancer could be an early predictor of treatment response in terms of complete tumor regression. Its possible impact on local control and survival is under further prospective evaluation by the authors' working group. (orig.)

  6. Intravenous 5-fluorouracil versus oral doxifluridine as preoperative concurrent chemoradiation for locally advanced rectal cancer. Prospective randomized trails

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam-Kyu; Min, Jin-Sik; Park, Jea-Kun; Yun, Seong-Hyun; Sung, Jin-Sil; Jung, Hyun-Chul; Roh, Jae-Kyung [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine

    2001-01-01

    Preoperative radiation treatment with concomitant intravenous infusion of 5-fluorouracil (5-FU) is known to be effective in shrinking and downstaging of tumors. However, chemotherapy has often been limited by its toxicity and poor patient compliance. Oral 5-FU is known to have several advantages over conventional intravenous 5-FU infusion such as lower toxicity and higher quality of life without compromising the efficacy of the treatment. The aim of this study was to compare intravenous 5-FU with oral doxifluridine with respect to tumor response, toxicity and quality of life. Twenty-eight patients with rectal cancer, staged as over T3N1 or T4 by transrectal ultrasonography between July 1997 and December 1998, were included in this study. Intravenous 5-FU (450 mg/m{sup 2}) and leucovorin (20 mg/m{sup 2}) were given for five consecutive days during the first and fifth weeks of radiation therapy (50.4 Gy) (n=14). Oral doxifluridine (700 mg/m{sup 2}/day) and leucovorin (20 mg/m{sup 2}) were given daily during radiation treatment (n=14). Quality of life was scored according to 22 activity items (good, >77; fair, >58; poor, <57). Surgical resection was performed 4 weeks after completion of concurrent chemoradiation treatment. Tumor response was classified into CR (complete remission), PR (partial response; 50% diminution of tumor volume or downstaging) and NR (no response). Tumor response was CR 3/14 (21.4%), PR 7/14 (50%) and NR 4/14 (28.6%) in the IV arm versus CR 2/14 (14.2%), PR 6/14 (42.9%) and NR 6/14 (42.9%) in the Oral arm (p=0.16, 0.23, 0.24), respectively. The quality of life was poor (36.4% versus 33.3%), fair and good (63.6% versus 66.7%) between the IV arm and Oral arm, respectively. Gastrointestinal toxicity was 2/14 (14.3%) in the IV arm versus 5/14 (35.7%) in the Oral arm, respectively. Stomatitis was only observed in the IV arm (1/14, 7.1%). Hematological toxicity was 3/14 (21.4%) in the IV arm versus 4/14 (28.5%) in the Oral arm, respectively. Systemic

  7. National and international guidelines for rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Wille-Jørgensen, P

    2014-01-01

    concerning the definition of rectal cancer. Ten of the 11 guidelines use the TNM staging system and there was general agreement regarding the recommendation of MRI and CT in rectal cancer. There was consensus concerning a multidisciplinary approach, preoperative chemoradiotherapy (CRT) and total mesorectal...

  8. Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation

    Energy Technology Data Exchange (ETDEWEB)

    Hernando-Requejo, Ovidio [Hospital Universitario Sanchinarro, Department of Radiation Oncology, Madrid (Spain); Hospital Universitario Sanchinarro, CEU San Pablo University, Madrid (Spain); HM Universitario Sanchinarro, Centro Integral Oncologico Clara Campal, Madrid (Spain); Lopez, Mercedes; Rodriguez, Almudena; Ciervide, Raquel; Valero, Jeannette; Sanchez, Emilio; Garcia-Aranda, Mariola; Potdevin, Guillermo [Hospital Universitario Sanchinarro, Department of Radiation Oncology, Madrid (Spain); Cubillo, Antonio; Rodriguez, Jesus [Hospital Universitario Sanchinarro, Department of Medical Oncology, Madrid (Spain); Hospital Universitario Sanchinarro, CEU San Pablo University, Madrid (Spain); Rubio, Carmen [Hospital Universitario Sanchinarro, Department of Radiation Oncology, Madrid (Spain); Hospital Universitario Sanchinarro, CEU San Pablo University, Madrid (Spain)

    2014-06-15

    To analyze the efficacy and safety of a new preoperative intensity-modulated radiotherapy (IMRT) and integrated-boost chemoradiation scheme. In all, 74 patients were treated with IMRT and concurrent standard dose capecitabine. The dose of the planning target volume (PTV) encompassing the tumor, mesorectum, and pelvic lymph nodes was 46 Gy in 23 fractions; the boost PTV, at a dose of 57.5 Gy in 23 fractions, included the macroscopic primary tumor and pathological lymph nodes. The patients underwent surgery 6-8 weeks after chemoradiation. The complete treatment data of 72 patients were analyzed. Tumor downstaging was achieved in 55 patients (76.38 %) and node downstaging in 34 (47.2 %). In 22 patients (30.6 %), there was complete pathological response (ypCR). The circumferential resection margin was free of tumor in 70 patients (97.2 %). The 3-year estimated overall survival and disease-free survival rates were 95.4 and 85.9 % respectively, and no local relapse was found; however, ten patients (13.8 %) developed distant metastases. High pathologic tumor (pT) downstaging was shown as a favorable prognostic factor for disease-free survival. No grade 4 acute radiotherapy-related toxicity was found. The IMRT and integrated-boost chemoradiation scheme offered higher rates of ypCR and pT downstaging, without a significant increase in toxicity. The circumferential margins were free of tumors in the majority of patients. Primary tumor regression was associated with better disease-free survival. (orig.) [German] Analyse von Wirksamkeit und Sicherheit eines neuen praeoperativen intensitaetsmodulierten Bestrahlungsschemas (IMRT) mit integriertem Boost. Insgesamt 74 Patienten wurden simultan mit IMRT und Capecitabin (Standarddosis) behandelt. Die Dosis des Planungszielvolumens (PTV) umfasste den Tumor, das Mesorektum sowie die Beckenlymphknoten und betrug 46 Gy in 23 Fraktionen. Das Boost-PTV betrug 57,5 Gy in 23 Fraktionen und umfasste den makroskopischen Primaertumor und die

  9. Tafazzin protein expression is associated with tumorigenesis and radiation response in rectal cancer: a study of Swedish clinical trial on preoperative radiotherapy.

    Directory of Open Access Journals (Sweden)

    Surajit Pathak

    Full Text Available BACKGROUND: Tafazzin (TAZ, a transmembrane protein contributes in mitochondrial structural and functional modifications through cardiolipin remodeling. TAZ mutations are associated with several diseases, but studies on the role of TAZ protein in carcinogenesis and radiotherapy (RT response is lacking. Therefore we investigated the TAZ expression in rectal cancer, and its correlation with RT, clinicopathological and biological variables in the patients participating in a clinical trial of preoperative RT. METHODS: 140 rectal cancer patients were included in this study, of which 65 received RT before surgery and the rest underwent surgery alone. TAZ expression was determined by immunohistochemistry in primary cancer, distant, adjacent normal mucosa and lymph node metastasis. In-silico protein-protein interaction analysis was performed to study the predictive functional interaction of TAZ with other oncoproteins. RESULTS: TAZ showed stronger expression in primary cancer and lymph node metastasis compared to distant or adjacent normal mucosa in both non-RT and RT patients. Strong TAZ expression was significantly higher in stages I-III and non-mucinious cancer of non-RT patients. In RT patients, strong TAZ expression in biopsy was related to distant recurrence, independent of gender, age, stages and grade (p = 0.043, HR, 6.160, 95% CI, 1.063-35.704. In silico protein-protein interaction study demonstrated that TAZ was positively related to oncoproteins, Livin, MAC30 and FXYD-3. CONCLUSIONS: Strong expression of TAZ protein seems to be related to rectal cancer development and RT response, it can be a predictive biomarker of distant recurrence in patients with preoperative RT.

  10. Pre-operative radiochemotherapy of primarily non-resectable rectal cancer; Praeoperative Radiochemotherapie bei primaer inoperablen Rektumkarzinomen

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Dworak, O. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Pathologie; Dunst, J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Koeckerling, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Chirurgische Klinik; Schwarz, B. [Erlangen-Nuernberg Univ., Erlangen (Germany). Abt. fuer Pathologie; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik

    1995-02-01

    Twenty patients with non-resectable rectal cancer (Mason CS III-VI) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50,4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m{sup 2} 5-FU per day as continuous infusion over 120 hours. The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor. In this pilot study, pre-operative radiochemotherapy was well tolerated. (orig.) [Deutsch] An der Strahlentherapeutischen Klinik haben wir im Zeitraum September 1989 bis Februar 1994 20 Patienten mit primaer nicht resektablen Rektumkarzinomen (CS III-IV nach Mason) praeoperativ bestrahlt (fuenf Fraktionen pro Woche, Einzeldosis 1,8 Gy im Isozentrum, Gesamtdosis 50,4 Gy grossvolumig, in Einzelfaellen Boost bis maximal 68 Gy). Simultan erfolgte in der ersten und fuenften Therapiewoche eine 120-Stunden-Dauerinfusion mit 1000 mg/m{sup 2} 5-FU pro Tag. Die Radiochemotherapie wurde gut toleriert. Es traten bei einem Patienten eine Grad-III-Dermatitis, bei sieben eine Grad-II-Enteritis, bei einem Patienten eine Grad-III- und bei drei Patienten eine Grad-II-Leukozytopenie auf. 17/20 Patienten wurden etwa sechs

  11. Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I-II multicenter study of the Dutch colorectal cancer group

    NARCIS (Netherlands)

    Hospers, Geke A.; Punt, Cornelis J. A.; Tesselaar, Margot E.; Cats, Annemieke; Havenga, Klaas; Leer, Jan W. H.; Marijnen, Corrie A.; Jansen, Edwin P.; Van Krieken, Han H. J. M.; Wiggers, Theo; de Velde, Cornelis J. H. Van; Mulder, Nanno H.

    2007-01-01

    Background: We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer. Methods: T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabi

  12. Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I-II multicenter study of the Dutch Colorectal Cancer Group.

    NARCIS (Netherlands)

    Hospers, G.A.; Punt, C.J.A.; Tesselaar, M.E.; Cats, A.; Havenga, K.; Leer, J.W.H.; Marijnen, C.A.M.; Jansen, E.P.W.A.; Krieken, J.H.J.M. van; Wiggers, T.; Velde, C.J. van de; Mulder, N.H.

    2007-01-01

    BACKGROUND: We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer. METHODS: T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabi

  13. Current concepts in rectal cancer.

    Science.gov (United States)

    Fleshman, James W; Smallwood, Nathan

    2015-03-01

    The history of rectal cancer management informs current therapy and points us in the direction of future improvements. Multidisciplinary team management of rectal cancer will move us to personalized treatment for individuals with rectal cancer in all stages.

  14. Late Patient-Reported Toxicity After Preoperative Radiotherapy or Chemoradiotherapy in Nonresectable Rectal Cancer: Results From a Randomized Phase III Study

    Energy Technology Data Exchange (ETDEWEB)

    Braendengen, Morten, E-mail: mortbrae@medisin.uio.no [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Department of Oncology and Pathology, Karolinska Institutet, Stockholm (Sweden); Tveit, Kjell Magne [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway); Bruheim, Kjersti [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Cvancarova, Milada [Department of Clinical Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo (Norway); Berglund, Ake [Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala (Sweden); Glimelius, Bengt [Department of Oncology and Pathology, Karolinska Institutet, Stockholm (Sweden); Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala (Sweden)

    2011-11-15

    Purpose: Preoperative chemoradiotherapy (CRT) is superior to radiotherapy (RT) in locally advanced rectal cancer, but the survival gain is limited. Late toxicity is, therefore, important. The aim was to compare late bowel, urinary, and sexual functions after CRT or RT. Methods and Materials: Patients (N = 207) with nonresectable rectal cancer were randomized to preoperative CRT or RT (2 Gy Multiplication-Sign 25 {+-} 5-fluorouracil/leucovorin). Extended surgery was often required. Self-reported late toxicity was scored according to the LENT SOMA criteria in a structured telephone interview and with questionnaires European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), International Index of Erectile Function (IIEF), and sexual function -vaginal changes questionnaire (SVQ). Results: Of the 105 patients alive in Norway and Sweden after 4 to 12 years of follow-up, 78 (74%) responded. More patients in the CRT group had received a stoma (73% vs. 52%, p = 0.09). Most patients without a stoma (7 of 12 in CRT group and 9 of 16 in RT group) had incontinence for liquid stools or gas. No stoma and good anal function were seen in 5 patients (11%) in the CRT group and in 11 (30%) in the RT group (p = 0.046). Of 44 patients in the CRT group, 12 (28%) had had bowel obstruction compared with 5 of 33 (15%) in the RT group (p = 0.27). One-quarter of the patients reported urinary incontinence. The majority of men had severe erectile dysfunction. Few women reported sexual activity during the previous month. However, the majority did not have concerns about their sex life. Conclusions: Fecal incontinence and erectile dysfunction are frequent after combined treatment for locally advanced rectal cancer. There was a clear tendency for the problems to be more common after CRT than after RT.

  15. Preoperative radio-chemotherapy for rectal cancer: Forecasting the next steps through ongoing and forthcoming studies; Chimioradiotherapie preoperatoire des cancers du rectum: ce que laissent presager les etudes en cours et a venir

    Energy Technology Data Exchange (ETDEWEB)

    Crehange, G.; Maingon, P. [Departement de radiotherapie, centre Georges-Francois-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon (France); Bosset, J.F. [Service d' oncologie radiotherapie, CHU Jean-Minjoz, boulevard Flemming, 25000 Besancon (France)

    2011-10-15

    Protracted preoperative radio-chemotherapy with a 5-FU-based scheme, or a short course of preoperative radiotherapy without chemotherapy, are the standard neo-adjuvant treatments for resectable stage II-III rectal cancer. Local failure rates are low and reproducible, between 6 and 15% when followed with a 'Total Meso-rectal Excision'. Nevertheless, the therapeutic strategy needs to be improved: distant metastatic recurrence rates remain stable around 30 to 35%, while both sphincter and sexual sequels are still significant. The aim of the present paper was to analyse the ongoing trials listed on the following search engines: the Institut National du Cancer in France, the National Cancer Institute and the National Institute of Health in the United States, and the major cooperative groups. Keywords for the search were: 'rectal cancer', 'preoperative radiotherapy', 'phase II-III', 'preoperative chemotherapy', 'adjuvant chemotherapy' and 'surgery'. Twenty-three trials were selected and classified in different groups, each of them addressing a question of strategy: (1) place of adjuvant chemotherapy; (2) optimization of preoperative radiotherapy; (3) evaluation of new radiosensitization protocols and/or neo-adjuvant chemotherapy; (4) optimization of techniques and timing of surgery; (5) place of radiotherapy for non resectable or metastatic tumors. (authors)

  16. The prognostic impact of preoperative blood monocyte count in pathological T3N0M0 rectal cancer without neoadjuvant chemoradiotherapy.

    Science.gov (United States)

    Zhang, Lu-Ning; Xiao, Weiwei; OuYang, Pu-Yun; You, Kaiyun; Zeng, Zhi-Fan; Ding, Pei-Rong; Pan, Zhi-Zhong; Xu, Rui-Hua; Gao, Yuan-Hong

    2015-09-01

    It remains controversial whether adjuvant therapy should be delivered to pathological T3N0M0 rectal cancer without neoadjuvant chemoradiotherapy. Thus identification of patients at high risk is of particular importance. Herein, we aimed to evaluate whether the absolute peripheral blood monocyte count can stratify the pathological T3N0M0M0 rectal cancer patients in survival. A total of 270 pathological T3N0M0 rectal cancer patients with total mesorectal excision-principle radical resection were included. The optimal cut-off value of preoperative monocyte count was determined by receiver operating characteristic curve analysis. Overall survival and disease-free survival between low- and high-monocyte were estimated by Kaplan-Meier method and Cox regression model. The optimal cut-off value for monocyte count was 595 mm(3). In univariate analysis, patients with monocyte counts higher than 595/mm(3) had significantly inferior 5-year overall survival (79.2 vs 94.2 %, P = 0.006) and disease-free survival (67.8 vs 86.0 %, P count remained to be associated with poor overall survival (HR = 2.55, 95 % CI 1.27-5.10; P = 0.008) and disease-free survival (HR = 2.63, 95 % CI 1.48-4.69; P = 0.001). Additionally, the significant association of monocyte count with disease-free survival was hardly influenced in the subgroup analysis, whereas this correlation was restricted to the males and patients with normal carcinoembryonic antigen (CEA) level (count is independently predictive of worse survival of pathological T3N0M0 rectal cancer patients without neoadjuvant chemoradiotherapy. Postoperative adjuvant therapy might be considered for patients with high-monocyte count.

  17. Radiological imaging of rectal cancer

    Directory of Open Access Journals (Sweden)

    Lidija Lincender-Cvijetić

    2012-11-01

    Full Text Available This article discusses the possibilities of diagnosing abdominal imaging in patients with rectal cancer, detecting lesions and assessing the stage of the lesions, in order to select the appropriate therapy. Before the introduction of imaging technologies, the diagnosis of colorectal pathology was based on conventional methods of inspecting intestines with a barium enema, with either a single or double contrast barium enema. Following the development of endoscopic methods and the wide use of colonoscopy, colonoscopy became the method of choice for diagnosing colorectal diseases. The improvement of Computerized Tomography (CT and Magnetic Resonance Imaging (MRI, gave us new possibilities for diagnosing colorectal cancer. For rectal cancer, trans-rectal US (TRUS or endo-anal US (EAUS have a significant role. For staging rectal cancer, the Multi Slice Computed Tomography (MSCT is not the method of choice, but Magnetic Resonance Imaging (MRI is preferred when it comes to monitoring the rectum. Therole of the MRI in the T staging of rectal cancer is crucial in preoperative assessment of: thickness – the width of the tumor, the extramural invasion, the circumference of resection margin (CRM, andthe assessment of the inclusion of mesorectal fascia. For successful execution of surgical techniques, good diagnostic imaging of the cancer is necessary in order to have a low level of recurrence. According to medical studies, the sensitivity of FDG-PET in diagnosing metastatic nodals is low, but for now it is not recommended in routine diagnosis of metastatic colorectal carcinoma.

  18. Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

    Energy Technology Data Exchange (ETDEWEB)

    Paez, David, E-mail: dpaez@santpau.cat [Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Salazar, Juliana; Pare, Laia [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Pertriz, Lourdes [Department of Radiotherapy, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Targarona, Eduardo [Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Rio, Elisabeth del [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Barnadas, Agusti; Marcuello, Eugenio [Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Baiget, Montserrat [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain)

    2011-12-01

    Purpose: Several studies have been performed to evaluate the usefulness of neoadjuvant treatment using oxaliplatin and fluoropyrimidines for locally advanced rectal cancer. However, preoperative biomarkers of outcome are lacking. We studied the polymorphisms in thymidylate synthase, epidermal growth factor receptor, glutathione S-transferase pi 1 (GSTP1), and several DNA repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 128 rectal cancer patients treated with preoperative chemoradiotherapy. Methods and Materials: Blood samples were obtained from 128 patients with Stage II-III rectal cancer. DNA was extracted from the peripheral blood nucleated cells, and the genotypes were analyzed by polymerase chain reaction amplification and automated sequencing techniques or using a 48.48 dynamic array on the BioMark system. The germline polymorphisms studied were thymidylate synthase, (VNTR/5 Prime UTR, 2R G>C single nucleotide polymorphism [SNP], 3R G>C SNP), epidermal growth factor receptor (Arg497Lys), GSTP1 (Ile105val), excision repair cross-complementing 1 (Asn118Asn, 8092C>A, 19716G>C), X-ray repair cross-complementing group 1 (XRCC1) (Arg194Trp, Arg280His, Arg399Gln), and xeroderma pigmentosum group D (Lys751Gln). The pathologic response, pathologic regression, progression-free survival, and overall survival were evaluated according to each genotype. Results: The Asterisk-Operator 3/ Asterisk-Operator 3 thymidylate synthase genotype was associated with a greater response rate (pathologic complete remission and microfoci residual tumor, 59% in Asterisk-Operator 3/ Asterisk-Operator 3 vs. 35% in Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk-Operator 3; p = .013). For the thymidylate synthase genotype, the median progression-free survival was 103 months for the Asterisk-Operator 3/ Asterisk-Operator 3 patients and 84 months for the Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk

  19. Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit.

    Science.gov (United States)

    Videhult, P; Smedh, K; Lundin, P; Kraaz, W

    2007-06-01

    The aims were to determine agreement between staging of rectal cancer made by magnetic resonance imaging (MRI) and histopathological examination and the influence of MRI on choice of radiotherapy (RT) and surgical procedure. In this retrospective audit, preoperative MRI was performed on 91 patients who underwent bowel resection, with 93% having total mesorectal excision. Tumour stage according to mural penetration, nodal status and circumferential resection margin (mCRM) involvement was assessed and compared with histopathology. Five radiologists interpreted the images. Overall agreement between MRI and histopathology for T stage was 66%. The greatest difficulty was in distinguishing between T1, T2 and minimal T3 tumours. The accuracy for mCRM (MRI) was 86% (78/91),with an interobserver variation between 80% and 100%. In the 13 cases with no agreement between mCRM and pCRM (pathological), seven had long-term RT and nine en bloc resections, indicating that the margins initially were involved with an even higher accuracy for mCRM. Preoperative short-term RT was routine, but based on MRI findings, choice of RT was affected in 29 cases (32%); 17 patients had no RT and 12 long-term RT. The surgical procedure was affected in 17 cases (19%) with planned perirectal en bloc resections in all. CRM was involved (CRM with high accuracy in rectal cancer. MRI could be used as a clinical guidance with high reliability as indicated by the low figures of histopathologically involved CRM.

  20. KRAS Mutation Status and Clinical Outcome of Preoperative Chemoradiation With Cetuximab in Locally Advanced Rectal Cancer: A Pooled Analysis of 2 Phase II Trials

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sun Young; Shim, Eun Kyung [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Yeo, Hyun Yang [Division of Translational and Clinical Research I, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Baek, Ji Yeon [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Hong, Yong Sang [Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Dae Yong [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Division of Translational and Clinical Research I, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Tae Won [Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Jee Hyun [Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Im, Seock-Ah [Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Kyung Hae [Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Chang, Hee Jin, E-mail: heejincmd@yahoo.com [Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Division of Translational and Clinical Research I, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2013-01-01

    Purpose: Cetuximab-containing chemotherapy is known to be effective for KRAS wild-type metastatic colorectal cancer; however, it is not clear whether cetuximab-based preoperative chemoradiation confers an additional benefit compared with chemoradiation without cetuximab in patients with locally advanced rectal cancer. Methods and Materials: We analyzed EGFR, KRAS, BRAF, and PIK3CA mutation status with direct sequencing and epidermal growth factor receptor (EGFR) and Phosphatase and tensin homolog (PTEN) expression status with immunohistochemistry in tumor samples of 82 patients with locally advanced rectal cancer who were enrolled in the IRIX trial (preoperative chemoradiation with irinotecan and capecitabine; n=44) or the ERBIRIX trial (preoperative chemoradiation with irinotecan and capecitabine plus cetuximab; n=38). Both trials were similarly designed except for the administration of cetuximab; radiation therapy was administered at a dose of 50.4 Gy/28 fractions and irinotecan and capecitabine were given at doses of 40 mg/m{sup 2} weekly and 1650 mg/m{sup 2}/day, respectively, for 5 days per week. In the ERBIRIX trial, cetuximab was additionally given with a loading dose of 400 mg/m{sup 2} on 1 week before radiation, and 250 mg/m{sup 2} weekly thereafter. Results: Baseline characteristics before chemoradiation were similar between the 2 trial cohorts. A KRAS mutation in codon 12, 13, and 61 was noted in 15 (34%) patients in the IRIX cohort and 5 (13%) in the ERBIRIX cohort (P=.028). Among 62 KRAS wild-type cancer patients, major pathologic response rate, disease-free survival and pathologic stage did not differ significantly between the 2 cohorts. No mutations were detected in BRAF exon 11 and 15, PIK3CA exon 9 and 20, or EGFR exon 18-24 in any of the 82 patients, and PTEN and EGFR expression were not predictive of clinical outcome. Conclusions: In patients with KRAS wild-type locally advanced rectal cancer, the addition of cetuximab to the chemoradiation with

  1. Effect of preoperative injection of carbon nanoparticle suspension on the outcomes of selected patients with mid-low rectal cancer

    Institute of Scientific and Technical Information of China (English)

    XingMao Zhang; JianWei Liang; Zheng Wang; Jiantao Kou; ZhiXiang Zhou

    2016-01-01

    Background: Carbon nanoparticles show significant lymphatic tropism and can be used to identify lymph nodes surrounding mid‑low rectal tumors. In this study, we analyzed the effect of trans anal injection of a carbon nanoparti‑cle suspension on the outcomes of patients with mid‑low rectal cancer who underwent laparoscopic resection. Methods: We collected the data of 87 patients with mid‑low rectal cancer who underwent laparoscopic resection between November 2014 and March 2015 at Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College. For 35 patients in the experimental group, the carbon nanoparticle suspension was injected transan‑ally into the submucosa of the rectum around the tumor 30 min before the operation; 52 patients in the control group underwent the operation directly without the injection of carbon nanoparticle suspension. We then compared the operation outcomes between the two groups. Results: In the experimental group, the rate of incomplete mesorectal excision was lower than that in the control group, but no significant difference was found (2.9% vs. 7.7%, P = 0.342). The distance between the tumor and thecircumferential resection margin was 5.8 (P = 0.001). The mean number of lymph nodes removed was 28.2 ± 9.4 in the experimental group and 22.7 ± 7.3in the control group (P and 4.5 ± 3.7, respectively (P < 0.001). Three patients in the experimental group received lateral lymph node resec‑tion. Among the three patients, we retrieved three nodes (one stained node) from the first patient, three nodes (two stained nodes) from the second patient, and two nodes (no stained nodes) from the third patient. Conclusions: Injecting a carbon nanoparticle suspension improved the outcomes of patients who underwent laparoscopic resection for mid‑low rectal cancer; it also improved the accuracy of pathologic staging. Moreover, for selected patients, this technique narrowed the scope of lateral lymph node dissection. ± 1

  2. Rectal cancer: a review

    OpenAIRE

    Fazeli, Mohammad Sadegh; Keramati, Mohammad Reza

    2015-01-01

    Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointe...

  3. Role of Adjuvant Chemotherapy in ypT0-2N0 Patients Treated with Preoperative Chemoradiation Therapy and Radical Resection for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, In Ja [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Kim, Dae Yong [Center for Colorectal Cancer, National Cancer Center, Goyang-si (Korea, Republic of); Kim, Hee Cheol [Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Nam Kyu [Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Hyeong-Rok [Department of Surgery, Chonnam National University Hwansun Hospital, Gwangju (Korea, Republic of); Kang, Sung-Bum [Department of Surgery, Seoul National University Bungdang Hospital, Bundang (Korea, Republic of); Choi, Gyu-Seog [Division of Colorectal Cancer Center, Kyungpook National University Medical Center, Daegu (Korea, Republic of); Lee, Kang Young [Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Seon-Hahn [Department of Surgery, Korea University Anam Hospital, Seoul (Korea, Republic of); Oh, Seung Taek [Department of Surgery, Seoul St. Mary Hospital, Catholic University, Seoul (Korea, Republic of); Lim, Seok-Byung; Kim, Jin Cheon [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Oh, Jae Hwan; Kim, Sun Young [Center for Colorectal Cancer, National Cancer Center, Goyang-si (Korea, Republic of); Lee, Woo Yong [Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Jung Bok [Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of); Yu, Chang Sik, E-mail: csyu@amc.seoul.kr [Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul (Korea, Republic of)

    2015-07-01

    Objective: To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. Patients and Methods: A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (−). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. Results: A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (−), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). Conclusions: Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.

  4. Novel Single-Nucleotide Polymorphism Markers Predictive of Pathologic Response to Preoperative Chemoradiation Therapy in Rectal Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin C., E-mail: jckim@amc.seoul.kr [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Ha, Ye J.; Roh, Seon A. [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Cho, Dong H. [Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Graduate School of East-West Medical Science, Kyung Hee University, Gyeoggi-do (Korea, Republic of); Choi, Eun Y. [Department of Surgery, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Kim, Tae W. [Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Department of Internal Medicine, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Jong H. [Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kang, Tae W. [Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon (Korea, Republic of); Kim, Seon Y. [Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon (Korea, Republic of); Kim, Yong S., E-mail: yongsung@kribb.re.kr [Institute of Innovative Cancer Research and Asan Institute for Life Sciences, Asan Medical Center, Seoul (Korea, Republic of); Medical Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon (Korea, Republic of)

    2013-06-01

    Purpose: Studies aimed at predicting individual responsiveness to preoperative chemoradiation therapy (CRT) are urgently needed, especially considering the risks associated with poorly responsive patients. Methods and Materials: A 3-step strategy for the determination of CRT sensitivity is proposed based on (1) the screening of a human genome-wide single-nucleotide polymorphism (SNP) array in correlation with histopathologic tumor regression grade (TRG); (2) clinical association analysis of 113 patients treated with preoperative CRT; and (3) a cell-based functional assay for biological validation. Results: Genome-wide screening identified 9 SNPs associated with preoperative CRT responses. Positive responses (TRG 1-3) were obtained more frequently in patients carrying the reference allele (C) of the SNP CORO2A rs1985859 than in those with the substitution allele (T) (P=.01). Downregulation of CORO2A was significantly associated with reduced early apoptosis by 27% (P=.048) and 39% (P=.023) in RKO and COLO320DM colorectal cancer cells, respectively, as determined by flow cytometry. Reduced radiosensitivity was confirmed by colony-forming assays in the 2 colorectal cancer cells (P=.034 and .015, respectively). The SNP FAM101A rs7955740 was not associated with radiosensitivity in the clinical association analysis. However, downregulation of FAM101A significantly reduced early apoptosis by 29% in RKO cells (P=.047), and it enhanced colony formation in RKO cells (P=.001) and COLO320DM cells (P=.002). Conclusion: CRT-sensitive SNP markers were identified using a novel 3-step process. The candidate marker CORO2A rs1985859 and the putative marker FAM101A rs7955740 may be of value for the prediction of radiosensitivity to preoperative CRT, although further validation is needed in large cohorts.

  5. Effect of time interval between capecitabine intake and radiotherapy on local recurrence-free survival in preoperative chemoradiation for locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeon Joo; Kim, Jong Hoon; Yu, Chang Sik; Kim, Tae Won; Jang, Se Jin; Choi, Eun Kyung; Kim, Jin Cheon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Choi, Won Sik [University of Ulsan College of Medicine, Gangneung (Korea, Republic of)

    2017-06-15

    The concentration of capecitabine peaks at 1–2 hours after administration. We therefore assumed that proper timing of capecitabine administration and radiotherapy would maximize radiosensitization and influence survival among patients with locally advanced rectal cancer. We retrospectively reviewed 223 patients with locally advanced rectal cancer who underwent preoperative chemoradiation, followed by surgery from January 2002 to May 2006. All patients underwent pelvic radiotherapy (50 Gy/25 fractions) and received capecitabine twice daily at 12-hour intervals (1,650 mg/m2/day). Patients were divided into two groups according to the time interval between capecitabine intake and radiotherapy. Patients who took capecitabine 1 hour before radiotherapy were classified as Group A (n = 109); all others were classified as Group B (n = 114). The median follow-up period was 72 months (range, 7 to 149 months). Although Group A had a significantly higher rate of good responses (44% vs. 25%; p = 0.005), the 5-year local recurrence-free survival rates of 93% in Group A and 97% in Group B did not differ significantly (p = 0.519). The 5-year disease-free survival and overall survival rates were also comparable between the groups. Despite the better pathological response in Group A, the time interval between capecitabine and radiotherapy administration did not have a significant effect on survivals. Further evaluations are needed to clarify the interaction of these treatment modalities.

  6. [A Case of Advanced Rectal Cancer in Which Combined Prostate Removal and ISR Using the da Vinci Surgical System with Preoperative Chemotherapy Allowed Curative Resection].

    Science.gov (United States)

    Kawakita, Hideaki; Katsumata, Kenji; Kasahara, Kenta; Kuwabara, Hiroshi; Shigoka, Masatoshi; Matsudo, Takaaki; Enomoto, Masanobu; Ishizaki, Tetsuo; Hisada, Masayuki; Kasuya, Kazuhiko; Tsuchida, Akihiko

    2016-11-01

    A 53-year-old male presented with a chief complaint of dyschezia.Lower gastrointestinal endoscopy confirmed the presence of a type II tumor in the lower part of the rectum, and a biopsy detected a well-differentiated adenocarcinoma.As invasion of the prostate and levator muscle of the anus was suspected on diagnostic imaging, surgery was performed after preoperative chemotherapy.With no clear postoperative complications, the patient was discharged 26 days after surgery. After 24 months, the number of urination ranged from 1 to 6, with a Wexner score of 6 and a mild desire to urinate in the absence of incontinence.At present, the patient is alive without recurrence.When combined with chemotherapy, robotassisted surgery allows the curative resection of extensive rectal cancer involving the suspected invasion of other organs.In this respect, it is likely to be a useful method to conserve anal and bladder function.

  7. Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

    Institute of Scientific and Technical Information of China (English)

    (L)ukasz Liszka; Ewa Zieli(n)ska-Paj(a)k; Jacek Paj(a)k; Dariusz Go(l)ka; Jacek Starzewski; Zbigniew Lorenc

    2007-01-01

    AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy.METHODS: Forty patients at the initial stage cT3NxMO submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5)and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status,ypN.RESULTS: Complete regression (ypTO, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging"and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5.No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG.CONCLUSION: Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients with rectal cancer at the stage of cT3NxMO. There is no unequivocal relationship between "T-downstaging"and TRG and NG. There is some concordance in the assessment of lymph node status with ypT, TRG and NG.TRG and NG are of limited value for the risk assessment of the lymph node involvement.

  8. SU-E-T-311: Dosimetric Comparison of Volumetric Modulated Arc Therapy Plans for Preoperative Radiotherapy Rectal Cancer Using Flattening Filter-Free and Flattening Filter Modes

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, W; Zhang, J; Lu, J; Chen, C [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2015-06-15

    Purpose: To compare the dosimetric difference of volumetric modulated arc therapy(VMAT) for preoperative radiotherapy rectal cancer using 6MV X-ray flattening filter free(FFF) and flattening filter(FF) modes. Methods: FF-VMAT and FFF-VMAT plans were designed to 15 rectal cancer patients with preoperative radiotherapy by planning treatment system(Eclipse 10.0),respectively. Dose prescription was 50 Gy in 25 fractions. All plans were normalized to 50 Gy to 95% of PTV. The Dose Volume Histogram (DVH), target and risk organ doses, conformity indexes (CI), homogeneity indexes (HI), low dose volume of normal tissue(BP), monitor units(MU) and treatment time (TT) were compared between the two kinds of plans. Results: FF-VMAT provided the lower Dmean, V105, HI, and higher CI as compared with FFF-VMAT. The small intestine of D5, Bladder of D5, Dmean, V40, V50, L-femoral head of V40, R-femoral head of Dmean were lower in FF-VMAT than in FFF-VMAT. FF-VMAT had higher BP of V5, but no significantly different of V10, V15, V20, V30 as compared with FFF-VMAT. FF-VMAT reduceed the monitor units(MU) by 21%(P<0.05), as well as the treatment time(TT) was no significantly different(P>0.05), as compared with FFF-VMAT. Conclusion: The plan qualities of FF and FFF VMAT plans were comparable and both clinically acceptable. FF-VMAT as compared with FFF-VMAT, showing better target coverage, some of OARs sparing, the MUs of FFF-VMAT were higher than FF-VMAT, yet were delivered within the same time. This work was supported by the Medical Scientific Research Foundation of Guangdong Procvince (A2014455 to Changchun Ma)

  9. Local radiological staging of rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goh, V.; Halligan, S. E-mail: s.halligan@imperial.ac.uk; Bartram, C.I

    2004-03-01

    Rectal cancer is a common malignancy with a highly variable outcome. Local recurrence is dependent upon tumour stage and surgical technique. The role of pre-operative imaging is to determine which patients may be safely managed by surgery alone and which need additional therapy in order to facilitate surgery and improve outcome. This decision depends on the distinction between those with early and advanced disease. While trans-rectal ultrasound has traditionally been used to answer this question, a role for magnetic resonance imaging (MRI) is increasingly argued. This review will focus on the treatment options for rectal cancer and the clinical questions that subsequently arise for the radiologist to answer.

  10. Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care

    DEFF Research Database (Denmark)

    Achiam, Michael Patrick; Løgager, Vibeke; Lund Rasmussen, Vera;

    2015-01-01

    was to prospectively evaluate the completion rate of preoperative colonic evaluation and the quality of perioperative colonic evaluation using magnetic resonance colonography (MRC) in patients with rectal cancer. MATERIALS AND METHODS: Patients diagnosed with rectal cancer were randomized to either group A: standard...... is a valuable tool and is recommended as part of the standard preoperative evaluation for patients with rectal cancer....

  11. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan; Blomqvist, Lennart; Swift, Ian; Sebag-Montefiore, David J; Tekkis, Paris; Brown, Gina

    2011-04-01

    To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy. Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined "good" prognosis tumors. "Good" prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated. Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.

  12. Preoperative oxaliplatin, capecitabine, and external beam radiotherapy in patients with newly diagnosed, primary operable, cT3NxMo, low rectal cancer. A phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Oefner, Dietmar [Paracelsus Private Medical Univ., Salzburg (Austria). Dept. of Surgery; Innsbruck Medical Univ. (Austria). Dept. of Visceral, Transplant and Thoracic Surgery; DeVries, Alexander F. [Feldkirch Hospital (Austria). Dept. of Radio-Oncology; Schaberl-Moser, Renate [Medical Univ. Graz (AT). Div. of Oncology] (and others)

    2011-02-15

    Purpose: In patients with locally advanced rectal cancer (LARC), preoperative chemoradiation is known to improve local control, and down-staging of the tumor serves as a surrogate for survival. Intensification of the systemic therapy may lead to higher downstaging rates and, thus, enhance survival. This phase II study investigated the efficacy and safety of preoperative capecitabine and oxaliplatin in combination with radiotherapy. Patients and Methods: Patients with LARC of the mid and lower rectum, T3NxM0 staged by MRI received radiotherapy (total dose 45 Gy) in combination with oral capecitabine (825 mg/m{sup 2} twice a day on radiotherapy days; weeks 1-4) and oxaliplatin 50 mg/m{sup 2} intravenously (days 1, 8, 15, and 22). Efficacy was evaluated as rate of tumor down-categorization at the T level. Results: A total of 59 patients were enrolled (19 women, 40 men; median age of 61 years) and all were evaluable for efficacy and toxicity. Down-categorization at the T level was observed in 53% with pathological complete response in 6 patients (10%). Actual total radiotherapy, oxaliplatin and capecitabine doses received were 97%, 90%, and 93% of the protocol-specified preplanned doses, respectively. Grade 3/4 toxicity was observed in 15 patients (25%). The most frequent was diarrhea (12%). Conclusions: Preoperative chemoradiation with capecitabine and oxaliplatin is feasible in patients with MRI-proven cT3 LARC. The only clinically relevant toxicity was diarrhea. Overall, efficacy of the multimodality treatment was good, but not markedly exceeding that of 5-FU- or capecitabine-based chemoradiation approaches. (orig.)

  13. Circumferential resection margin positivity after preoperative chemoradiotherapy based on magnetic resonance imaging for locally advanced rectal cancer: implication of boost radiotherapy to the involved mesorectal fascia.

    Science.gov (United States)

    Kim, Kyung Hwan; Park, Min Jung; Lim, Joon Seok; Kim, Nam Kyu; Min, Byung Soh; Ahn, Joong Bae; Kim, Tae Il; Kim, Ho Geun; Koom, Woong Sub

    2016-04-01

    To identify patients who are at a higher risk of pathologic circumferential resection margin involvement using preoperative magnetic resonance imaging. Between October 2008 and November 2012, 165 patients with locally advanced rectal cancer (cT4 or cT3 with fascia) who received preoperative chemoradiotherapy were analysed. The morphologic patterns on post-chemoradiotherapy magnetic resonance imaging were categorized into five patterns from Pattern A (most-likely negative pathologic circumferential resection margin) to Pattern E (most-likely positive pathologic circumferential resection margin). In addition, the location of mesorectal fascia involvement was classified as lateral, posterior and anterior. The diagnostic accuracy of the morphologic criteria was calculated using receiver operating characteristic curve analysis. Pathologic circumferential resection margin involvement was identified in 17 patients (10.3%). The diagnostic accuracy of predicting pathologic circumferential resection margin involvement was 0.73 using the five-scale magnetic resonance imaging pattern. The sensitivity, specificity, positive predictive value and negative predictive value for predicting pathologic circumferential resection margin involvement were 76.5, 65.5, 20.3 and 96.0%, respectively, when cut-off was set between Patterns C and D. On multivariate logistic regression, the magnetic resonance imaging patterns D and E (P= 0.005) and posterior or lateral mesorectal fascia involvement (P= 0.017) were independently associated with increased probability of pathologic circumferential resection margin involvement. The rate of pathologic circumferential resection margin involvement was 30.0% when the patient had Pattern D or E with posterior or lateral mesorectal fascia involvement. Patients who are at a higher risk of pathologic circumferential resection margin involvement can be identified using preoperative magnetic resonance imaging although the predictability is moderate. © The

  14. Prognostic impact of the lymph node metastatic ratio on 5-year survival of patients with rectal cancer not submitted to preoperative chemoradiation

    Directory of Open Access Journals (Sweden)

    Alfredo Luiz Jacomo

    2011-12-01

    Full Text Available Lymph node metastases are a major prognostic factor in colorectal cancer. Inadequate lymph node resection is related to shorter survival. The lymph nodes ratio (LNR has been used as a prognostic factor in patients with colon cancer. Few studies have evaluated the impact of LNR on the 5-year survival of patients with rectal cancer. OBJECTIVE: To evaluate the impact of LNR on the survival of patients with rectal cancer not submitted to preoperative chemoradiotherapy. METHODS: Ninety patients with rectal cancer excluding colon tumors, synchronous tumors, hereditary colorectal cancer and those undergoing preoperative chemoradiation. The patients were divided into three groups according t Metástases linfonodais representam um dos principais fatores prognósticos no câncer colorretal. A ressecção linfonodal inadequada relaciona-se à menor sobrevida. A proporção entre linfonodos metastáticos (PLM vem sendo utilizada como fator prognóstico em doentes com câncer de cólon. Poucos estudos avaliaram o impacto da PLM na sobrevida de doentes com câncer retal. OBJETIVO: Avaliar o impacto da PLM na sobrevida de doentes com câncer de reto não submetidos à quimioradioterapia pré-operatória. MÉTODOS: Foram incluídos 90 doentes com adenocarcinoma retal excluindo-se tumores de cólon, tumores sincrônicos, câncer colorretal hereditário e aqueles submetidos a tratamento radioquimioterápico pré-operatório. Os doentes foram divididos em três grupos segundo a PLM: PLM-0, sem linfonodos comprometidos; PLM-1, 1 a 20% dos linfonodos comprometidos; e PLM-2, mais de 21% dos linfonodos comprometidos. A identificação do ponto de corte da amostra selecionada foi obtida a partir da curva de características de operação do receptor (curva ROC. A sobrevida foi avaliada pelo teste de Kaplan-Meier, a diferença entre os grupos pelo teste de Cox-Mantel e a correlação entre as variáveis pelo teste de Pearson, adotando-se um nível de significância de 5

  15. MRI and Diffusion-Weighted MRI Volumetry for Identification of Complete Tumor Responders After Preoperative Chemoradiotherapy in Patients With Rectal Cancer: A Bi-institutional Validation Study.

    NARCIS (Netherlands)

    Lambregts, Doenja M J; Rao, Sheng-Xiang; Sassen, Sander; Martens, Milou H; Heijnen, Luc a; Buijsen, Jeroen; Sosef, Meindert; Beets, Geerard L; Vliegen, Roy a; Beets-Tan, Regina G H

    2015-01-01

    BACKGROUND:: Retrospective single-center studies have shown that diffusion-weighted magnetic resonance imaging (DWI) is promising for identification of patients with rectal cancer with a complete tumor response after neoadjuvant chemoradiotherapy (CRT), using certain volumetric thresholds.\

  16. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome.

    Science.gov (United States)

    Pucciarelli, Salvatore; Toppan, Paola; Friso, Maria Luisa; Russo, Valentina; Pasetto, Lara; Urso, Emanuele; Marino, Filippo; Ambrosi, Alessandro; Lise, Mario

    2004-11-01

    The aim of this study was to evaluate factors associated with pathologic tumor response following pre-operative chemoradiation therapy, and the prognostic impact of pathologic response on overall and disease-free survival. Between 1994 and 2002, 132 patients underwent chemoradiation therapy followed by surgery for middle to lower rectal cancer. After excluding 26 cases (metastatic cancer, n = 13; nonradical surgery, n = 6; local excision procedure, n = 4; non-5-fluorouracil-based chemotherapy, n = 2; incomplete data on preoperative chemoradiation therapy regimen used, n = 1), the remaining 106 patients were included in the study. Variables considered were the following: age, gender, tumor location, pretreatment T and N stage, modality of 5-fluorouracil administration, total radiotherapy dose delivered, chemoradiation therapy regimen used (Regimen A: chemotherapy (bolus of 5-fluorouracil and leucovorin, days 1-5 and 29-33) + radiotherapy (45 Gy/25 F/1.8 Gy/F); Regimen B: chemotherapy (5-fluorouracil continuous venous infusion +/- weekly bolus of carboplatin or oxaliplatin) + radiotherapy (50.4 Gy/28 F/1.8 Gy/F)), time interval between completion of chemoradiation therapy and surgery, postoperative chemotherapy administration, surgical procedures, pT, pN, and pTNM stage, and response to chemoradiation therapy defined as tumor regression grade, scored from 1 (no tumor on surgical specimen) to 5 (absence of regressive changes). Statistical analysis was performed by means of logistic regression analysis (Cox's model for overall and disease-free survival). Median age of the 106 patients was 60 (range, 31-79) years and the male:female ratio, 66:40. Median distance of tumor from the anal verge was 6 (range, 1-11) cm. Pretreatment TNM stage, available in 104 patients, was cT3T4N0, n = 41; cT2N1, n = 9; cT3N1, n = 39; and cT4N1, n = 17. The median radiotherapy dose delivered was 50.4 (range, 40-56) Gy; 58 patients received 5-fluorouracil by continuous venous infusion, and

  17. Clinical study of suppository delivery of 5-fluorouracil and pathological effects on metastatic lymph nodes caused by preoperative combined treatment with radiation, intraluminal hyperthermia and 5-fluorouracil suppository in rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Takaaki [Kyoto Prefectural Univ. of Medicine (Japan)

    1997-11-01

    Preoperative combined treatment with radiation, intraluminal hyperthermia, and 5-fluorouracil (5-FU) suppository has been reported effective in shrinking locally advanced rectal cancers and facilitating subsequent surgery. Suppository and intravenous 5-FU administration were compared with respect to tissue concentrations in rectal cancer cases. Just before the operation patients received 100 mg of 5-FU via suppository or intravenously. Portal and systemic blood, tumor tissue, normal mucosa and muscle layer separately at 5, 10, 15 cm in the oral direction from the tumor and the pararectal lymph node were harvested for high-performance liquid chromatography determination of 5-FU concentrations. Rectal 5-FU concentrations were significantly higher in the suppository cases compared with the intravenously administrated ones. Suppository distributed more 5-FU at pararectal lymph nodes than intravenous injection. This fact revealed 5-FU suppositories to be a useful drug delivery system for rectal cancer. The pathological effects on metastatic lymph nodes caused by combined treatment were evaluated in 22 cases. Normal lymph nodes showed congestion only. Fibrotic and necrotic changes were characteristic of damaged metastatic areas. In 6 cases (27.3%), no metastatic cells were detected on fibrotically changed areas. The down staging of the lymph node metastatic factor was carried out by preoperative combined treatment. High concentrations of 5-FU at mucosa could suggest the usefulness of 5-FU suppository administration just before operation for prevention of suture-line implantation. (author)

  18. Preoperative Chemoradiotherapy with Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer. A Phase I–II Multicenter Study of the Dutch Colorectal Cancer Group

    Science.gov (United States)

    Punt, Cornelis J. A.; Tesselaar, Margot E.; Cats, Annemieke; Havenga, Klaas; Leer, Jan W. H.; Marijnen, Corrie A.; Jansen, Edwin P.; Van Krieken, Han H. J. M.; Wiggers, Theo; Van de Velde, Cornelis J. H.; Mulder, Nanno H.

    2007-01-01

    Background We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer. Methods T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabine of 1000 mg/m2 twice daily (days 1–14, 25–38) added to RT with 50.4 Gy and surgery after 6–8 weeks. The MTD, determined during phase I, was used in the subsequent phase II, in which R0 resection rate (a negative circumferential resection margin) was the primary end point. Results Twenty-one patients were evaluable. In the phase I part, oxaliplatin at 85 mg/m2 was established as MTD. In phase II, the main toxicity was grade III diarrhea (18%). All patients underwent surgery, and 20 patients had a resectable tumor. An R0 was achieved in 17/21 patients, downstaging to T0-2 in 7/21 and a pCR in 2/21. Conclusion Combination of Capox-RT has an acceptable acute toxicity profile and a high R0 resection rate of 81% in locally advanced rectal cancer. However the pCR rate was low. PMID:17653805

  19. Management of locally advanced primary and recurrent rectal cancer

    NARCIS (Netherlands)

    J.H.W. de Wilt (Johannes); M. Vermaas (Maarten); F.T.J. Ferenschild (Floris); C. Verhoef (Kees)

    2007-01-01

    textabstractTreatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality

  20. Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy.

    Science.gov (United States)

    Shimada, Yoshifumi; Takii, Yasumasa; Maruyama, Satoshi; Ohta, Tamaki

    2011-12-01

    The current Japanese general rules for clinical and pathologic studies on cancer of the colon, rectum, and anus state that a 3-cm distal resection margin is needed in resecting rectosigmoid cancer and rectal cancer with a distal edge above the peritoneal reflection, and 2 cm is needed for rectal cancer with a distal edge below the peritoneal reflection. The appropriateness of these rules has not been proved. Our aim was to evaluate the appropriateness of the Japanese rules. We retrospectively analyzed surgical and pathology records of patients who underwent surgery at a tertiary care cancer center in Japan. The study included 381 consecutive patients with stage I to IV rectosigmoid or rectal cancer without preoperative chemotherapy or radiotherapy. We investigated both intramural and mesorectal distal spread, using whole-mount sections to measure the maximum length of distal spread. Long distal spread was defined as distal spread longer than the distal resection margin stated in the Japanese general rules. Risk factors for both distal spread and long distal spread were evaluated. Of 381 patients, 325 (85.3%) had no distal spread and a total of 56 (14.7%) had distal spread. Distal spread was within the limits specified by the Japanese general rules in 48 of the 381 patients (12.6%) and beyond the Japanese limits (long distal spread) in 8 patients (2.1%). The prevalence of distal spread increased with TNM stage (stage I, 2.7%; stage II, 5.3%; stage III, 17.4%; stage IV, 46.2%). Long distal spread was not observed in stage I or II, was found in only 1.4% of patients with stage III disease and in 11.5% of patients with stage IV. The maximum extent of distal spread in patients with rectosigmoid cancer or rectal cancer with the distal edge above the peritoneal reflection was 38 mm; in patients with rectal cancer with the distal edge below the peritoneal reflection, 35 mm. Multivariable analyses showed that nodal involvement and distant metastasis were independent risk

  1. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, W.M.; Million, R.R.; Bland, K.I.; Pfaff, W.W.; Copeland, E.M. 3d.

    1987-01-01

    This is an analysis of 23 patients with clinically and/or surgically unresectable adenocarcinoma of the rectum on initial evaluation who were treated with preoperative irradiation and surgery between March 1970 and April 1981. All patients have had follow-up for at least 5 years. Five patients (22%) had exploratory laparotomy and diverting colostomy before irradiation. All patients were irradiated with megavoltage equipment to the pelvis at 180 rad/fraction, continuous-course technique. Total doses ranged from 3500 to 6000 rad with a mean of 4800 rad and a median of 5000 rad. All patients had surgery 2-11 weeks (mean: 4.9 weeks; median: 4 weeks) after radiation therapy. Twelve patients (52%) had lesions that were incompletely resected because of positive margins (7 patients), distant metastasis (1 patient), or both (4 patients). All of these patients died of cancer within 5 years of treatment. Eleven patients had an apparent complete excision of their rectal cancer; six patients (55%) subsequently had a local recurrence. The 5-year absolute survival rate for patients who had complete resection was 18% (2 of 11 patients). The 5-year absolute and determinate survival rates for the entire study were 9% (2 of 23 patients) and 9% (2 of 22 patients), respectively. One patient (in the incomplete resection group) died after operation secondary to sepsis and diffuse intravascular coagulation.

  2. Locally advanced rectal cancer: management challenges

    Directory of Open Access Journals (Sweden)

    Kokelaar RF

    2016-10-01

    Full Text Available RF Kokelaar, MD Evans, M Davies, DA Harris, J Beynon Department of Colorectal Surgery, Singleton Hospital, Swansea, UK Abstract: Between 5% and 10% of patients with rectal cancer present with locally advanced rectal cancer (LARC, and 10% of rectal cancers recur after surgery, of which half are limited to locoregional disease only (locally recurrent rectal cancer. Exenterative surgery offers the best long-term outcomes for patients with LARC and locally recurrent rectal cancer so long as a complete (R0 resection is achieved. Accurate preoperative multimodal staging is crucial in assessing the potential operability of advanced rectal tumors, and resectability may be enhanced with neoadjuvant therapies. Unfortunately, surgical options are limited when the tumor involves the lateral pelvic sidewall or high sacrum due to the technical challenges of achieving histological clearance, and must be balanced against the high morbidity associated with resection of the bony pelvis and significant lymphovascular structures. This group of patients is usually treated palliatively and subsequently survival is poor, which has led surgeons to seek innovative new solutions, as well as revisit previously discarded radical approaches. A small number of centers are pioneering new techniques for resection of beyond-total mesorectal excision tumors, including en bloc resections of the sciatic notch and composite resections of the first two sacral vertebrae. Despite limited experience, these new techniques offer the potential for radical treatment of previously inoperable tumors. This narrative review sets out the challenges facing the management of LARCs and discusses evolving management options. Keywords: rectal cancer, exenteration, pelvic sidewall, sacrectomy

  3. Long-term quality of life in patients with rectal cancer treated with preoperative (chemo)-radiotherapy within a randomized trial; Evaluation a long terme de la qualite de vie de patients atteints de cancer rectal apras (chimio) radiotherapie dans un essai controle

    Energy Technology Data Exchange (ETDEWEB)

    Tiv, M.; Puyraveau, M.; Mercier, M.; Bosset, J.F. [EA3181, Besancon University Hospital, University of Franche-Comte, 25 - Besancon (France); Puyraveau, M. [Clinical Research Management Unit, Besancon University Hospital, 25 - Besancon (France); Mineur, L. [Department of Radiation Therapy, Clinic Sainte-Catherine, 84 - Avignon (France); Calais, G. [Department of Radiation Therapy, University Francois-Rabelais, 37 - Tours (France); Maingon, P. [Department of Radiation Therapy, Cancer Center Dijon, 21 - Dijon (France); Bardet, E. [Department of Radiation Therapy, centre Rene-Gauducheau, 44 - Nantes-Saint-Herblain (France); Mercier, M.; Bosset, J.F. [Department of Radiation Therapy, Besancon University Hospital, 25 - Besancon (France)

    2010-10-15

    Purpose: Few studies have evaluated the quality of life (QoL) of patients with rectal cancer. This report describes the quality of life of French patients who entered the 22921 EORTC trial that investigated the role and place of chemotherapy (CT) added to preoperative radiotherapy (preop-RT). Patients and Methods: Patients without recurrences were evaluated with EORTC QLQ-C30 and QLQ-CR38 questionnaires, after a median time of 4.6 years from randomization. Results: All the scores of QLQ-C30 functions were high, from 78 up to 88, with those of global health quality of life scale (GHQL) status being 73. The mean scores of symptoms were low except for diarrhea. For QLQ-CR38, the mean scores for 'body image' and 'future perspective' were high at 79.6 and 69.7 respectively. The scores for 'sexual functioning' and 'enjoyment' were low. Men had more sexual problems than females (62.5 vs 25 mean scores respectively). Chemotherapy was associated with more diarrhea complaints, lower 'role', lower 'social functioning' and lower global health quality of life scale. Conclusion: The overall quality of life of patients with rectal cancer is quite good 4.6 years after the beginning preoperative treatments. However, adding chemotherapy to preoperative radiotherapy has a negative effect on diarrhea complaints and some quality of life dimensions. (authors)

  4. [Neoadjuvant and surgical treatment for rectal cancer].

    Science.gov (United States)

    Rödel, Claus; Knoefel, Wolfram Trudo; Schlitt, Hans J; Staib, Ludger; Höhler, Thomas

    2009-01-01

    According to the 2008 guidelines on colorectal cancer, whether preoperative therapy is indicated for rectal cancer should be judged based on the T and N categories. A few centres limit the indication for preoperative radio(chemo)therapy to patients with tumours that, according to magnetic resonance tomography (MRT), extend to the fascia mesorectalis or are 1 mm or less away from it - so-called circumferential resection margin-positive or CRM-positive tumours. Omitting preoperative therapy for MRT CRM-negative tumours is, however, a matter that still requires further study in clinical trials. The high rate of distant metastases continues to be a problem. Assuming that pathohistological complete remission (pCR) is a predictive marker of long-term disease-free survival after neoadjuvant radiochemotherapy, attempts are now being undertaken to intensify the neoadjuvant therapy. Phase II trials show improved pCR rates by combining the preoperative radiation with the double combinations oxaliplatin or irinotecan plus infusional or oral 5-FU (capecitabine). In the case of limited T1 rectal cancer without further risk factors, transanal local excision can be used.

  5. Radiotherapy and local control in rectal cancer.

    Science.gov (United States)

    Valentini, V; Rosetto, M E; Fares, C; Mantini, G; Salvi, G; Turriziani, A

    1998-01-01

    Recurrence is a stage in the natural history of rectal cancer. Preoperative radiotherapy or postoperative radiochemotherapy lower the rate of recurrence, improving local control. From 1980 to 1997, at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 380 patients with rectal cancer of early clinical stage T2-3, candidates for surgery for cure, underwent radiation therapy. 119 patients underwent postoperative radiotherapy (45-50 Gy); 45 patients underwent "sandwich" radiotherapy (45 Gy:27 Gy before and 28 Gy after surgery), of whom 7 were treated with preoperative radiotherapy alone; 145 patients underwent preoperative concomitant radiochemotherapy according to 3 different protocols, radiotherapy (38 Gy) combined with mitomycin C and 5-FU; radiotherapy (50.4 Gy) combined with cisplatin and 5-FU; radiotherapy (45 Gy) combined with 5-FU and folinic acid. 71 patients were treated with preoperative radiotherapy (38 Gy) combined with IORT (10 Gy). Median follow-up was 6 years. Overall local control was 85% at 3 years, 83% at 5 years, 81% at 10 years. The rate of local control at 5 years was: 76% for postoperative radiotherapy, 83% for "sandwich" radiotherapy, 84% for preoperative radiochemotherapy and 93% for preoperative radiotherapy combined with IORT. Local control was shown to be significantly better with preoperative treatment as compared to postoperative treatment (p = 0.02). The incidence of metastases was 35% in the patients with local recurrence and 16% in those with local control. The difference in survival was highly significant in patients with local control as compared to those with local recurrence: at 5 years 87% and 32% respectively. Patients with local control showed a lower incidence of metastasis and a better survival.

  6. Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Hong Il [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Hallym University Medical Center, Hallym University Sacred Heart Hospital, Department of Radiology, Anyang-si, Gyeonggi-do (Korea, Republic of); Kim, Ah Young; Park, Seong Ho; Ha, Hyun Kwon [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Yu, Chang Sik [University of Ulsan College of Medicine, Asan Medical Center, Department of Colon and Rectal Surgery, Seoul (Korea, Republic of)

    2013-12-15

    To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects. One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm{sup 2}) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC{sub 150-1000} were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis. DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (A{sub z} = 0.910) was superior to that of T2-weighed MR tumour volumetry (A{sub z} = 0.792) and post-CRT ADC (A{sub z} = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively. DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC. (orig.)

  7. Morbidity and Mortality Following Short Course Preoperative Radiotherapy in Rectal Carcinoma

    Directory of Open Access Journals (Sweden)

    Farshid Farhan

    2015-10-01

    Full Text Available The aim of this study was to evaluate the morbidity and mortality in patients with operable stage II and III rectal cancers within one or two months after surgery, who has been treated pre-operatively with short course radiotherapy. Twenty-eight patients with rectal adenocarcinoma, consecutively referred to the Cancer Institute of Imam Khomeini Hospital from March 2009 to March 2010, were selected for the study after staging by endorectal ultrasound and CT of abdomen, pelvis, and chest; and if they had inclusion criteria for short course schedule, they were treated with radiotherapy alone at 2500 cGy for 5 sessions, and then they were referred to the surgical service for operation one week later. They were visited there by a surgeon unaware of the research who completed a questionnaire about pre-operative, operative, and post-operative complications. Of 28 patients, 25 patients underwent either APR or LAR surgery with TME. One patient developed transient anal pain grade I and one patient had dysuria grade I; they were improved in subsequent follow-up. Short course schedule can be performed carefully in patients with staged rectal cancer without concerning about serious complications. This shorter treatment schedule is cost-effective and would be more convenient for patients due to fewer trips to the hospital and the main treatment, i.e. operating the patient, will be done with the shortest time the following diagnosis.

  8. Treatment of locally advanced rectal cancer

    NARCIS (Netherlands)

    Klaassen, RA; Nieuwenhuijzen, GAP; Martijn, H; Rutten, HJT; Hospers, GAP; Wiggers, T

    2004-01-01

    Historically, locally advanced rectal cancer is known for its dismal prognosis. The treatment of locally advanced rectal cancer is subject to continuous change due to development of new and better diagnostic tools, radiotherapeutic techniques, chemotherapeutic agents and understanding of the

  9. Significance of Magnetic Resonance Imaging-Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation.

    Science.gov (United States)

    Fayaz, Mohamed Salah; Demian, Gerges Attia; Fathallah, Wael Moftah; Eissa, Heba El-Sayed; El-Sherify, Mustafa Shawki; Abozlouf, Sadeq; George, Thomas; Samir, Suzanne Mona

    2016-08-01

    To study the predictive and prognostic value of magnetic resonance imaging (MRI)-assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery.

  10. Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation

    Science.gov (United States)

    Fayaz, Mohamed Salah; Demian, Gerges Attia; Fathallah, Wael Moftah; Eissa, Heba El-Sayed; Abozlouf, Sadeq; George, Thomas; Samir, Suzanne Mona

    2016-01-01

    Purpose To study the predictive and prognostic value of magnetic resonance imaging (MRI)–assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. Methods This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. Results In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). Conclusion MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery. PMID:28717704

  11. COMPARISON OF PREOPERATIVE RECTAL DICLOFENAC AND RECTAL PARACETAMOL FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Ketaki

    2014-01-01

    Full Text Available Acute postoperative pain has adverse effects on the patients moral as well as various physiological functions of the body. We conducted a prospective randomized study to compare the efficacy of preoperative rectal diclofenac and paracetamol for postoperative analgesia in pediatric age group. Sixty children (3 – 13 yrs. undergoing minor surgical procedures were randomly alloc ated into 2 groups, group I comprising of 30 children who received diclofenac suppository post induction and group II comprising of 30 children who received paracetamol suppository post induction. Pain was assessed by the “Hanallah pain scale” which catego rizes pain based on 5 parameters, viz, systolic blood pressure, crying, movements, agitation (confused, excited, and complaints of pain 1 . We concluded that though both, diclofenac sodium and paracetamol are good postoperative analgesics when given by rect al route in pediatric patients undergoing minor surgeries, diclofenac sodium provides better analgesia than paracetamol when given by rectal route in pediatric patients.

  12. Proforma-based reporting in rectal cancer.

    Science.gov (United States)

    Taylor, F; Mangat, N; Swift, I R; Brown, G

    2010-10-04

    The improvements in outcomes associate with the use of preoperative therapy rather than postoperative treatment means that clinical teams are increasingly reliant on imaging to identify high-risk features of disease to determine treatment plans. For many solid tumours, including rectal cancer, validated techniques have emerged in identifying prognostic factors pre-operatively. In the MERCURY study, a standardised scanning technique and the use of reporting proformas enabled consistently accurate assessment and documentation of the prognostic factors. This is now an essential tool to enable our clinical colleagues to make treatment decisions. In this review, we describe the proforma-based reporting tool that enables a systematic approach to the interpretation of the magnetic resonance images, thereby enabling all the clinically relevant features to be adequately assessed.

  13. Value of intraoperative radiotherapy in locally advanced rectal cancer

    NARCIS (Netherlands)

    Ferenschild, Floris T. J.; Vermaas, Maarten; Nuyttens, Joost J. M. E.; Graveland, Wilfried J.; Marinelli, Andreas W. K. S.; van der Sijp, Joost R.; Wiggers, Theo; Verhoef, Cornelis; Eggermont, Alexander M. M.; de Wilt, Johannes H. W.

    2006-01-01

    PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable an

  14. The result of implementation of multidisciplinary teams in rectal cancer

    DEFF Research Database (Denmark)

    Wille-Jørgensen, Peer; Sparre, Peter; Glenthøj, Anders

    2013-01-01

    , postoperative mortality, local recurrence, distant recurrence and over-all and disease-free survival. Results:  811 patients were diagnosed with primary rectal cancer in Hvidovre and Bispebjerg Hospitals 1.5.2001-31.8.2006. The frequency of preoperative MRI scans increased in the MDT cohort and perioperative...

  15. Patient factors may predict anastomotic complications after rectal cancer surgery

    Directory of Open Access Journals (Sweden)

    Dana M. Hayden

    2015-03-01

    Conclusion: Our study identifies preoperative anemia as possible risk factor for anastomotic leak and neoadjuvant chemoradiation may lead to increased risk of complications overall. Further prospective studies will help to elucidate these findings as well as identify amenable factors that may decrease risk of anastomotic complications after rectal cancer surgery.

  16. Does the addition of oxaliplatin to preoperative chemoradiation benefit cT4 or fixed cT3 rectal cancer treatment? A subgroup analysis from a prospective study.

    Science.gov (United States)

    Wiśniowska, K; Nasierowska-Guttmejer, A; Polkowski, W; Michalski, W; Wyrwicz, L; Pietrzak, L; Rutkowski, A; Malinowska, M; Kryński, J; Kosakowska, E; Zwoliński, J; Winiarek, M; Olędzki, J; Kuśnierz, J; Zając, L; Bednarczyk, M; Szczepkowski, M; Tarnowski, W; Paśnik, K; Radziszewski, J; Partycki, M; Bęczkowska, K; Styliński, R; Wierzbicki, R; Bury, P; Jankiewicz, M; Paprota, K; Lewicka, M; Ciseł, B; Skórzewska, M; Mielko, J; Danek, A; Nawrocki, G; Sopyło, R; Kępka, L; Bujko, K

    2016-12-01

    Whether there is any benefit derived from adding oxaliplatin to fluoropyrimidine-based preoperative chemoradiation is currently unknown in cases of advanced cT3 or cT4 tumours. Our aim was to evaluate this issue by analysing a randomized trial, which compared two schedules of preoperative treatment (chemoradiation vs. 5 × 5 Gy with 3 cycles of consolidation chemotherapy) for cT4 or fixed cT3 rectal cancer. Delivery of oxaliplatin was mandatory to the first part of the study. For the second part, its delivery in both treatment-assigned groups was left to the discretion of the local investigator. We analysed a subgroup of 272 patients (136 in the oxaliplatin group and 136 in the fluorouracil-only group) from institutions that had omitted oxaliplatin in the second part of the study. Circumferential resection margin negative (CRM-) status rate was 68% in the oxaliplatin group and 70% in the fluorouracil-only group, p = 0.72. The pathological complete response rate (pCR) was correspondingly 14% vs. 7%, p = 0.10. Following multivariable analysis, when comparing the CRM- status in the oxaliplatin group to the fluorouracil-only group, the odds ratio was 0.79 (95 CI 0.35-1.74), p = 0.54; there being no interaction between concomitant chemoradiation and 5 × 5 Gy with consolidation chemotherapy; pinteraction = 0.073. For pCR, the corresponding results were 0.47 (95 CI 0.19-1.16), p = 0.10, pinteraction = 0.84. No benefit was found of adding oxaliplatin in terms of CRM nor pCR rates for either concomitant or sequential settings in preoperative radiochemotherapy for very advanced rectal cancer. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  17. [The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

    Science.gov (United States)

    Grande, M; Danza, F M

    1999-01-01

    The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

  18. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience

    DEFF Research Database (Denmark)

    Rafaelsen, Søren R; Sørensen, Torben; Jakobsen, Anders

    2008-01-01

    OBJECTIVE: To evaluate the effect of experience on preoperative staging of rectal cancer using magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). MATERIAL AND METHODS: From January 2002 to May 2006, 134 consecutive patients with biopsy-proven rectal cancer were examined with a 1....... In addition to this supervision, the person responsible for staging should be trained through a defined training programme....

  19. Clinical Diagnostic Value of Endoluminal Ultrasound on the Preoperative Staging of Rectal Cancer%腔内超声对直肠癌术前分期的诊断价值

    Institute of Scientific and Technical Information of China (English)

    乔晓玲; 张新源

    2012-01-01

    目的 探讨腔内超声(Endoluminal ultrasound,ELUS)对术前直肠癌分期评价的临床应用价值.方法 对69例直肠癌患者术前进行ELUS检查进行术前分期诊断,并且与术后病理诊断进行对照.结果 术前ELUS检查T1期诊断正确率为93.33%(14/15),T2期为83.33%(15/18),T3期为74.07% (20/27),T4期为66.67% (6/9).ELUS诊断正确率为79.71%(55/69).ELUS对转移淋巴结诊断总正确率为65.22% (45/69),灵敏度为76.19%,特异度为61.71%.结论 ELUS对于直肠癌癌组织的浸润程度以及周围转移淋巴结诊断与术后病理诊断的正确率较高,有希望成为直肠癌术前分期的有效方法.%Objective To study the clinical value of endoluminal ultrasound (ELUS) in the preoperative staging of rectal cancer. Methods 69 cases of rectal cancer were examined with ELUS before surgery for preoperative staging and compared with the postoperative pathological diagnosis. Results The accuracy of T1, T2, T3, T4 stage of ELUS were 93. 33% (14/15), 83. 33% (15/18), 74. 07% (20/27) ,66. 67% (6/ 9), the overall accuracy of T stage of ELUS was 79. 71%(55/69). The accuracy, sensitivity and specificity of ELUS in lymph node metastasis were 79. 71%, 76.19% and 61. 71%. Conclusion ELUS should become effective method in the preoperative assessment of depth of tumor invasion and lymph node metastasis compared with pathological diagnosis.

  20. PET-MRI in Diagnosing Patients With Colon or Rectal Cancer

    Science.gov (United States)

    2015-11-25

    Recurrent Colon Cancer; Recurrent Rectal Cancer; Stage IIA Colon Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

  1. NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu [Massachusetts General Hospital, Boston, Massachusetts (United States); Moughan, Jennifer [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Garofalo, Michael C. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Bendell, Johanna [Sarah Cannon Research Institute, Nashville, Tennessee (United States); Berger, Adam C. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Oldenburg, Nicklas B.E. [North Main Radiation Oncology, Providence, Rhode Island (United States); Anne, Pramila Rani [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Perera, Francisco [London Regional Cancer Program/Western Ontario, London, Ontario (Canada); Lee, R. Jeffrey [Intermountain Medical Center, Salt Lake City, Utah (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Nowlan, Adam [Piedmont Hospital, Atlanta, Georgia (United States); DeNittis, Albert [Main Line Community Clinical Oncology Program, Wynnewood, Pennsylvania (United States); Crane, Christopher [University of Texas-MD Anderson Cancer Center, Houston, Texas (United States)

    2015-09-01

    Purpose: To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. Methods and Materials: Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). Results: Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. Conclusion: The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

  2. Significance of thermoradiotherapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ike, Hideyuki; Fukano, Masahiko; Yamaguchi, Sigeki [Yokohama City Univ. (Japan). School of Medicine] [and others

    1997-05-01

    In patients with rectal cancer, results of 27 cases receiving thermoradiotherapy and of 68 cases, radiotherapy before operation were compared with those of 119 cases receiving expanded radical operation. Radiotherapy was done with 10 MV X-ray generated by linear-accelerator at 2.0 Gy x 5/week and 60 Gy in total. Hyperthermotherapy was performed with the capacitive heating method with 8 MHz radiofrequency (Thermotoron RF8) twice/week x 5. Every thermotherapy was done for 40 min at 42degC-43degC within 1 hr after the radiotherapy. Good results were observed in cases whose cancer was disappeared by either preoperative therapy. However, results in survival and recurrence rates were not always improved when compared with those receiving surgery alone. (K.H.)

  3. Modern management of rectal cancer: A 2006 update

    Institute of Scientific and Technical Information of China (English)

    Glen C Balch; Alex De Meo; Jose G Guillem

    2006-01-01

    The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and NO), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection.Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1NOM0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended.In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases,preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered,including: (1) total mesorectal excision (TME); (2)autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin;(5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7)postoperative quality

  4. Sentinel node detection after preoperative short-course radiotherapy in rectal carcinoma is not reliable

    NARCIS (Netherlands)

    Braat, AE; Moll, FCP; de Vries, JE; Wiggers, T

    2005-01-01

    Background: Seninel node (SN) detection may be used in patients with colonic carcinoma. However, its use in patients with rectal carcinoma may be unreliable. To address this, SN detection was evaluated in patients with rectal carcinoma after short-course preoperative radiotherapy. Methods: Patent Bl

  5. PROGNOSTIC FACTORS ANALYSIS FOR STAGEⅠ RECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    武爱文; 顾晋; 薛钟麒; 王怡; 徐光炜

    2001-01-01

    To explore the death-related factors of stageⅠrectal cancer patients. Methods: 89 cases of stage I rectal cancer patients between 1985 and 2000 were retrospectively studied for prognostic factors. Factors including age, gender, tumor size, circumferential occupation, gross type, pathological type, depth of tumor invasion, surgical procedure, adjuvant chemotherapy and postoperative complication were chosen for cox multivariate analysis (forward procedure) using Spss software (10.0 version). Results: multivariate analysis demonstrated that muscular invasion was an independent negative prognostic factor for stageⅠrectal cancer patients (P=0.003). Conclusion: Muscular invasion is a negative prognostic factor for stage I rectal cancer patients.

  6. Current trends in staging rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Abdus Samee; Chelliah Ramachandran Selvasekar

    2011-01-01

    Management of rectal cancer has evolved over the years.In this condition preoperative investigations assist in deciding the optimal treatment.The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis.Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection.Endoanal ultrasound (EUS) is useful for tumor (T) staging;hence EUS is a useful imaging modality for early rectal cancer.Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence.Computerized tomography (CT) of the chest,abdomen and pelvis is used to rule out distant metastasis.Identification of the malignant nodes using EUS,CT and MRI is based on the size,morphology and internal characteristics but has drawbacks.Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor.In this situation,EUS and MRI may provide complementary information to decide further treatment.Functional imaging using positron emission tomography (PET) is useful,particularly PET/CT fusion scans to identify areas of the functionally hot spots.In the current state,imaging has enabled the multidisciplinary team of surgeons,oncologists,radiologists and pathologists to decide on the patient centered management of rectal cancer.In future,functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

  7. Rectal cancer surgery: volume-outcome analysis.

    LENUS (Irish Health Repository)

    Nugent, Emmeline

    2010-12-01

    There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.

  8. Drugs Approved for Colon and Rectal Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for use in colon cancer and rectal cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters.

  9. Preoperative anemia in colon cancer: assessment of risk factors.

    Science.gov (United States)

    Dunne, James R; Gannon, Christopher J; Osborn, Tiffany M; Taylor, Michelle D; Malone, Debra L; Napolitano, Lena M

    2002-06-01

    Anemia is common in cancer patients and is associated with reduced survival. Recent studies document that treatment of anemia with blood transfusion in cancer patients is associated with increased infection risk, tumor recurrence, and mortality. We therefore investigated the incidence of preoperative anemia in colorectal cancer and assessed risk factors for anemia. Prospective data were collected on 311 patients diagnosed with colorectal cancer over a 6-year period from 1994 through 1999. Patients were stratified by age, gender, presenting complaint, preoperative hematocrit, American Joint Committee on Cancer (AJCC) stage, and TNM classification. Discrete variables were compared using Pearson's Chi-square analysis. Continuous variables were compared using Student's t test. Differences were considered significant when P colon cancer with an incidence of 57.6 per cent followed by left colon cancer (42.2%) and rectal cancer (29.8%). Patients with right colon cancer had significantly lower preoperative hematocrits compared with left colon cancer (33 +/- 8.5 vs 36 +/- 7.4; P rectal cancer (33 +/- 8.5 vs 38 +/- 6.0; P colon cancer also had significantly increased stage at presentation compared with left colon cancer (2.3 +/- 1.3 vs 2.1 +/- 1.2; P cancer. We conclude that there is a high incidence of anemia in patients with colon cancer. Patients with right colon cancer had significantly lower preoperative hematocrits and higher stage of cancer at diagnosis. Complete colon evaluation with colonoscopy is warranted in patients with anemia to improve earlier diagnosis of right colon cancer. A clinical trial of preoperative treatment of anemic colorectal cancer patients with recombinant human erythropoietin is warranted.

  10. Lifetime costs of colon and rectal cancer management in Canada.

    Science.gov (United States)

    Maroun, Jean; Ng, Edward; Berthelot, Jean-Marie; Le Petit, Christel; Dahrouge, Simone; Flanagan, William M; Walker, Hugh; Evans, William K

    2003-01-01

    Colorectal cancer is the second leading cause of cancer-related mortality among Canadians. We derived the direct health care costs associated with the lifetime management of an estimated 16,856 patients with a diagnosis of colon and rectal cancer in Canada in 2000. Information on diagnostic approaches, treatment algorithms, follow-up and care at disease progression was obtained from various databases and was integrated into Statistics Canada's Population Health Model (POHEM) to estimate lifetime costs. The average lifetime cost (in Canadian dollars) of managing patients with colorectal cancer ranged from $20,319 per case for TNM stage I colon cancer to $39,182 per case for stage III rectal cancer. The total lifetime treatment cost for the cohort of patients in 2000 was estimated to be over $333 million for colon and $187 million for rectal cancer. Hospitalization represented 65% and 61% of the lifetime costs of colon and rectal cancer respectively. Disease costing models can be important policy- relevant tools to assist in resource allocation. Our results highlight the importance of performing preoperative tests and staging in an ambulatory care setting, where possible, to achieve optimal cost efficiencies. Similarly, terminal care might be delivered more efficiently in the home environment or in palliative care units.

  11. ENDOSCOPIC TECHNOLOGIES IN EARLY RECTAL CANCER TREATMENT

    Directory of Open Access Journals (Sweden)

    D. V. Samsonov

    2015-01-01

    Full Text Available Total mesorectal excision is the “golden standard” of surgical treatment for rectal cancer. Development of endoscopic technologies allowed to implement the benefits of minimally invasive surgery in early rectal cancer treatment, decrease morbidity and mortality, improve functional outcome and quality of life. Oncological safety of this method is still a subject for discussion due to lack of lymph node harvest. Endoscopic operations for early rectal cancer are being actively implemented in daily practice, but lack of experience does not allow to include this method in national clinical prac-tice guidelines.

  12. Induction chemotherapy with capecitabine and oxaliplatin followed by chemoradiotherapy before total mesorectal excision in patients with locally advanced rectal cancer

    DEFF Research Database (Denmark)

    Schou, J.V.; Larsen, F O; Rasch, L

    2012-01-01

    Preoperative chemoradiation in patients with locally advanced rectal cancer has no impact on overall survival (OS) and distant recurrences. The aim of the study was to evaluate local downstaging, toxicity and long-term outcome in patients with locally advanced rectal cancer after induction therapy...

  13. Intermediate-fraction neoadjuvant radiotherapy for rectal cancer.

    Science.gov (United States)

    Zhan, Tiancheng; Gu, Jin; Li, Ming; Du, Changzheng

    2013-04-01

    In China, standard neoadjuvant chemoradiation therapy has not been well accepted, not only because of financial constraints but also because of the poorly-tolerated long duration of the regimen. The current study aimed to evaluate the impact of a modified neoadjuvant radiation regimen on the prognosis of rectal cancer patients in China. This was a nonrandomized cohort study evaluating outcomes of patients who chose to undergo preoperative radiotherapy compared with those who chose not to undergo preoperative radiotherapy (controls). The study was carried out in Peking University Cancer Hospital, a tertiary care cancer center in China. Records of patients with locally advanced, mid-to-low rectal cancer who underwent total mesorectal excision at Peking University Cancer Hospital from 2001 through 2005 were analyzed in this study. Patients who chose preoperative radiotherapy received a total dose of 30 Gy delivered in 10 once-daily fractions of 3.0 Gy each, with at least a 14-day delay of surgery after delivery of the last fraction. Tumor downstaging was evaluated. Local recurrence, distant metastases, and disease-free and overall survival were analyzed with the Kaplan-Meier method. A total of 101 patients accepted and 162 patients declined the modified preoperative radiotherapy regimen. Of the 101 patients receiving preoperative radiotherapy, 5 (5%) had a complete response, and 50 (50%) achieved TNM downstaging. The local recurrence rate was 5% with preoperative radiotherapy and 18% in the control groups (p = 0.02). Within the preoperative radiotherapy group, 5-year disease-free survival and overall survival rates were significantly higher in patients with T-, N-, or TNM-downstaging than in patients without downstaging. Evaluation of literature reports indicated that clinical safety and effectiveness of the modified protocol are comparable to results of standard neoadjuvant procedures. The allocation to study groups was not randomized, and patient self-selection may

  14. Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy(sandwich treatment)in rectal carcinoma.Methods From October 1990 to January 2002,260 patients with stage Ⅱ(117 patients)and stage Ⅲ(143 patients)rectal carcinoma were randomly divided into three groups:sandwich group(92 patients,group A),postoperative radiotherapy group(98 patients,Group B)and operation group(70 patients,Group C).The preoperative accelerated hyperfractionation(15Gy/6f/3d)was given for sandwic...

  15. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention

    Institute of Scientific and Technical Information of China (English)

    Sheng-Xiang Rao; Meng-Su Zeng; Jian-Ming Xu; Xin-Yu Qin; Cai-Zhong Chen; Ren-Chen Li; Ying-Yong Hou

    2007-01-01

    AIM: To determine the accuracy of high-resolution magnetic resonance imaging (MRI) using phased-array coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.METHODS: In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging (in-plane resolution, 0.66 × 0.56)with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity,specificity, accuracy, positive predictive value, and negative predictive value were evaluated.RESULTS: The overall magnetic resonance accuracy was 85.1% for T staging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value,and negative predictive value was 70%, 97.9%, 89.6%,93.3% and 88.5% for ≤ T2 tumors, 90.5%, 76%,85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%,95.5%, 62.5% and 100% for T4 tumors, and 80%,90.4%, 88%, 70.6% and 94% for predicting mesorectal fascia involvement, respectively.CONCLUSION: High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.

  16. FXYD-3 expression in relation to local recurrence of rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Loftas, Per; Arbman, Gunnar; Sun, Xiao Feng; Hallbook, Olof [Dept. of Clinical and Experimental Medicine, Linkoping University, Norrkoping (Sweden); Edler, David [Dept. of Surgery, Karolinska Institute, Stockholm (Sweden); Syk, Erik [Dept. of Surgery, Ersta Hospital, Stockholm (Sweden)

    2016-03-15

    In a previous study, the transmembrane protein FXYD-3 was suggested as a biomarker for a lower survival rate and reduced radiosensitivity in rectal cancer patients receiving preoperative radiotherapy. The purpose of preoperative irradiation in rectal cancer is to reduce local recurrence. The aim of this study was to investigate the potential role of FXYD-3 as a biomarker for increased risk for local recurrence of rectal cancer. FXYD-3 expression was immunohistochemically examined in surgical specimens from a cohort of patients with rectal cancer who developed local recurrence (n = 48). The cohort was compared to a matched control group without recurrence (n = 81). Weak FXYD-3 expression was found in 106/129 (82%) of the rectal tumors and strong expression in 23/129 (18%). There was no difference in the expression of FXYD-3 between the patients with local recurrence and the control group. Furthermore there was no difference in FXYD-3 expression and time to diagnosis of local recurrence between patients who received preoperative radiotherapy and those without. Previous findings indicated that FXYD-3 expression may be used as a marker of decreased sensitivity to radiotherapy or even overall survival. We were unable to confirm this in a cohort of rectal cancer patients who developed local recurrence.

  17. [Current MRI staging of rectal cancer].

    Science.gov (United States)

    Wietek, B M; Kratt, T

    2012-11-01

    Colorectal carcinoma is the second most prevalent cause for cancer, and has very variable outcomes. Advancements in surgery, the change from adjuvant to neo-adjuvant radio-chemo-therapies as well as in clinical diagnostics have improved the prognosis for patients in a multi-modal therapy concept. An accurate primary staging including a reliable prediction of the circumferential resection margin (CRM) has established MR Imaging (MRI) beside intraluminal endoscopic ultrasound (EUS). MRI facilitates the selection of patients likely to benefit from a preoperative therapy, especially in cases of unfavorable factors. Currently the relationship of the tumor to the mesorectal fascia has become a more important prognostic factor than the T-staging, particularly for surgical therapy. In addition further prognostic factors like the depth of infiltration into the perirectal fat and the extramural venous infiltration (EMVI) have important impact on therapy and prognosis. High resolution MRI has proved useful in clarifying the relationship between the tumor and the mesorectal fascia, which represents the CRM at the total mesorectal excision (TME) especially in the upper and middle third. Preoperative evaluation of the other prognostic factors as well as the nodal status is still difficult. It is used increasingly not only for primary staging but also progressively for the monitoring of neoadjuvant therapy. The addition of diffusion weighted imaging (DWI) is an interesting option for the improvement of response evaluation. The following overview provides an introduction of MRI diagnosis as well as its importance for the evaluation of the clinically relevant prognostic factors leading to an improvement of therapy and prognosis of patients with rectal carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Chemoradiation-induced changes in serum CEA and plasma TIMP-1 in patients with locally advanced rectal cancer

    DEFF Research Database (Denmark)

    Aldulaymi, Bahir; Christensen, Ib J; Sölétormos, György

    2010-01-01

    Preoperative biomarkers serum CEA and plasma TIMP-1 have been shown to have prognostic and predictive value in patients with colorectal cancer. The aim of the present study was to evaluate the possible impact of chemoradiotherapy (CRT) on preoperative biomarker levels in patients with rectal cancer....

  19. 临床病理指标预测直肠癌新辅助治疗效果初探%Clinical pathologic factors predicting tumor response after preoperative neoadjuvant therapy for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    吴文铭; 邱辉忠; 吴斌; 肖毅; 林国乐; 周立

    2010-01-01

    Objective To identify the clinical pathologic factors predicting tumor response of preoperative neoadjuvant therapy in patients with rectal cancer. Methods Seventy-nine patients with rectal cancer underwent neoadjuvant therapy before surgery from July 2000 to July 2009 were included in this study. Clinical pathologic factors were retrospectively analyzed to check the predicting effect of tumor response to the neoadjuvant therapy. Pathologic complete response (pCR) and T down-staging were the study endpoints. Results Of the 79 patients, 10 cases ( 12. 7% ) got pCR after the neoadjuvant treatment. T down-staging was achieved in 41 patients(51.9% ). The colonoscopy showed that the tumor occupied ≤1/3proportion of the bowel lumen in 22 patients, and 7 of them got pCR after the neoadjuvant therapy. Chisquare analysis showed that the proportion of tumor occupied in the bowel lumen was relevant to pCR rate (P < 0. 05). Serum carcino-embryonic antigen (CEA) level was examined in 74 patients. Twenty-seven cases of the 46 patients with a serum CEA level < 5 μg/L got a T down-staging. Twenty-three cases of the 38 patients with a normal range of both serum CEA/CA19-9 levels got a T down-staging. Chi-square analysis showed normal range of both serum CEA/CA19-9 levels indicated better T down-staging. Conclusions It's defined some possible predictive factors for effects of neoadjuvant therapy in patients with rectal cancer.Particularly, patients with less tumor occupation of the bowel lumen and a serum CEA level < 5 μg/L seem to be more likely to get better clinical results.%目的 寻找对直肠癌新辅助治疗疗效具有预测意义的临床病理指标.方法 回顾性分析2000年7月至2009年7月行新辅助治疗的79例直肠癌患者的临床病理资料,探讨其与新辅助治疗效果之间的关系.以病理完全缓解和T分期降期作为研究终点.结果 本组患者经新辅助治疗后病理完全缓解(pCR)者共10例(12.7%).T分期降期患者共41

  20. [Rectal cancer: diagnosis, screening and treatment].

    Science.gov (United States)

    Decanini-Terán, César Oscar; González-Acosta, Jorge; Obregón-Méndez, Jorge; Vega-de Jesús, Martín

    2011-01-01

    Rectal cancer is one of the primary malignant neoplasms occurring in Mexican patients of reproductive age. Unfortunately, randomized studies in rectal cancer do not exist as they do with well-recognized colon cancer. We must individualize the epidemiology, risk factors, diagnostic approach, staging and treatment because management is different in rectal cancers affecting the mid- and lower third of the rectum than in the upper third and in colon cancers. Histological staging is the primary prognostic factor. TNM staging (tumor, node, and metastasis) is used internationally by the American Joint Committee on Cancer (AJCC). Staging is done with the assistance of endorectal ultrasound, which is best used in early-stage cancer; however, there are certain disadvantages in detecting node involvement. Magnetic resonance, on the other hand, allows for the evaluation of stenotic tumors and node involvement. Once the correct diagnosis and staging have been made, the next step is correct treatment. Neoadjuvant treatment has demonstrated to be better than adjuvant treatment. Abdominoperineal resection is rarely practiced currently, with sphincter preservation being the preferred procedure. Laparoscopic approach has conferred the advantages of the approach itself when performed by experts in the procedure but there is insufficient evidence to make it the "gold standard." Rectal cancer is a complex pathology that must be considered totally different from colon cancer for diagnosis and treatment. The patient must be staged completely and appropriately for individualizing correct treatment. More long-term studies are needed for optimizing treatment modalities.

  1. Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer.

    Science.gov (United States)

    Gollins, S; Sebag-Montefiore, D

    2016-02-01

    Improved surgical technique plus selective preoperative radiotherapy have decreased rectal cancer pelvic local recurrence from, historically, 25% down to about 5-10%. However, this improvement has not reduced distant metastatic relapse, which is the main cause of death and a key issue in rectal cancer management. The current standard is local pelvic treatment (surgery ± preoperative radiotherapy) followed by adjuvant chemotherapy, depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline magnetic resonance imaging, downstaging long-course preoperative chemoradiation (LCPCRT) is generally used. However, for non-CRM-threatened disease, varying approaches are currently adopted in the UK, including straight to surgery, short-course preoperative radiotherapy and LCPCRT. Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating preoperative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full-dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse. Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy-based schedules. Although several measures of neoadjuvant treatment response assessment based on imaging or pathology are promising predictive biomarkers for long-term survival, none has been validated in prospective phase III studies. The phase III setting will enable this, also providing translational opportunities to examine molecular predictors of response and survival. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. Synchronous rectal and prostate cancer – The impact of MRI on incidence and imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Sturludóttir, Margrét, E-mail: margret.sturludottir@karolinska.se [Department of Radiology, Karolinska University Hospital, 17176 Solna (Sweden); Martling, Anna, E-mail: anna.martling@ki.se [Center of Surgical Gastroenterology, Karolinska University Hospital, 17176 Solna (Sweden); Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Solna (Sweden); Carlsson, Stefan, E-mail: stefan.carlsson@ki.se [Department of Urology, Karolinska University Hospital, 17176 Solna (Sweden); Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Solna (Sweden); Blomqvist, Lennart, E-mail: lennart.k.blomqvist@ki.se [Department of Radiology, Karolinska University Hospital, 17176 Solna (Sweden); Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Solna (Sweden)

    2015-04-15

    Highlights: •Prostate and rectal cancers are two of the most common cancers in male. •Synchronous diagnosis of prostate and rectal cancer is a rare identity. •Strong increase in the synchronous diagnosis likely due to improved diagnostic methods. •Pre-treatment MRI for rectal cancer has led to increased synchronous diagnosis. -- Abstract: Objective: To evaluate the incidence of synchronous diagnosis of rectal and prostate cancer and to identify how the role of magnetic resonance imaging (MRI) for preoperative staging of rectal cancer has affected the incidence. Methods: Regional data from the Swedish Colorectal Cancer Registry and the Regional Cancer Registry in Stockholm-Gotland area (two million inhabitants) between the years 1995–2011 were used. Patients were included when the rectal cancer was diagnosed prior to the prostate cancer. Medical records and pre-treatment MRI were retrospectively reviewed. Results: Of 29,849 patients diagnosed with either disease, synchronous diagnosis was made in 29 patients (0.1%). Two patients were diagnosed in the years 1995–1999, seven patients between the years 2000–2005 and 20 patients between the years 2006–2011. The most common presentation, for the prostate cancer was incidental finding during staging for rectal cancer, n = 20, and of those led MRI to the diagnosis in 14 cases. At retrospective review, all patients had focal lesions in the prostate on MRI and patients with higher suspicion of malignancy on MRI had more locally advanced disease. Conclusion: Synchronous rectal and prostate cancer are a rare entity, but a strong increase in synchronous diagnosis is seen which may be attributed to improved diagnostic methods, including the use of pre-treatment MRI in routine work-up for rectal cancer.

  3. Rectal and colon cancer : Not just a different anatomic site

    NARCIS (Netherlands)

    Tamas, K.; Walenkamp, A. M. E.; de Vries, E. G. E.; van Vugt, M. A. T. M.; Beets-Tan, R. G.; van Etten, B.; de Groot, D. J. A.; Hospers, G. A. P.

    2015-01-01

    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total

  4. Rectal and colon cancer : Not just a different anatomic site

    NARCIS (Netherlands)

    Tamas, K.; Walenkamp, A. M. E.; de Vries, E. G. E.; van Vugt, M. A. T. M.; Beets-Tan, R. G.; van Etten, B.; de Groot, D. J. A.; Hospers, G. A. P.

    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total

  5. Rectal cancer treatment: Improving the picture

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Multidisciplinary approach for rectal cancer treatment is currently well defined. Nevertheless, new and promising advances are enriching the portrait. Since the US NIH Consensus in the early 90's some new characters have been added. A bird's-eye view along the last decade shows the main milestones in the development of rectal cancer treatment protocols. New drugs, in combination with radiotherapy are being tested to increase response and tumor control outcomes. However, therapeutic intensity is often associated with toxicity. Thus, innovative strategies are needed to create a better-balanced therapeutic ratio. Molecular targeted therapies and improved technology for delivering radiotherapy respond to the need for accuracy and precision in rectal cancer treatment.

  6. Opposite association of serum prolactin and survival in patients with colon and rectal carcinomas: influence of preoperative radiotherapy.

    Science.gov (United States)

    Barrera, Marcos Gutiéerrez De La; Trejo, Belem; Luna-Péerez, Pedro; López-Barrera, Fernándo; Escalera, Gonzalo Martínez De La; Clapp, Carmen

    2006-01-01

    Prolactin (PRL) is a pleiotropic hormone associated with the progression of various cancers, including colorectal cancer (CRC). Here we investigate whether the association of serum PRL concentration and survival is affected by tumor location and preoperative radiotherapy (PRERT) in patients with CRC cancer. Serum PRL was determined in 82 CRC patients without previous treatment. Patients with PRL concentrations at and above the 75th percentile (high PRL) or below this level (low PRL), had a significant correlation with overall survival determined using the Kaplan-Meier method. In colon cancer, there was an increased risk of mortality when PRL values were at and above the highest quartile (22% vs. 73%; P = 0.01). In contrast, in rectal cancer, high PRL values were associated with a significant overall survival advantage (88% vs. 44%; P = 0.05), which became more significant (100% vs. 34%; P = 0.005) when only rectal cancer patients receiving PRERT were compared. These findings suggest that tumor location and adjuvant radiotherapy influence the association between circulating PRL and survival in CRC.

  7. Surgeon-related factors and outcome in rectal cancer.

    Science.gov (United States)

    Porter, G A; Soskolne, C L; Yakimets, W W; Newman, S C

    1998-01-01

    OBJECTIVE: To determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival. SUMMARY BACKGROUND DATA: Variation in patient outcome in rectal cancer has been shown among centers and among individual surgeons. However, the prognostic importance of surgeon-related factors is largely unknown. METHODS: All patients undergoing potentially curative low anterior resection or abdominoperineal resection for primary adenocarcinoma of the rectum between 1983 and 1990 at the five Edmonton general hospitals were reviewed in a historic-prospective study design. Preoperative, intraoperative, pathologic, adjuvant therapy, and outcome variables were obtained. Outcomes of interest included LR and disease-specific survival (DSS). To determine survival rates and to control both confounding and interaction, multivariate analysis was performed using Cox proportional hazards regression. RESULTS: The study included 683 patients involving 52 surgeons, with > 5-year follow-up obtained on 663 (97%) patients. There were five colorectal-trained surgeons who performed 109 (16%) of the operations. Independent of surgeon training, 323 operations (47%) were done by surgeons performing < 21 rectal cancer resections over the study period. Multivariate analysis showed that the risk of LR was increased in patients of both noncolorectal trained surgeons (hazard ratio (HR) = 2.5, p = 0.001) and those of surgeons performing < 21 resections (HR = 1.8, p < 0.001). Stage (p < 0.001), use of adjuvant therapy (p = 0.002), rectal perforation or tumor spill (p < 0.001), and vascular/neural invasion (p = 0.002) also were significant prognostic factors for LR. Similarly, decreased disease-specific survival was found to be independently associated with noncolorectal-trained surgeons (HR = 1.5, p = 0.03) and surgeons performing < 21 resections (HR = 1.4, p = 0.005). Stage (p < 0

  8. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

    Science.gov (United States)

    Lee, Hong Seok; Choi, Doo Ho; Park, Hee Chul; Park, Won; Yu, Jeong Il; Chung, Kwangzoo

    2016-01-01

    Purpose To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. Materials and Methods We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Results Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Conclusion Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary. PMID:27592514

  9. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hong Seok; Choi, Doo Ho; Park, Hee Chul; Park, Won; Yu, Jeong Il; Chung, Kwang Zoo [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary.

  10. VMAT planning study in rectal cancer patients

    OpenAIRE

    Shang, Jun; Kong, Wei; Wang, Yan-Yang; Ding, Zhe; Yan, Gang; Zhe, Hong

    2014-01-01

    Background To compare the dosimetric differences among fixed field intensity-modulated radiation therapy (IMRT), single-arc volumetric-modulated arc therapy (SA-VMAT) and double-arc volumetric-modulated arc therapy (DA-VMAT) plans in rectal cancer. Method Fifteen patients with rectal cancer previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the VM...

  11. [Adjuvant chemotherapy for patients with rectal cancer].

    Science.gov (United States)

    Qvortrup, Camilla; Mortensen, John Pløen; Pfeiffer, Per

    2013-09-09

    A new Cochrane meta-analysis evaluated adjuvant chemotherapy (5-fluorouracil (5FU)-based, not modern combination chemotherapy) in almost 10,000 patients with rectal cancer and showed a 17% reduction in mortality corresponding well to the efficacy observed in recent studies, which reported a reduction in mortality just about 20%. The authors recommend adjuvant chemotherapy which is in accordance with the Danish national guidelines where 5-FU-based chemotherapy is recommended for stage III and high-risk stage II rectal cancer.

  12. GLUT-1 expression and response to chemoradiotherapy in rectal cancer.

    LENUS (Irish Health Repository)

    Brophy, Sarah

    2009-12-15

    Preoperative chemoradiotherapy is used in locally advanced rectal cancer to reduce local recurrence and improve operability, however a proportion of tumors do not undergo significant regression. Identification of predictive markers of response to chemoradiotherapy would improve patient selection and may allow response modification by targeting of specific pathways. The aim of this study was to determine whether expression of glucose transporter-1 (GLUT-1) and p53 in pretreatment rectal cancer biopsies was predictive of tumor response to chemoradiotherapy. Immunohistochemical staining for GLUT-1 and p53 was performed on 69 pretreatment biopsies and compared to tumor response in the resected specimen as determined by the tumor regression grade (TRG) scoring system. GLUT-1 expression was significantly associated with reduced response to chemoradiotherapy and increasing GLUT expression correlated with poorer response (p=0.02). GLUT-1 negative tumors had a 70% probability of good response (TRG3\\/4) compared to a 31% probability of good response in GLUT-1 positive tumors. GLUT-1 may be a useful predictive marker of response to chemoradiotherapy in rectal cancer.

  13. GLUT-1 expression and response to chemoradiotherapy in rectal cancer.

    Science.gov (United States)

    Brophy, Sarah; Sheehan, Katherine M; McNamara, Deborah A; Deasy, Joseph; Bouchier-Hayes, David J; Kay, Elaine W

    2009-12-15

    Preoperative chemoradiotherapy is used in locally advanced rectal cancer to reduce local recurrence and improve operability, however a proportion of tumors do not undergo significant regression. Identification of predictive markers of response to chemoradiotherapy would improve patient selection and may allow response modification by targeting of specific pathways. The aim of this study was to determine whether expression of glucose transporter-1 (GLUT-1) and p53 in pretreatment rectal cancer biopsies was predictive of tumor response to chemoradiotherapy. Immunohistochemical staining for GLUT-1 and p53 was performed on 69 pretreatment biopsies and compared to tumor response in the resected specimen as determined by the tumor regression grade (TRG) scoring system. GLUT-1 expression was significantly associated with reduced response to chemoradiotherapy and increasing GLUT expression correlated with poorer response (p=0.02). GLUT-1 negative tumors had a 70% probability of good response (TRG3/4) compared to a 31% probability of good response in GLUT-1 positive tumors. GLUT-1 may be a useful predictive marker of response to chemoradiotherapy in rectal cancer.

  14. Preoperative radiotherapy and extracellular matrix remodeling in rectal mucosa and tumour matrix metalloproteinases and plasminogen components

    Energy Technology Data Exchange (ETDEWEB)

    Angenete, Eva; Oeresland, Tom; Falk, Peter; Breimer, Michael; Ivarsson, Marie-Louise (Dept. of Surgery, Inst. of Clinical Sciences, Sahlgrenska Academy at Univ. of Goeteborg, Goeteborg (Sweden)); Hultborn, Ragnar (Dept. of Oncology, Institute of Clinical Sciences, Sahlgrenska Univ. Hospital/Sahlgrenska, Goeteborg (Sweden))

    2009-11-15

    Background. Preoperative radiotherapy reduces recurrence but increases postoperative morbidity. The aim of this study was to explore the effect of radiotherapy in rectal mucosa and rectal tumour extracellular matrix (ECM) by studying enzymes and growth factors involved in ECM remodeling. Materials and methods. Twenty patients with short-term preoperative radiotherapy and 12 control patients without radiotherapy were studied. Biopsies from rectal mucosa and tumour were collected prior to radiotherapy and at surgery. Tissue MMP-1, -2, -9, TIMP-1, uPA, PAI-1, TGF-beta1 and calprotectin were determined by ELISA. Biopsies from irradiated and non-irradiated peritoneal areas were also analysed. Results. Radiotherapy increased the tissue levels of MMP-2 and PAI-1 in both the rectal mucosa and tumours while calprotectin and uPA showed an increase only in the mucosa after irradiation. The increase of calprotectin was due to an influx of inflammatory cells as revealed by immunohistochemistry. Prior to irradiation, the tumour tissues had increased levels of MMP-1, -2, -9, total TGF-beta1, uPA, PAI-1 and calprotectin compared to mucosa, while TIMP-1 and the active TGF-beta1 fraction showed no statistical difference. Conclusions. This study indicates a radiation-induced effect on selected ECM remodeling proteases. This reaction may be responsible for early and late morbidity. Interference of this response might reduce these consequences.

  15. Surgery for Locally Recurrent Rectal Cancer: Tips, Tricks, and Pitfalls.

    Science.gov (United States)

    Warrier, Satish K; Heriot, Alexander G; Lynch, Andrew Craig

    2016-06-01

    Rectal cancer can recur locally in up to 10% of the patients who undergo definitive resection for their primary cancer. Surgical salvage is considered appropriate in the curative setting as well as select cases with palliative intent. Disease-free survival following salvage resection is dependent upon achieving an R0 resection margin. A clear understanding of applied surgical anatomy, appropriate preoperative planning, and a multidisciplinary approach to aggressive soft tissue, bony, and vascular resection with appropriate reconstruction is necessary. Technical tips, tricks, and pitfalls that may assist in managing these cancers are discussed and the roles of additional boost radiation and intraoperative radiation therapy in the management of such cancers are also discussed.

  16. Patterns of metastasis in colon and rectal cancer

    OpenAIRE

    Matias Riihimäki; Akseli Hemminki; Jan Sundquist; Kari Hemminki

    2016-01-01

    Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR ...

  17. Female urogenital dysfunction following total mesorectal excision for rectal cancer

    Directory of Open Access Journals (Sweden)

    Raja Ashraf

    2006-01-01

    Full Text Available Abstract Background The effect of Total Mesorectal Excision (TME on sexual function in the male is well documented. However, there is little literature in female patients. The aim of this study was to review the pelvic autonomic nervous anatomy in the female and to perform a retrospective audit of urinary and sexual function in women following surgery for rectal cancer where TME had been performed. Urogenital dysfunction was assessed through interview and questionnaire. Method Twenty-three questionnaires, eighteen returned, were sent to women with a mean age 65.5 yrs (range 34–86. All had undergone total mesorectal excision for rectal cancer between 1998–2001. Mean follow-up was 18.8 months (range 3–35. Results Preoperatively 5/18 (28% were sexually active, 3/18 (17% of patients described urinary frequency and nocturia and 7/18 (39% described symptoms of stress incontinence prior to surgery. Postoperatively all sexually active patients remained active although all described some discomfort with penetration. Two of the patients sexually active described reduced libido secondary to the stoma. Postoperative urinary symptoms developed with 59% reporting the development of nocturia, 18% developed stress incontinence and one patient required a permanent catheter. Of those with symptoms, 80% persisted longer than three months from surgery. Symptoms were predominant in those patients with low rectal cancers, particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy. Conclusion The treatment of rectal cancer involves surgery to the pelvic floor. Despite nerve preservation this is associated with the development of worsening nocturia and stress incontinence. This is most marked in those patients who had previously undergone a hysterectomy. Further studies are warranted to assess the interaction with previous gynaecological surgery.

  18. EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review.

    Science.gov (United States)

    Tudyka, V; Blomqvist, L; Beets-Tan, R G H; Boelens, P G; Valentini, V; van de Velde, C J; Dieguez, A; Brown, G

    2014-04-01

    Some interesting shifts have taken place in the diagnostic approach for detection of colorectal lesions over the past decade. This article accompanies the recent EURECCA consensus group reccomendations for optimal management of colon and rectal cancers. In summary, imaging has a crucial role to play in the diagnosis, staging assessment and follow up of patients with colon and rectal cancer. Recent advances include the use of CT colonography instead of Barium Enema in the diagnosis of colonoic cancer and as an alternative to colonoscopy. Modern mutlidetector CT scanning techniques have also shown improvements in prognostic stratification of patients with colonic cancer and clinical trials are underway testing the selective use of neoadjuvant therapy for imaging identified high risk colon cancers. In rectal cancer, high resolution MRI with a voxel size less or equal to 3 × 1 × 1 mm3 on T2-weighted images has a proven ability to accurately stage patients with rectal cancer. Moreover, preoperative identification of prognostic features allows stratification of patients into different prognostic groups based on assessment of depth of extramural spread, relationship of the tumour edge to the mesorectal fascia (MRF) and extramural venous invasion (EMVI). These poor prognostic features predict an increased risk of local recurrence and/or metastatic disease and should form the basis for preoperative local staging and multidisciplinary preoperative discussion of patient treatment options.

  19. Current management of locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Mette Bak; Laurberg, Søren; Holm, Thorbjörn

    2011-01-01

    ABSTRACT Objective: A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). Method: A systematic literature search was undertaken using PubMed, Embase, Web...

  20. Management of synchronous rectal and prostate cancer.

    LENUS (Irish Health Repository)

    Kavanagh, D O

    2012-11-01

    Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution\\'s experience with this and propose a treatment algorithm based on the best available evidence.

  1. Evidence and research in rectal cancer.

    NARCIS (Netherlands)

    Valentini, V.; Beets-Tan, R.; Borras, J.M.; Krivokapic, Z.; Leer, J.W.H.; Pahlman, L.; Rodel, C.; Schmoll, H.J.; Scott, N.; Velde, C.V.; Verfaillie, C.

    2008-01-01

    The main evidences of epidemiology, diagnostic imaging, pathology, surgery, radiotherapy, chemotherapy and follow-up are reviewed to optimize the routine treatment of rectal cancer according to a multidisciplinary approach. This paper reports on the knowledge shared between different specialists inv

  2. Conventional CT for the prediction of an involved circumferential resection margin in primary rectal cancer

    NARCIS (Netherlands)

    Wolberink, Steven V. R. C.; Beets-Tan, Regina G. H.; de Haas-Kock, Danielle F. M.; Span, Mark M.; van de Jagt, Eric J.; van de Velde, Cornelis J. H.; Wiggers, Theo

    2007-01-01

    Purpose: To determine the accuracy of conventional computed tomography (CT) scan in the preoperative prediction of an involved circumferential resection margin (CRM) in primary rectal cancer. Methods: 125 patients with biopsy-proven adenocarcinoma of the rectum underwent CT of the abdomen before und

  3. MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer

    NARCIS (Netherlands)

    Beets-Tan, Regina G H; Beets, Geerard L

    2014-01-01

    Guidelines recommend MRI as part of the staging work-up of patients with rectal cancer because it can identify high-risk groups requiring preoperative treatment. Phenomenal tumour responses have been observed with current chemoradiotherapy regimens-even complete regression in 25% of patients. For th

  4. Dose-Effect Relationship in Chemoradiotherapy for Locally Advanced Rectal Cancer

    DEFF Research Database (Denmark)

    Jakobsen, Anders; Ploen, John; Vuong, Té

    2012-01-01

    PURPOSE: Locally advanced rectal cancer represents a major therapeutic challenge. Preoperative chemoradiation therapy is considered standard, but little is known about the dose-effect relationship. The present study represents a dose-escalation phase III trial comparing 2 doses of radiation...

  5. Rectal cancer radiotherapy: Towards European consensus

    Energy Technology Data Exchange (ETDEWEB)

    Valentini, Vincenzo (Cattedra di Radioterapia, Univ. Cattolica S.Cuore, Rome (Italy)), E-mail: vvalentini@rm.unicatt.it; Glimelius, Bengt (Dept. of Oncology, Radiology and Clinical Immunology, Uppsala Univ., Uppsala (Sweden))

    2010-11-15

    Background and purpose. During the first decade of the 21st century several important European randomized studies in rectal cancer have been published. In order to help shape clinical practice based on best scientific evidence, the International Conference on 'Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) was organized. This article summarizes the consensus about imaging and radiotherapy of rectal cancer and gives an update until May 2010. Methods. Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round no 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: 'large consensus', 'moderate consensus', 'minimum consensus'. Results. The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only three (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by >85%. Considerable progress has been made in staging and treatment, including radiation treatment of rectal cancer. Conclusions. This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain

  6. Review on adjuvant chemotherapy for rectal cancer - why do treatment guidelines differ so much?

    Science.gov (United States)

    Poulsen, Laurids Ø; Qvortrup, Camilla; Pfeiffer, Per; Yilmaz, Mette; Falkmer, Ursula; Sorbye, Halfdan

    2015-04-01

    The use of postoperative adjuvant chemotherapy is controversial for rectal adenocarcinoma. Both international and national guidelines display a great span varying from recommending no adjuvant chemotherapy at all, over single drug 5-fluororuacil (5-FU), to combinations of 5-FU/oxaliplatin. A review of the literature was made identifying 24 randomized controlled trials on adjuvant treatment of rectal cancer based on about 10 000 patients. The trials were subdivided into a number of clinically relevant subgroups. As regards patients treated with preoperative (chemo) radiotherapy, four randomized studies were found where use of adjuvant chemotherapy showed no benefit in survival. Three trials were found in which a subset of patients received preoperative (chemo) radiotherapy. Two of these trials showed a statistically significant benefit of adjuvant chemotherapy. Twenty trials were identified in which the patients did not receive preoperative (chemo) radiotherapy, including five Asian studies in which a statistically significant benefit from adjuvant chemotherapy was reported. Most of the data found did not support the use of postoperative adjuvant chemotherapy for patients already treated with preoperative (chemo) radiotherapy. For patients not treated preoperatively, several studies support the use of single agent 5-FU chemotherapy. Treatment guidelines seem to differ according to if preoperative chemoradiation is considered of importance for use of adjuvant chemotherapy and if adjuvant colon cancer studies are considered transferrable to rectal cancer patients regardless of the molecular differences.

  7. Improved survival after rectal cancer in Denmark

    DEFF Research Database (Denmark)

    Bülow, S; Harling, H; Iversen, L H

    2010-01-01

    treated from 1994 to 2006. Method The study was based on the National Rectal Cancer Registry and the National Colorectal Cancer Database, supplemented with data from the Central Population Registry. The analysis included actuarial overall and relative survival. Results A total of 10 632 patients were......Objective In 1995, an analysis showed an inferior prognosis after rectal cancer in Denmark compared with the other Scandinavian countries. The Danish Colorectal Cancer Group (DCCG) was established with the aim of improving the prognosis, and in this study we present a survival analysis of patients...... operated on. The overall 5-year survival increased from 0.37 in 1994 to 0.51% in 2006; the improvement was greater in men (20% points) than in women (10% points), and greatest in stage III (20% points). The relative 5-year survival increased from 0.46 to 0.62, including an improvement of 23% points in men...

  8. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer

    DEFF Research Database (Denmark)

    Brännström, Fredrik; Bjerregaard, Jon K; Winbladh, Anders

    2015-01-01

    BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment...... on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours. RESULTS: Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated...

  9. The frequencies and clinical implications of mutations in 33 kinase-related genes in locally advanced rectal cancer: a pilot study.

    LENUS (Irish Health Repository)

    Abdul-Jalil, Khairun I

    2014-08-01

    Locally advanced rectal cancer (LARC: T3\\/4 and\\/or node-positive) is treated with preoperative\\/neoadjuvant chemoradiotherapy (CRT), but responses are not uniform. The phosphatidylinositol 3-kinase (PI3K), MAP kinase (MAPK), and related pathways are implicated in rectal cancer tumorigenesis. Here, we investigated the association between genetic mutations in these pathways and LARC clinical outcomes.

  10. Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy.

    Directory of Open Access Journals (Sweden)

    Saghar Samimi Sede

    2014-09-01

    Full Text Available To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.Ninety female patients (American Society of Anesthesiologists (ASA physical status I-II, scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS was used to assess pain intensity at rest.In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg compared to diclofenac group (16.8± 2.8 mg and placebo group (20.1 ± 3.6 mg (p<0.05. VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05. There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05.According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone.

  11. Review on adjuvant chemotherapy for rectal cancer - why do treatment guidelines differ so much?

    DEFF Research Database (Denmark)

    Poulsen, Laurids Ø; Qvortrup, Camilla; Pfeiffer, Per

    2015-01-01

    chemotherapy for patients already treated with preoperative (chemo) radiotherapy. For patients not treated preoperatively, several studies support the use of single agent 5-FU chemotherapy. Treatment guidelines seem to differ according to if preoperative chemoradiation is considered of importance for use......BACKGROUND: The use of postoperative adjuvant chemotherapy is controversial for rectal adenocarcinoma. Both international and national guidelines display a great span varying from recommending no adjuvant chemotherapy at all, over single drug 5-fluororuacil (5-FU), to combinations of 5-FU....../oxaliplatin. METHODS: A review of the literature was made identifying 24 randomized controlled trials on adjuvant treatment of rectal cancer based on about 10 000 patients. The trials were subdivided into a number of clinically relevant subgroups. RESULTS: As regards patients treated with preoperative (chemo...

  12. Small bowel obstruction after reconstruction of the pelvic floor with porcine dermal collagen (Permacol) after extended abdominoperineal extirpation for rectal cancer: report of two cases

    DEFF Research Database (Denmark)

    Jess, P; Bulut, O

    2010-01-01

    Abstract Preoperative chemoradiation with impaired wound healing and extended perineal excisionh in abdominoperineal resection for low rectal cancer, in an attempt to improve the oncological results, have required new techniques for pelvic floor reconstruction. Various myocutaneous flaps have been...

  13. UFT (tegafur-uracil) in rectal cancer

    DEFF Research Database (Denmark)

    Casado, E; Pfeiffer, P; Feliu, J

    2008-01-01

    BACKGROUND: Major achievements in the treatment of localised rectal cancer include the development of total mesorectal excision and the perioperative administration of radiotherapy in combination with continuous infusion (CI) 5-fluorouracil (5-FU). This multimodal approach has resulted in extended...... survival and lower local relapse rates, with the potential for sphincter-preserving procedures. However, CI 5-FU is inconvenient for patients and is costly. Oral fluoropyrimidines like UFT (tegafur-uracil) offer a number of advantages over 5-FU. METHODS: We undertook a review of published articles...... and abstracts relating to clinical studies of UFT in the treatment of locally advanced rectal cancer (LARC). Pre- and postoperative studies carried out in patients with newly diagnosed or recurrent disease were included. RESULTS: The combination of UFT and radiotherapy was effective and well tolerated...

  14. Laparoscopic ovarian transposition before pelvic radiation in rectal cancer patient: safety and feasibility

    Directory of Open Access Journals (Sweden)

    Al-Asari Sami

    2012-09-01

    Full Text Available Abstract Background Infertility due to pelvic radiation for advanced rectal cancer treatment is a major concern particularly in young patients. Pre-radiation laparoscopic ovarian transposition may offer preservation of ovarian function during the treatment however its use is limited. Aim The study investigates the safety, feasibility and effectiveness of pre-radiation laparoscopic ovarian transposition and its effect on ovarian function in the treatment o locally advanced rectal cancer. Methods Charts review of all young female patients diagnosed with locally advanced rectal cancer, underwent laparoscopic ovarian transposition, then received preoperative radiotherapy at king Faisal Specialist Hospital and Research Centre between 2003–2007. Results During the period studied three single patients age between 21–27 years underwent pre-radiation laparoscopic ovarian transposition for advanced rectal cancer. All required pretreatment laparoscopic diversion stoma due to rectal stricture secondary to tumor that was performed at the same time. One patient died of metastatic disease during treatment. The ovarian hormonal levels (FSH and LH were normal in two patients. One has had normal menstrual period and other had amenorrhoea after 4 months follow-up however her ovarian hormonal level were within normal limits. Conclusions Laparoscopic ovarian transposition before pelvic radiation in advanced rectal cancer treatment is an effective and feasible way of preservation of ovarian function in young patients at risk of radiotherapy induced ovarian failure. However, this procedure is still under used and it is advisable to discuss and propose it to suitable patients.

  15. Technological advances in radiotherapy of rectal cancer

    DEFF Research Database (Denmark)

    Appelt, Ane L; Sebag-Montefiore, David

    2016-01-01

    PURPOSE OF REVIEW: This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. RECENT FINDINGS: The dosimetric....... Overall results are encouraging, as toxicity levels - although varying across reports - appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment...

  16. Molecular targeted treatment and radiation therapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Marquardt, Friederike; Roedel, Franz; Capalbo, Gianni; Weiss, Christian; Roedel, Claus [Dept. of Radiation Therapy, Univ. of Frankfurt/Main (Germany)

    2009-06-15

    Background: EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor) inhibitors confer clinical benefit in metastatic colorectal cancer when combined with chemotherapy. An emerging strategy to improve outcomes in rectal cancer is to integrate biologically active, targeted agents as triple therapy into chemoradiation protocols. Material and methods: cetuximab and bevacizumab have now been incorporated into phase I-II studies of preoperative chemoradiation therapy (CRT) for rectal cancer. The rationale of these combinations, early efficacy and toxicity data, and possible molecular predictors for tumor response are reviewed. Computerized bibliographic searches of Pubmed were supplemented with hand searches of reference lists and abstracts of ASCO and ASTRO meetings. Results: the combination of cetuximab and CRT can be safely applied without dose compromises of the respective treatment components. Disappointingly low rates of pathologic complete remission have been noted in several phase II studies. The K-ras mutation status and the gene copy number of EGFR may predict tumor response. The toxicity pattern (radiation-induced enteritis, perforations) and surgical complications (wound healing, fistula, bleeding) observed in at least some of the clinical studies with bevacizumab and CRT warrant further investigations. Conclusion: longer follow-up (and, finally, randomized trials) is needed to draw any firm conclusions with respect to local and distant failure rates, and toxicity associated with these novel treatment approaches. (orig.)

  17. The Great Pretender: Rectal Syphilis Mimic a Cancer

    Directory of Open Access Journals (Sweden)

    Andrea Pisani Ceretti

    2015-01-01

    Full Text Available Rectal syphilis is a rare expression of the widely recognised sexual transmitted disease, also known as the great imitator for its peculiarity of being confused with mild anorectal diseases because of its vague symptoms or believed rectal malignancy, with the concrete risk of overtreatment. We present the case of a male patient with primary rectal syphilis, firstly diagnosed as rectal cancer; the medical, radiological, and endoscopic features are discussed below.

  18. Pathological Assessment of Rectal Cancer after Neoadjuvant Chemoradiotherapy: Distribution of Residual Cancer Cells and Accuracy of Biopsy

    Science.gov (United States)

    Xiao, Lin; Yu, Xin; Deng, Wenjing; Feng, Huixia; Chang, Hui; Xiao, Weiwei; Zhang, Huizhong; Xi, Shaoyan; Liu, Mengzhong; Zhu, Yujia; Gao, Yuanhong

    2016-01-01

    We investigated the distribution of residual cancer cells (RCCs) within different layers of the bowel wall in surgical specimens and the value of biopsies of primary rectal lesion after preoperative volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients with rectal cancer. Between April 2011 and April 2013, 178 patients with rectal cancer who received preoperative VMAT, concurrent chemotherapy, and surgery were evaluated; 79 of the patients received a biopsy of the primary lesion after chemoradiotherapy and prior to surgery. The distribution of RCCs in the surgical specimens and the sensitivity and specificity of the biopsy of primary rectal lesions for pathological response were evaluated. Fifty-two patients had a complete pathological response in the bowel wall. Of the 120 patients with ypT2-4, the rate of detection of RCCs in the mucosa, submucosa, and muscularis propria was 20%, 36.7%, 69.2%, respectively. The sensitivity and specificity of biopsies of primary rectal lesions was 12.9% and 94.1%, respectively. After chemoradiotherapy, the RCCs were primarily located in the deeper layers of the bowel wall, and the biopsy results for primary rectal lesions were unreliable due to poor sensitivity. PMID:27721486

  19. [Downstaging after neoadjuvant therapy for rectal cancer modifies the planned original surgery].

    Science.gov (United States)

    Scutari, F; Tramutola, G; Morlino, A; Rossi, M T; Manzione, L; Rosati, G; Sopranzi, A

    2008-01-01

    Cancer of the rectum has been for more years burdened with a heavy rate of local relapse about 30%. The introduction of total meso-rectum excision has reduced the rate of up to 5-8%. Later more studies proved how the preoperative radiotherapy was able to reduce the rate of local relapse. The Authors introduce studies about downstaging after neoadjuvant chemoradiotherapy for rectal cancer and discuss about their own series from 2005 to 2007.

  20. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    DEFF Research Database (Denmark)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A

    2013-01-01

    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  1. Postoperative adjuvant chemotherapy in rectal cancer operated for cure.

    Science.gov (United States)

    Petersen, Sune Høirup; Harling, Henrik; Kirkeby, Lene Tschemerinsky; Wille-Jørgensen, Peer; Mocellin, Simone

    2012-03-14

    Colorectal cancer is one of the most common types of cancer in the Western world. Apart from surgery - which remains the mainstay of treatment for resectable primary tumours - postoperative (i.e., adjuvant) chemotherapy with 5-fluorouracil (5-FU) based regimens is now the standard treatment in Dukes' C (TNM stage III) colon tumours i.e. tumours with metastases in the regional lymph nodes but no distant metastases. In contrast, the evidence for recommendations of adjuvant therapy in rectal cancer is sparse. In Europe it is generally acknowledged that locally advanced rectal tumours receive preoperative (i.e., neoadjuvant) downstaging by radiotherapy (or chemoradiotion), whereas in the US postoperative chemoradiotion is considered the treatment of choice in all Dukes' C rectal cancers. Overall, no universal consensus exists on the adjuvant treatment of surgically resectable rectal carcinoma; moreover, no formal systematic review and meta-analysis has been so far performed on this subject. We undertook a systematic review of the scientific literature from 1975 until March 2011 in order to quantitatively summarize the available evidence regarding the impact of postoperative adjuvant chemotherapy on the survival of patients with surgically resectable rectal cancer. The outcomes of interest were overall survival (OS) and disease-free survival (DFS). CCCG standard search strategy in defined databases with the following supplementary search. 1. Rect* or colorect* - 2. Cancer or carcinom* or adenocarc* or neoplasm* or tumour - 3. Adjuv* - 4. Chemother* - 5. Postoper* Randomised controlled trials (RCT) comparing patients undergoing surgery for rectal cancer who received no adjuvant chemotherapy with those receiving any postoperative chemotherapy regimen. Two authors extracted data and a third author performed an independent search for verification. The main outcome measure was the hazard ratio (HR) between the risk of event between the treatment arm (adjuvant chemotherapy

  2. Immunological Landscape and Clinical Management of Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Elísabeth ePérez-Ruiz

    2016-02-01

    Full Text Available The clinical management of rectal cancer and colon cancer differs due to increased local relapses in rectal cancer. However, the current molecular classification does not differentiate rectal cancer and colon cancer as two different entities. In recent years, the impact of the specific immune microenvironment in cancer has attracted renewed interest, and is currently recognized as one of the major determinants of clinical progression in a wide range of tumors. In colorectal cancer, the density of lymphocytic infiltration is associated with better overall survival. Due to the need for biomarkers of response to conventional treatment with chemoradiotherapy in rectal tumors, the immune status of rectal cancer emerges as a useful tool to improve the management of patients.

  3. MicroRNA in rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Azadeh Azizian; Jens Gruber; B Michael Ghadimi; Jochen Gaedcke

    2016-01-01

    In rectal cancer,one of the most common cancers worldwide,the proper staging of the disease determines the subsequent therapy.For those with locally advancedrectal cancer,a neoadjuvant chemoradiotherapy(CRT) is recommended before any surgery.However,response to CRT ranges from complete response(responders) to complete resistance(non-responders).To date we are not able to separate in advance the first group from the second,due to the absence of a valid biomarker.Therefore all patients receive the same therapy regardless of whether they reap benefits.On the other hand almost all patients receive a surgical resection after the CRT,although a watch-and-wait procedure or an endoscopic resection might be sufficient for those who responded well to the CRT.Being highly conserved regulators of gene expression,micro RNAs(mi RNAs) seem to be promising candidates for biomarkers.Many studies have been analyzing the mi RNAs expressed in rectal cancer tissue to determine a specific mi RNA profile for the ailment.Unfortunately,there is only a small overlap of identified mi RNAs between different studies,posing the question as to whether different methods or differences in tissue storage may contribute to that fact or if the results simply are not reproducible,due to unknown factors with undetected influences on mi RNA expression.Other studies sought to find mi RNAs which correlate to clinical parameters(tumor grade,nodal stage,metastasis,survival) and therapy response.Although several mi RNAs seem to have an impact on the response to CRT or might predict nodal stage,there is still only little overlap between different studies.We here aimed to summarize the current literature on rectal cancer and mi RNA expression with respect to the different relevant clinical parameters.

  4. Current debate in the oncologic management of rectal cancer.

    Science.gov (United States)

    Millard, Trish; Kunk, Paul R; Ramsdale, Erika; Rahma, Osama E

    2016-10-15

    Despite the considerable amount of research in the field, the management of locally advanced rectal cancer remains a subject to debate. To date, effective treatment centers on surgical resection with the standard approach of total mesorectal resection. Radiation therapy and chemotherapy have been incorporated in order to decrease local and systemic recurrence. While it is accepted that a multimodality treatment regimen is indicated, there remains significant debate for how best to accomplish this in regards to order, dosing, and choice of agents. Preoperative radiation is the standard of care, yet remains debated with the option for chemoradiation, short course radiation, and even ongoing studies looking at the possibility of leaving radiation out altogether. Chemotherapy was traditionally incorporated in the adjuvant setting, but recent reports suggest the possibility of improved efficacy and tolerance when given upfront. In this review, the major studies in the management of locally advanced rectal cancer will be discussed. In addition, future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy, inclusion of radiation, and non-operative management.

  5. Dual-energy CT can detect malignant lymph nodes in rectal cancer

    DEFF Research Database (Denmark)

    Al-Najami, I.; Lahaye, M. J.; Beets-Tan, Regina G H

    2017-01-01

    node assessment, and compared it to Magnetic Resonance Imaging (MRI). The objective of this prospective observational feasibility study was to determine the clinical value of the DECT for the detection of metastases in the pelvic lymph nodes of rectal cancer patients and compare the findings to MRI......Background There is a need for an accurate and operator independent method to assess the lymph node status to provide the most optimal personalized treatment for rectal cancer patients. This study evaluates whether Dual Energy Computed Tomography (DECT) could contribute to the preoperative lymph...... and histopathology. Materials and methods The patients were referred to total mesorectal excision (TME) without any neoadjuvant oncological treatment. After surgery the rectum specimen was scanned, and lymph nodes were matched to the pathology report. Fifty-four histology proven rectal cancer patients received...

  6. An isolated vaginal metastasis from rectal cancer

    Directory of Open Access Journals (Sweden)

    Ai Sadatomo

    2016-02-01

    Conclusion: We should keep the vagina within the field of view of pelvic MRI, which is one of the preoperative diagnostic tools for colorectal cancer. If female patients show gynecological symptoms, gynecological examination should be recommended. Isolated vaginal metastases are an indication for surgical resection, and adjuvant chemotherapy is also recommended.

  7. Disseminated lung cancer presenting as a rectal mass

    DEFF Research Database (Denmark)

    Noergaard, Mia M; Stamp, Inger M H; Bodtger, Uffe

    2016-01-01

    Primary lung cancer is the leading cause of cancer-related deaths globally, and approximately 50% had metastatic disease at the time of diagnosis. A rectal mass and unintended weight loss are common manifestations of rectal cancer. Our case presented with a rectal mass, but workup revealed...... a metastatic lesion from lung cancer. Lung cancer metastases to the lower gastrointestinal tract imply reduced survival compared with the already poor mean survival of stage IV lung cancer. Despite relevant therapy, the patient died 5 months after referral....

  8. Learning Curves in Robotic Rectal Cancer Surgery: A literature Review

    Directory of Open Access Journals (Sweden)

    Nasir

    2016-10-01

    Full Text Available Background Laparoscopic rectal cancer surgery offers several advantages over open surgery, including quicker recovery, shorter hospital stay and improved cosmesis. However, laparoscopic rectal surgery is technically difficult and is associated with a long learning curve. The last decade has seen the emergence of robotic rectal cancer surgery. In contrast to laparoscopy, robotic surgery offers stable 3D views with advanced dexterity and ergonomics in narrow spaces such as the pelvis. Whether this translates into a shorter learning curve is still debated. The aim of this literature search is to ascertain the learning curve of robotic rectal cancer surgery. Methods This review analyses the literature investigating the learning curve of robotic rectal cancer surgery. Using the Medline database a literature search of articles investigating the learning curve of robotic rectal surgery was performed. All relevant articles were included. Results Twelve original studies fulfilled the inclusion criteria. The current literature suggests that the learning curve of robotic rectal surgery varies between 15 and 44 cases and is probably shorter to that of laparoscopic rectal surgery. Conclusions There are only a few studies assessing the learning curve of robotic rectal surgery and they possess several differences in methodology and outcome reporting. Nevertheless, current evidence suggests that robotic rectal surgery might be easier to learn than laparoscopy. Further well designed studies applying CUSSUM analysis are required to validate this motion.

  9. Prediction of nodal involvement in primary rectal carcinoma without invasion to pelvic structures: accuracy of preoperative CT, MR, and DWIBS assessments relative to histopathologic findings.

    Directory of Open Access Journals (Sweden)

    Jun Zhou

    Full Text Available OBJECTIVE: To investigate the accuracy of preoperative computed tomography (CT, magnetic resonance (MR imaging and diffusion-weighted imaging with background body signal suppression (DWIBS in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. METHODS AND MATERIALS: Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS were compared with the final histological findings. RESULTS: The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01 but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05. The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria. CONCLUSION: MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.

  10. Rectal and colon cancer: Not just a different anatomic site.

    Science.gov (United States)

    Tamas, K; Walenkamp, A M E; de Vries, E G E; van Vugt, M A T M; Beets-Tan, R G; van Etten, B; de Groot, D J A; Hospers, G A P

    2015-09-01

    Due to differences in anatomy, primary rectal and colon cancer require different staging procedures, different neo-adjuvant treatment and different surgical approaches. For example, neoadjuvant radiotherapy or chemoradiotherapy is administered solely for rectal cancer. Neoadjuvant therapy and total mesorectal excision for rectal cancer might be responsible in part for the differing effect of adjuvant systemic treatment on overall survival, which is more evident in colon cancer than in rectal cancer. Apart from anatomic divergences, rectal and colon cancer also differ in their embryological origin and metastatic patterns. Moreover, they harbor a different composition of drug targets, such as v-raf murine sarcoma viral oncogene homolog B (BRAF), which is preferentially mutated in proximal colon cancers, and the epidermal growth factor receptor (EGFR), which is prevalently amplified or overexpressed in distal colorectal cancers. Despite their differences in metastatic pattern, composition of drug targets and earlier local treatment, metastatic rectal and colon cancer are, however, commonly regarded as one entity and are treated alike. In this review, we focused on rectal cancer and its biological and clinical differences and similarities relative to colon cancer. These aspects are crucial because they influence the current staging and treatment of these cancers, and might influence the design of future trials with targeted drugs.

  11. Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

    Directory of Open Access Journals (Sweden)

    Tsumura Ayako

    2012-10-01

    Full Text Available Abstract This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann’s procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.

  12. Postoperative adjuvant chemoradiotherapy in rectal cancer

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    Chang, Sei Kyung; Kim, Jong Woo; Oh, Do Yeun; Chong, So Young; Shin, Hyun Soo [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2006-09-15

    To evaluate the role of postoperative adjuvant chemoradiotherapy in rectal cancer, we retrospectively analyzed the treatment outcome of patients with rectal cancer taken curative surgical resection and postoperative adjuvant chemoradiotherapy. A total 46 patients with AJCC stage II and III carcinoma of rectum were treated with curative surgical resection and postoperative adjuvant chemoradiotherapy. T3 and T4 stage were 38 and 8 patients, respectively. N0, N1, and N2 stage were 12, 16, 18 patients, respectively. Forty patients received bolus infusions of 5-fluorouracil (500 mg/m{sup 2}/day) with leucovorin (20 mg/m{sup 2}/day), every 4 weeks interval for 6 cycles. Oral Uracil/Tegafur on a daily basis for 6 {approx} 12 months was given in 6 patients. Radiotherapy with 45 Gy was delivered to the surgical bed and regional pelvic lymph node area, followed by 5.4 {approx} 9 Gy boost to the surgical bed. The follow up period ranged from 8 to 75 months with a median 35 months. Treatment failure occurred in 17 patients (37%). Locoregional failure occurred in 4 patients (8.7%) and distant failure in 16 patients (34.8%). There was no local failure only. Five year actuarial overall survival (OS) was 51.5% and relapse free survival (RFS) was 58.7%. The OS and RFS were 100%, 100% in stage N0 patients, 53.7%, 47.6% in N1 patients, and 0%, 41.2% in N2 patients ({rho} = 0.012, {rho} = 0.009). The RFS was 55%, 78.5%, and 31.2% in upper, middle, and lower rectal cancer patients, respectively ({rho} = 0.006). Multivariate analysis showed that N stage ({rho} = 0.012) was significant prognostic factor for OS and that N stage ({rho} = 0.001) and location of tumor ({rho} = 0.006) were for RFS. Bowel complications requiring surgery occurred in 3 patients. Postoperative adjuvant chemoradiotherapy was an effective modality for locoregional control of rectal cancer. But further investigations for reducing the distant failure rate are necessary because distant failure rate is still high.

  13. Correlation between K-ras genetype with tumor regression of rectal cancer after preoperative chemoradiotherapy%K-ras基因型与直肠癌术前放化疗后肿瘤病理消退的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王伟; 丁喆

    2012-01-01

    目的:探讨K-ras基因突变是否可作为直肠癌术前放化疗后肿瘤组织病理消退的预测因子.方法:收集我院行术前放化疗的Ⅱ、Ⅲ期直肠癌患者46例,通过放化疗前活检石蜡包埋组织获取DNA样本,经PCR扩增后测序,明确K-ras基因第12、13密码子突变情况.根据Dwork's直肠癌肿瘤消退分级标准评定放化疗后肿瘤组织的病理改变,将TRG2+3+4定义为肿瘤组织消退良好,TRG0+1肿瘤组织无明显消退.结果:46例患者中成功提取DNA 43例,K-ras基因突变15例(34.9%),其中第12密码子突变11例(73.3%),第13密码子突变4例(26.7%).43例患者中TRG2+3+4者29例(67.4%),TRG0+1者14例(32.6%).K-ras基因突变组和野生组肿瘤组织消退良好者分别为66.7%和67.8%,2组相比差异无统计学意义(P=0.793).结论:在K-ras 基因突变型和野生型的直肠癌患者中,术前放化疗后直肠肿瘤病理消退程度无差异,K-ras基因突变不能作为直肠癌术前放化疗后肿瘤组织病理消退的预测因子.%Objective:To evaluate whether the presence of K-ras gene mutations is a useful tumor-response marker in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy. Methods:46 patients with locally advanced rectal cancer who were treated with preoperative chemoradiotherapy were enrolled. DNA was isolated from paraffin-embedded tissues before chemoradiotherapy amplified by PCR,and then sequenced in order to detect K-ras mutations in codons 12,13. Post-operative specimens were classified according to the Dwork's tumor regression grading (TRG). Good tumor regression was defined as TRG 2+3+4, insignificant tumor regression as TRG 0+1. Results:DNA was successfully extracted from 43 patients,K-ras mutation occurred in 15 patients (34.9%), of which mutation in codon 12 occurred in 11 patients (73.3%),and mutation in,codon 13 occurred in 4 patients (26.7%). 29 (67.4%) patients were graded as TRG 2+3+4,14(32.6%)as

  14. Challenges in the multimodality treatment of rectal cancer

    NARCIS (Netherlands)

    Swellengrebel, Hendrik Albert Maurits

    2013-01-01

    Remaining questions and current goals in the treatment of rectal cancer include optimizing staging accuracy, establishing the optimal neoadjuvant strategy to be implemented in the different stages of rectal cancer and possibly leading to the evidence-based introduction of organ sparing and non-opera

  15. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Raquel Conde-Muíño

    2015-01-01

    Full Text Available There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40–60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile’s ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice.

  16. Predictive Biomarkers to Chemoradiation in Locally Advanced Rectal Cancer.

    Science.gov (United States)

    Conde-Muíño, Raquel; Cuadros, Marta; Zambudio, Natalia; Segura-Jiménez, Inmaculada; Cano, Carlos; Palma, Pablo

    2015-01-01

    There has been a high local recurrence rate in rectal cancer. Besides improvements in surgical techniques, both neoadjuvant short-course radiotherapy and long-course chemoradiation improve oncological results. Approximately 40-60% of rectal cancer patients treated with neoadjuvant chemoradiation achieve some degree of pathologic response. However, there is no effective method of predicting which patients will respond to neoadjuvant treatment. Recent studies have evaluated the potential of genetic biomarkers to predict outcome in locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation. The articles produced by the PubMed search were reviewed for those specifically addressing a genetic profile's ability to predict response to neoadjuvant treatment in rectal cancer. Although tissue gene microarray profiling has led to promising data in cancer, to date, none of the identified signatures or molecular markers in locally advanced rectal cancer has been successfully validated as a diagnostic or prognostic tool applicable to routine clinical practice.

  17. [Association of preoperative platelet count with the prognosis of patients with colorectal cancer].

    Science.gov (United States)

    Chen, Li-Ling; Zhang, Li; Li, Yue-Ling; Li, Xiao-Ling; Liu, Wen-Hui; Yan, Jin; Yang, Yan-Fang

    2016-04-01

    To explore the association between preoperative platelet count and the outcomes of patients with colorectal cancer (CRC). This study was conducted among a cohort of 486 CRC patients, who underwent surgery in Sichuan Provincial Cancer Hospital between January, 2010 and July, 2013 and were prospectively followed up for their outcomes. The association between preoperative platelet counts and clinicopathologic factors of the patients were analyzed. Survival analysis of the patients was performed using log-rank test, and the factors affecting the patients' outcomes were analyzed by univariate and multivariate analyses using the Cox proportional hazard model. In this cohort, preoperative platelet count was significantly associated with the tumor site, depth of tumor invasion (T), and distant metastasis (M) (all Prectal cancer, the overall postoperative survival differed significantly between high and low preoperative platelet count groups (Χ(2)=8.813, P=0.003 and Χ(2)=5.110, P=0.024, respectively), but this difference was not observed in patients with colon cancer (PTNM stage, vascular invasion, perineural invasion, and preoperative CEA level (RR=1.814, 95%CI: 1.056-3.115). In subgroup analysis, preoperative platelet count was identified as an independent prognostic factor in patients with rectal cancer (RR=2.718, 95% CI: 1.132-6.526), but not in patients with colon cancer (RR=1.396, 95%CI: 0.705-2.765). As an independent prognostic factor in CRC patients, preoperative platelet count may serve as an important indicator for predicting the outcomes of rectal cancer, but its prognostic value for colon cancer needs further clarification.

  18. SEOM Clinical Guideline of localized rectal cancer (2016).

    Science.gov (United States)

    González-Flores, E; Losa, F; Pericay, C; Polo, E; Roselló, S; Safont, M J; Vera, R; Aparicio, J; Cano, M T; Fernández-Martos, C

    2016-12-01

    Localized rectal adenocarcinoma is a heterogeneous disease and current treatment recommendations are based on a preoperative multidisciplinary evaluation. High-resolution magnetic resonance imaging and endoscopic ultrasound are complementary to do a locoregional accurate staging. Surgery remains the mainstay of treatment and preoperative therapies with chemoradiation (CRT) or short-course radiation (SCRT) must be considered in more locally advanced cases. Novel strategies with induction chemotherapy alone or preceding or after CRT (SCRT) and surgery are in development.

  19. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging.

    Science.gov (United States)

    Algebally, Ahmed Mohamed; Mohey, Nesreen; Szmigielski, Wojciech; Yousef, Reda Ramadan Hussein; Kohla, Samah

    2015-01-01

    The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery.

  20. Increased use of multidisciplinary treatment modalities adds little to the outcome of rectal cancer treated by optimal total mesorectal excision.

    LENUS (Irish Health Repository)

    Chang, Kah Hoong

    2012-10-01

    Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer. The roles of chemotherapy and radiotherapy have become more defined, accompanied by improvements in preoperative staging and histopathological assessment. We analyse our ongoing results in the light of changing patterns of treatment over consecutive time periods.

  1. Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer.

    Science.gov (United States)

    Ikoma, Naruhiko; You, Y Nancy; Bednarski, Brian K; Rodriguez-Bigas, Miguel A; Eng, Cathy; Das, Prajnan; Kopetz, Scott; Messick, Craig; Skibber, John M; Chang, George J

    2017-08-10

    Purpose After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment. Patients and Methods Patients with locally advanced (cT3-4 or cN+) rectal cancer who were treated with preoperative chemoradiotherapy followed by total mesorectal excision at our institution during 1993 to 2008 were identified. We examined patterns of recurrence location, time to recurrence, treatment factors, and survival. Results A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-only recurrence (11.2 months) than in lung-only recurrence (18.2 months) or locoregional-only recurrence (24.7 months; P = .001). Salvage surgery was performed in 57% of patients with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence ( P recurrence ( P = .353). Conclusion We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

  2. Postoperative adjuvant chemotherapy in rectal cancer operated for cure

    DEFF Research Database (Denmark)

    Petersen, Sune Høirup; Harling, Henrik; Kirkeby, Lene Tschemerinsky

    2012-01-01

    in Dukes´ C (TNM stage III) colon tumours i.e. tumours with metastases in the regional lymph nodes but no distant metastases. In contrast, the evidence for recommendations of adjuvant therapy in rectal cancer is sparse. In Europe it is generally acknowledged that locally advanced rectal tumours receive...

  3. Late adverse effects of radiation therapy for rectal cancer - a systematic overview

    Energy Technology Data Exchange (ETDEWEB)

    Birgisson, Helgi; Paahlman, Lars; Gunnarsson, Ulf [Dept. of Surgery, Univ. Hospital, Univ. of Uppsala, Uppsala (Sweden); Glimelius, Bengt [Dept. of Oncology, Radiology and Clinical Immunology, Univ. Hospital, Univ. of Uppsala, Uppsala (Sweden); Dept. of Oncology and Pathology, Karolinska Inst., Stockholm (Sweden)

    2007-05-15

    Purpose. The use of radiation therapy (RT) together with improvement in the surgical treatment of rectal cancer improves survival and reduces the risk for local recurrences. Despite these benefits, the adverse effects of radiation therapy limit its use. The aim of this review was to present a comprehensive overview of published studies on late adverse effects related to the RT for rectal cancer. Methods. Meta-analyses, reviews, randomised clinical trials, cohort studies and case-control studies on late adverse effects, due to pre- or postoperative radiation therapy and chemo-radiotherapy for rectal cancer, were systematically searched. Most information was obtained from the randomised trials, especially those comparing preoperative short-course 5x5 Gy radiation therapy with surgery alone. Results. The late adverse effects due to RT were bowel obstructions; bowel dysfunction presented as faecal incontinence to gas, loose or solid stools, evacuation problems or urgency; and sexual dysfunction. However, fewer late adverse effects were reported in recent studies, which generally used smaller irradiated volumes and better irradiation techniques; although, one study revealed an increased risk for secondary cancers in irradiated patients. Conclusions. These results stress the importance of careful patient selection for RT for rectal cancer. Improvements in the radiation technique should further be developed and the long-term follow-up of the randomised trials is the most important source of information on late adverse effects and should therefore be continued.

  4. Pouch Techniques in Rectal Cancer Surgery

    Institute of Scientific and Technical Information of China (English)

    Christoph A. Maurer

    2009-01-01

    Rectal cancer of the middle and distal third of the rectum are nowadays managed by low or ultra-low anterior resection with total mesorectal excision and coloanal anastomosis. Following straight coloanal anastomosis, patients often suffer from high stool frequency, urgency and, occasionally, fecal incontinence. To overcome these problems, several types of colonic reservoirs (pouches) have been proposed. The following article elucidates the indications and contraindications for the creation of a pouch. Furthermore, the paper gives a short overview of the different pouch designs that are widely accepted and currently in use, with special emphasis of the typical advantages, disadvantages and feasibility. Current guide-lines recommend to perform a colonic pouch since it provides functional benefits over straight coloanal anastomosis with no increase in postoperative complications.

  5. Laparoscopic rectal cancer surgery: Where do we stand?

    Institute of Scientific and Technical Information of China (English)

    Mukta K Krane; Alessandro Fichera

    2012-01-01

    Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer.In contrast,laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm.While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach,whether the same oncologic clearance,specifically an adequate TME can be obtained is of concern.The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes.The data from 8 RCTs,3 metaanalyses,and 2 Cochrane Database of Systematic Reviews was reviewed.Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss,earlier retum of bowel function,and shorter hospital length of stay.Concerns that laparoscopic rectal cancer surgery compromises shortterm oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature.Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

  6. The importance of rectal cancer MRI protocols on iInterpretation accuracy

    Directory of Open Access Journals (Sweden)

    Lindholm Johan

    2008-08-01

    Full Text Available Abstract Background Magnetic resonance imaging (MRI is used for preoperative local staging in patients with rectal cancer. Our aim was to retrospectively study the effects of the imaging protocol on the staging accuracy. Patients and methods MR-examinations of 37 patients with locally advanced disease were divided into two groups; compliant and noncompliant, based on the imaging protocol, without knowledge of the histopathological results. A compliant rectal cancer imaging protocol was defined as including T2-weighted imaging in the sagittal and axial planes with supplementary coronal in low rectal tumors, alongside a high-resolution plane perpendicular to the rectum at the level of the primary tumor. Protocols not complying with these criteria were defined as noncompliant. Histopathological results were used as gold standard. Results Compliant rectal imaging protocols showed significantly better correlation with histopathological results regarding assessment of anterior organ involvement (sensitivity and specificity rates in compliant group were 86% and 94%, respectively vs. 50% and 33% in the noncompliant group. Compliant imaging protocols also used statistically significantly smaller voxel sizes and fewer number of MR sequences than the noncompliant protocols Conclusion Appropriate MR imaging protocols enable more accurate local staging of locally advanced rectal tumors with less number of sequences and without intravenous gadolinium contrast agents.

  7. Preoperative Arterial Interventional Chemotherapy on Cervical Cancer

    Institute of Scientific and Technical Information of China (English)

    WANG Hui; LING HU-Hua; TANG Liang-dan; ZHANG Xing-hua

    2008-01-01

    Objective:To discuss the therapeutic effect of preoperative interventional chemotherapy on cervical cancer.Methods:Preoperative interventional chemotherapy by femoral intubation was performed in 25 patients with bulky cervical cancer.The patients received bleomycin 45 mg and cisplatin or oxaliplatin 80 mg/m2.Results:25 cases(including 8 cases with stage Ⅰ and 17 cases with stage Ⅱ)received one or two courses of preoperative interventional chemotherapy.The size of the focal lesions was decreased greatly and radical hysterectomy and lymphadenectomy were performed successfully in all the patients.All of the specimens were sent for pathological examination.Lymphocyte infiltration was found more obvious in the cancer tissues as compared with their counterpart before treatment.As a result,relevant vaginal bleeding was stopped completely shortly after the treatment.Conclusion:Arterial interventional chemotherapy was proved to reduce the local size of cervical cancer and thus control the hemorrhage efficiently.The patients with cervical cancer can receive radical hysterectomy therapy after the interventional chemotherapy.

  8. Laparoscopic resection for low rectal cancer: evaluation of oncological efficacy.

    LENUS (Irish Health Repository)

    Moran, Diarmaid C

    2011-09-01

    Laparoscopic resection of low rectal cancer poses significant technical difficulties for the surgeon. There is a lack of published follow-up data in relation to the surgical, oncological and survival outcomes in these patients.

  9. Management of rectal cancer: Times they are changing

    Directory of Open Access Journals (Sweden)

    Marilia Cravo

    2014-09-01

    In this review, we critically examine recent advances in staging, surgery, and chemoradiation in the management of patients with rectal cancer which have not typically been incorporated in published treatment guidelines.

  10. Caspase-3 activity predicts local recurrence in rectal cancer.

    NARCIS (Netherlands)

    Heer, P. de; Bruin, E.C. de; Klein-Kranenbarg, E.; Aalbers, R.I.; Marijnen, C.A.M.; Putter, H.; Bont, H.J. de; Nagelkerke, J.F.; Krieken, J.H.J.M. van; Verspaget, H.W.; Velde, C.J. van de; Kuppen, P.J.

    2007-01-01

    PURPOSE: Radiotherapy followed by total mesorectal excision surgery has been shown to significantly reduce local recurrence rates in rectal cancer patients. Radiotherapy, however, is associated with considerable morbidity. The present study evaluated the use of biochemical detection of enzymatic

  11. Simultaneous laparoscopy-assisted resection for rectal and gastric cancer.

    Science.gov (United States)

    Wei, Hongbo; Master, Jiafeng Fang; Chen, Tufeng; Zheng, Zongheng; Wei, Bo; Huang, Yong; Huang, Jianglong; Master, Haozhong Xu

    2014-01-01

    Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery.

  12. The Application Value of Background Suppression Diffusion Weighted Imaging (DWIBS) in Preoperative Staging of Rectal Cancer%全身磁共振背景抑制扩散成像在直肠癌术前分期中的应用价值

    Institute of Scientific and Technical Information of China (English)

    徐芹艳; 孙世杭; 孙西河; 董鹏; 王锡臻; 常光辉; 管玥; 葛艳明

    2012-01-01

    Objective To investigate the clinic value of background suppression diffusion weighted imaging( DWIBS) in preoperative staging of rectal cancer. Materials and Methods 39 cases of rectal cancer confirmed by colonoscopy received DWIBS. The data was divided into three (T2, T3 T4) groups on the basis of pathological results about T stage of rectal cancer. The relative signal intensity and the ADC values of the tumor were measured, the length, perimeter and thickness of the lesion were examined on DWIBS sequence. The difference of every index among groups and correlative a-nalysis were taken. Preoperative NM staging was made, the results were compared with the results of pathological NM staging and the accuracy, specificity and sensitivity of DWIBS NM staging was calculated. Results Among 39 cancer lesions, DWIBS correctly detected 39 lesions, the sensitivity and accuracy both were 100%. Thickness of the lesion were different from each other(f 0.05 ). The overall diagnostic accuracy rate of N staging was 84. 61% ; For No stage the sensitivity was 85.71% , the specificity was 83.33%. For N, stage, the diagnostic sensitivity was 70.00% , the specificity was 89.66%. For N, stage, the sensitivity was 100% , specificity was 80. 65%. 6 cases of distant metastasis were correctly diagnosed by DWIBS. Conclusion DWIBS is sensitive and accuracy in NM staging of rectal cancer, it is an effective method to show the metastatic lymph node and distant metastasis, and also has high accuracy and sensitivity in detecting the primary tumor of rectal cancer. However,the application of DW1BS in T staging exists certain limits, combining with conventional MRI sequences is helpful to improve the accuracy of T staging.%目的 探讨全身磁共振背景抑制扩散加权成像(DWIBS)对直肠癌术前分期的应用价值.资料与方法 对39例经肠镜证实的直肠癌患者,术前行全身磁共振DWIBS检查,以直肠癌原发灶病理结果为标准将本组资料分为T2、T3、T4三

  13. Germline polymorphisms may act as predictors of response to preoperative chemoradiation in locally advanced T3 rectal tumors

    DEFF Research Database (Denmark)

    Spindler, Karen-Lise G; Nielsen, Jens N; Lindebjerg, Jan;

    2007-01-01

    with locally advanced T3 rectal tumors were analyzed for thymidylate synthase, epidermal growth factor receptor Sp1-216, and epidermal growth factor A61G gene polymorphisms by polymerase chain reaction. Treatment consisted of preoperative radiotherapy (total dose 65 Gy) and concomitant chemotherapy (Uftoral......PURPOSE: Patients with locally advanced T3 rectal tumors who present with complete pathologic response to preoperative chemoradiation have a low rate of local recurrence and an excellent prognosis. Predictive markers for complete pathologic response are needed with the perspective of improving...... individualized treatment of these patients. This study was designed to investigate the predictive value of a new combination of three gene polymorphisms: thymidylate synthase, epidermal growth factor receptor Sp1-216, and epidermal growth factor A61G. METHODS: Pretreatment blood samples from 60 patients...

  14. Cruciferous vegetables and colo-rectal cancer.

    Science.gov (United States)

    Lynn, Anthony; Collins, Andrew; Fuller, Zoë; Hillman, Kevin; Ratcliffe, Brian

    2006-02-01

    Cruciferous vegetables have been studied extensively for their chemoprotective effects. Although they contain many bioactive compounds, the anti-carcinogenic actions of cruciferous vegetables are commonly attributed to their content of glucosinolates. Glucosinolates are relatively biologically inert but can be hydrolysed to a range of bioactive compounds such as isothiocyanates (ITC) and indoles by the plant-based enzyme myrosinase, or less efficiently by the colonic microflora. A number of mechanisms whereby ITC and indoles may protect against colo-rectal cancer have been identified. In experimental animals cruciferous vegetables have been shown to inhibit chemically-induced colon cancer. However, the results of recent epidemiological cohort studies have been inconsistent and this disparity may reflect a lack of sensitivity of such studies. Possible explanations for the failure of epidemiological studies to detect an effect include: assessment of cruciferous vegetable intake by methods that are subject to large measurement errors; the interaction between diet and genotype has not been considered: the effect that post-harvest treatments may have on biological effects of cruciferous vegetables has not been taken into account.

  15. Patterns of metastasis in colon and rectal cancer.

    Science.gov (United States)

    Riihimäki, Matias; Hemminki, Akseli; Sundquist, Jan; Hemminki, Kari

    2016-07-15

    Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR = 2.4) and the nervous system (1.5) and less frequently within the peritoneum (0.3). Mucinous and signet ring adenocarcinomas more frequently metastasized within the peritoneum compared with generic adenocarcinoma (3.8 [colon]/3.2 [rectum]), and less frequently into the liver (0.5/0.6). Lung metastases occurred frequently together with nervous system metastases, whereas peritoneal metastases were often listed with ovarian and pleural metastases. Thoracic metastases are almost as common as liver metastases in rectal cancer patients with a low stage at diagnosis. In colorectal cancer patients with solitary metastases the survival differed between 5 and 19 months depending on T or N stage. Metastatic patterns differ notably between colon and rectal cancers. This knowledge should help clinicians to identify patients in need for extra surveillance and gives insight to further studies on the mechanisms of metastasis.

  16. Clinical results of tumor shrinkage and evaluation of quality of life in low rectal carcinoma after preoperative combined treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kojima, Osamu; Suganuma, Yasushi; Tamura, Takao; Ohnishi, Kazuyoshi; Nishiue, Takashi; Itoh, Masahiko; Horie, Hiroshi; Sawai, Seiji; Takahashi, Toshio (Kyoto Prefectural Univ. of Medicine (Japan))

    1992-10-01

    To improve the surgical rate and the quality of life (QOL) for patients with advanced low rectal carcinoma, we investigated whether preoperative treatments (irradiation and hyperthermia and 5-fluorouracil (5-FU) suppository, irradiation and hyperthermia, irradiation and 5-FU suppository, irradiation alone and 5-FU suppository alone) were useful. The tumor shrinkage rate after preoperative treatments was highest in the irradiation, hyperthermia and 5-FU suppository group. Pathologically complete regression was observed in the 2 of 18 cases (12%). According to our criteria of histological changes, the irradiation, hyperthermia and 5-FU suppository group showed the greatest effectiveness. The 4 year postoperative survival rate and the 4 year local recurrence rate were 100% and 8% in the irradiation, hyperthermia and 5-FU suppository group and the data suggest that these results were the best of the 5 treatments. After the carcinoma was shrunk after irradiation, hyperthermia and 5-FU suppository, the patients could receive curatively a sphincter-saving operation (super-low anterior resection and transanal rectal resection). The fecal continence of 7 patients after sphincter-saving operations was increased as good by manometric study, defecography and clinical evaluation. In conclusion, our data suggest that the preoperative combined treatment of irradiation, hyperthermia and 5-FU suppository prevents local recurrence and increases the possibility of a sphincter-saving operation for advanced rectal carcinoma. (author).

  17. Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy

    Science.gov (United States)

    Farrell, John J; Hicks, Jennifer L; Wallace, Stephanie E; Seftel, Allen D

    2017-01-01

    With the universal adoption of antibiotic prophylaxis prior to prostate biopsy, the current risk of post-biopsy infection (including sepsis) is study of preoperative rectal cultures to screen for rectal colonization with fluoroquinolone-resistant bacteria using ciprofloxacin-supplemented MacConkey agar culture media. To evaluate the feasibility and practicality of this test, one provider used the results of rectal swab cultures collected during the preoperative outpatient evaluation to adjust each patient’s preoperative antibiotic prophylaxis when fluoroquinolone-resistant enteric bacteria were detected, whereas two other providers continued usual preoperative care and empiric antimicrobial prophylaxis. Rectal colonization with fluoroquinolone-resistant bacteria was detected in 19/152 (12.5%) of patients. In our intention-to-treat analysis (N=268), the rate of post-biopsy sepsis was 3.6% lower in the group that was screened for rectal colonization with fluoroquinolone-resistant bacteria prior to transrectal prostate biopsy. The observed risk reduction in the rectal screening group trended toward, but did not achieve, statistical significance. We suggest that preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria may be a useful step toward mitigating post-prostate biopsy sepsis. PMID:28280717

  18. Preoperative irradiation and cystectomy for bladder cancer.

    Science.gov (United States)

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F

    1982-03-01

    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  19. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin

    Energy Technology Data Exchange (ETDEWEB)

    Slater, A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Halligan, S. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Taylor, S.A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Marshall, M. [Intestinal Imaging Centre, St Mark' s Hospital, Northwick Park, London (United Kingdom)

    2006-01-15

    Aim: To determine the effect of rectal distension, used by some workers to facilitate staging, on mesorectal tissues. Subjects and methods: Ninety-seven consecutive rectal cancer staging MRI examinations were identified of which 76 were analysable: 48 studies were performed using rectal insufflation of 100 ml room air and 28 were performed without distension. Median age was 69 and 72 years, respectively. In each patient a single experienced observer measured the distance from the outer rectal wall to the inner margin of the mesorectal fascia at four locations (12, 3, 6 and 9 o'clock), excluding sites of tumour involvement, from the T1-weighted axial image at the level of the sacro-coccygeal junction. The two groups of measurements were compared using Mann-Whitney test statistic, and frequencies then categorized into <5 mm or {>=}5 mm, and compared using Fisher's exact test. Results: The median distance between the rectal wall and mesorectal fascia in the distended group was approximately half that found in the non-distended group, and significantly lower at the 3, 6 and 9 o'clock positions (p<0.001). 68/167 (41%) of measurements were 5 mm or less, compared with 19/104 (18%) in the non-distended group (p<0.001). Conclusion: Rectal distension before MRI significantly reduces the distance between the rectal wall and mesorectal fascia. Although this is advocated to facilitate visualization of the primary tumour, it potentially affects the accuracy with which a clear circumferential resection margin can be predicted.

  20. CURRENT TREATMENT POLICY FOR RECTAL CANCER WITH SYNCHRONOUS DISTANT METASTASES (A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    M. I. Davydov

    2014-01-01

    Full Text Available Treatment results of low rectal cancer patient with internal sphincter involvement and synchronous liver metastases is presented. After combined treatment including preoperative targeted therapy, chemotherapy, chemoradiotherapy a synchronous resection of primary tumour and liver metastases was carried out (R0. Synchronous right hepihepatectomy and proctectomy was performed with resection of the deep part of external sphincter, neorectum creation by transverse coloplasty, neoanal sphincter creation using colonic smooth muscle layer without preventive colostomy. A possibility of synchronous plastic sphincter-sparing surgery in metastatic rectal cancer patient with locally advanced tumour is demonstrated. Such treatment allows to remove the risk of primary tumour complications, facilitates further chemotherapy treatment and improves quality of life and long-term treatment outcome.

  1. Dual-energy CT can detect malignant lymph nodes in rectal cancer

    DEFF Research Database (Denmark)

    Al-Najami, I.; Lahaye, M. J.; Beets-Tan, Regina G H

    2017-01-01

    node assessment, and compared it to Magnetic Resonance Imaging (MRI). The objective of this prospective observational feasibility study was to determine the clinical value of the DECT for the detection of metastases in the pelvic lymph nodes of rectal cancer patients and compare the findings to MRI......Background There is a need for an accurate and operator independent method to assess the lymph node status to provide the most optimal personalized treatment for rectal cancer patients. This study evaluates whether Dual Energy Computed Tomography (DECT) could contribute to the preoperative lymph...... a pelvic DECT scan and a standard MRI. The Dual Energy CT quantitative parameters were analyzed: Water and Iodine concentration, Dual-Energy Ratio, Dual Energy Index, and Effective Z value, for the benign and malignant lymph node differentiation. Results DECT scanning showed statistical difference between...

  2. VEGF concentrations in tumour arteries and veins from patients with rectal cancer

    DEFF Research Database (Denmark)

    Werther, Kim; Bülow, Steffen; Hesselfeldt, Peter;

    2002-01-01

    , automated complete white cell and platelet counts were performed. In serum and EDTA plasma, no significant differences in VEGF concentrations were observed (p = 0.1 and p = 0.5), respectively) between tumour arteries and tumour veins. However, in supernatants from lysed blood, VEGF concentrations were......This pilot study investigated the hypothesis that the tumour itself is the source of the elevated vascular endothelial growth factor (VEGF) concentrations which are often observed in peripheral blood from patients with rectal cancer. Twenty-four consecutive patients with primary rectal cancer were...... included. Blood samples were drawn preoperatively from peripheral veins (I) and intraoperatively from peripheral veins (II), tumour arteries (III), and tumour veins (IV). In the four compartments, VEGF concentrations were measured in serum, EDTA plasma, and supernatants from lysed whole blood. Additionally...

  3. Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Kiyoto Takehara; Hideki Aoki; Yuko Takehara; Rie Yamasaki; Kohji Tanakaya; Hitoshi Takeuchi

    2012-01-01

    Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis.Curative resection is currently the only effective treatment,and the efficacy of chemotherapy is unclear.This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma.We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases.He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil,leucovorin and oxaliplatin plus bevacizumab,FOLFIRI consisting of 5-fluorouracil,leucovorin and irinotecan plus bevacizumab,and irinotecan plus cetuximab.One of the liver tumors showed a different response to chemotherapy and was diagnosed as a leiomyosarcoma following histopathological examination.This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas.The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.

  4. Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

    Science.gov (United States)

    Thorne, Kymberley; Hutchings, Hayley; Islam, Saiful; Holland, Gail; Hatcher, Olivia; Gwynne, Sarah; Jenkins, Ian; Coyne, Peter; Duff, Michael; Feldman, Melanie; Winter, Des C; Gollins, Simon; Quirke, Phil; West, Nick; Brown, Gina; Fitzsimmons, Deborah; Brown, Alan; Beynon, John

    2016-01-01

    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. A more selective approach to RT may be appropriate given the associated toxicity. Methods and analysis This trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8–12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up. Objectives Objectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored. Ethics and dissemination The trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review

  5. Effect of preoperative nutritional risk to postoperative nutritional status of elderly rectal cancer patients%术前营养风险评估对老年直肠癌患者围手术期营养状况的影响

    Institute of Scientific and Technical Information of China (English)

    魏娜; 毕建军; 赵克聪; 范静宇; 孙海燕

    2012-01-01

    目的 分析营养风险评估对老年直肠癌患者围手术期营养状况的影响.方法 应用营养风险筛查2002 (NRS-2002)对85例老年直肠癌患者进行术前营养风险筛查,根据筛查结果将患者分为有营养风险组25例和无营养风险组60例,分别于术前1d、术后1d、术后7d检测两组患者的白蛋白(ALB)、前白蛋白(PALB)、血总淋巴细胞计数(TLC)和转铁蛋白(TFN),比较其差异.结果 术前85例患者中25例NRS-2002≥3分,存在营养风险,营养风险发生率为29.4%.术前1d两组患者各血清指标比较差异均无统计学意义(P>0.05);术后1d,营养风险组PALB为(12.4±3.7)mg/L低于无营养风险组( 14.3±3.9) mg/L,两组比较,差异有统计学意义(t=2.026,P<0.05);术后7d营养风险组ALB、TFN值低于无营养风险组,两组比较,差异有统计学意义(t分别为2.412,2.153;P <0.05).结论 存在营养风险的老年直肠癌患者围手术期营养状况变化明显,临床护理人员应对该类患者进行相应的营养指导.%Objective To investigate the effect of nutritional risk to nutritional status of peroperative elderly rectal cancer patients.Methods 85 elderly patients with rectal cancer were screened for preoperative nutritional status by NRS-2002 and divided into nutritional risk group and non-nutritional risk group.ALB,PALB,TLC and TFN of two groups were measured 1day before operation,1day and 7 days after operation.The values were compared between two groups.Results Before operation,25 patients out of 85 were at nutritional risk with NRS-2002≥3 and incidence of nutritional risk of 29.4%.The PALB value of the nutritional risk group was significantly lower than that of the non-nutritional risk group 1day after operation [(12.4±37)mg/L vs ( 14.3 ± 3.9 ) mg/L ;t =2.026,P<0.05].After 7 days,the average levels of all indexes of the nutritional risk group were lower than those of the non-nutritional risk group.Among those,differences of ALB and

  6. Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind

    2013-01-01

    L after treatment with COMP-RCS. Seven studies fulfilled the inclusion criteria. Different aspects of HRQoL seemed to be impaired for a shorter or longer period of time after surgery, in disease free patients treated for PARC and LRRC. However, the included studies all had methodological problems, which...... in the study was 164 (86%) patients treated with standard rectal cancer surgery (STAN-RCS). The Danish version showed satisfactory psychometric properties for the scales concerning body image, sexual functioning, male sexual problems and defecations problems. Reduced psychometric properties were found....... The majority of the scales improved or remained stable during the first year after surgery, a decrease was seen only for body image. One year after surgery HRQoL in patients with COMP-RSC was comparable to patients with STAN-RCS and NORM-data with exception of a poorer physical and emotional role function...

  7. Preoperative evaluation for lung cancer resection

    Science.gov (United States)

    Spyratos, Dionysios; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients. PMID:24672690

  8. Low Rectal Cancer Study (MERCURY II)

    Science.gov (United States)

    2016-03-11

    Adenocarcinoma; Adenocarcinoma, Mucinous; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Cystic, Mucinous, and Serous; Colorectal Neoplasms; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Rectal Diseases

  9. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery.

    Science.gov (United States)

    van de Velde, C J H; Boelens, P G; Tanis, P J; Espin, E; Mroczkowski, P; Naredi, P; Pahlman, L; Ortiz, H; Rutten, H J; Breugom, A J; Smith, J J; Wibe, A; Wiggers, T; Valentini, V

    2014-04-01

    The first multidisciplinary consensus conference on colon and rectal cancer was held in December 2012, achieving a majority of consensus for diagnostic and treatment decisions using the Delphi Method. This article will give a critical appraisal of the topics discussed during the meeting and in the consensus document by well-known leaders in surgery that were involved in this multidisciplinary consensus process. Scientific evidence, experience and opinions are collected to support multidisciplinary teams (MDT) with arguments for medical decision-making in diagnosis, staging and treatment strategies for patients with colon or rectal cancer. Surgery is the cornerstone of curative treatment for colon and rectal cancer. Standardizing treatment is an effective instrument to improve outcome of multidisciplinary cancer care for patients with colon and rectal cancer. In this article, a review of the following focuses; Perioperative care, age and colorectal surgery, obstructive colorectal cancer, stenting, surgical anatomical considerations, total mesorectal excision (TME) surgery and training, surgical considerations for locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC), surgery in stage IV colorectal cancer, definitions of quality of surgery, transanal endoscopic microsurgery (TEM), laparoscopic colon and rectal surgery, preoperative radiotherapy and chemoradiotherapy, and how about functional outcome after surgery?

  10. Expression of Human Epidermal Growth Factor Receptor-2 in Resected Rectal Cancer

    Science.gov (United States)

    Meng, Xiangjiao; Huang, Zhaoqin; Di, Jian; Mu, Dianbin; Wang, Yawei; Zhao, Xianguang; Zhao, Hanxi; Zhu, Wanqi; Li, Xiaolin; Kong, Lingling; Xing, Ligang

    2015-01-01

    Abstract The addition of trastuzumab to chemotherapy was demonstrated to be beneficial for advanced human epidermal growth factor receptor-2 (HER-2) positive gastric cancer. However, the HER-2 status of rectal cancer remains uncertain. This study aimed to determine the HER-2 expression in a large multicenter cohort of rectal cancer patients. The clinical and pathological features of 717 patients were retrospectively reviewed. All the patients were diagnosed with primary rectal adenocarcinoma without distant metastasis and took surgery directly without any preoperative anticancer treatment. HER-2 status was assessed on resected samples. A total of 99 cases with IHC3+ and 16 cases with IHC 2+ plus gene amplification were determined as HER-2 positive. 22.6% of HER-2 positive patients had local recurrence, whereas 16.9% of HER-2 negative patients did (P = 0.146). HER-2 positive tumors were more likely to have distant metastasis (P = 0.007). Univariate analysis revealed that pathological tumor stage, pathological node stage, positive margin, and lymphovascular invasion were significantly correlated with 5-year disease-free survival (DFS) and 5-year overall survival (OS). The patients with >10 dissected lymph nodes showed significantly longer OS (P = 0.045) but not DFS (P = 0.054). HER-2 negative patients had significantly better 5-year DFS (P < 0.001) and 5-year OS (P = 0.013) than those of the HER-2 positive patients. In the subgroup analysis for the early rectal cancer and locally advanced rectal cancer, HER-2 was also a poor predictor for survival. Multivariate analysis revealed that HER-2 was an independent prognostic factor for 5-year DFS (hazard ratio [HR] = 1.919, 95% confidence interval [CI] 1.415–2.605, P < 0.001) and for 5-year OS (HR = 1.549, 95% CI 1.097–2.186, P = 0.013). When the treatment was included in the analysis for locally advanced patients, HER-2 was a prognostic factor for 5-year DFS (P = 0.001) but not for

  11. 直肠癌术前容积调强与固定野调强技术的剂量学比较%Dosimetric Comparison between Preoperative Volumetric Modulated Arc Therapy and Fixed-field Intensity-modulated Radiotherapy for Rectal Cancer

    Institute of Scientific and Technical Information of China (English)

    杨波; 庞廷田; 孙显松; 胡克; 邱杰; 张福泉

    2014-01-01

    Objective To compare the dosimetric characteristics of preoperative volumetric modulated arc therapy ( VMAT) and fixed-field intensity-modulated radiotherapy ( FF-IMRT) for rectal cancer .Methods The CT images of 15 patients with rectal cancer were transferred into Eclipse planning system .FF-IMRT and VMAT plans were optimized on an Eclipse treatment planning system using beam data generated for Varian Trilogy linear accelerator .Same institutional dose-volume constraints for rectal cancer were used in both techniques .Targets and organs at risk were evaluated .Results The target volume coverage could meet the requirement of described dosage in both VMAT plan group and FF-IMRT plan group .Compared with the FF-IMRT plan group , the plan-ning target volume ( PTV) 105% ( PTV105%) coverage, Dmean, and Dmax significantly increased in the VMAT plan group ( P=0.011, P=0.017, and P=0.006, respectively), the radiation conformity index (CI) significantly decreased ( P=0.008 ) , and the homogeneity index showed no significant difference ( P=0.193 ) . Compared with the FF-IMRT plan group , the V50 of the bladder in the VMAT plan group was increased by about 15%( P=0.009 ) , and the Dmax increased by 0.7 Gy ( P=0.003 );the V30 of the small intestine decreased by 10% (P=0.004), and the Dmax was increased by 0.9 Gy (P=0.000); the V10, V30, and V40 of the bone marrow reduced by 2%, 10%, and 10%( P=0.000 , P=0.000 , and P=0.000 ) , and the Dmean re-duced by 1.7 Gy ( P=0.000 );the D5 of the left and right femoral heads reduced by 3.2 Gy and 2.4 Gy ( P=0.000 , P=0.000 ); the V10 , V20 , V30 , and V40 of the body also significantly decreased ( P=0.003 , P=0.000 , P=0.000 , and P=0.004 ) .The VMAT group also had significantly lower number of monitor units ( MU) when compared with the FF-IMRT plan group ( P=0.000 ) .Conclusions In patients with rectal canc-er, preoperative VMAT can achieve equivalent or superior dose distribution compared with the FF -IMRT.In addi-tion, VMAT can

  12. Treatment of advanced rectal cancer after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    Hai-Yi Liu; Xiao-Bo Liang; Yao-Ping Li; Yi Feng; Dong-Bo Liu; Wen-Da Wang

    2011-01-01

    Renal transplantation is a standard procedure for end-stage renal disease today. Due to immunosuppressive drugs and increasing survival time after renal trans-plantation, patients with transplanted kidneys carry an increased risk of developing malignant tumors. In this case report, 3 patients with advanced rectal can-cer after renal transplantation for renal failure were treated with anterior resection or abdominoperineal resection plus total mesorectal excision, followed by adjuvant chemotherapy. One patient eventually died of metastasized cancer 31 mo after therapy, although his organ grafts functioned well until his death. The other 2 patients were well during the 8 and 21 mo follow-up periods after rectal resection. We therefore strongly argue that patients with advanced rectal cancer should receive standard oncology treatment, including opera-tion and adjuvant treatment after renal transplantation. Colorectal cancer screening in such patients appears justified.

  13. Rectal cancer survival in the Nordic countries and Scotland

    DEFF Research Database (Denmark)

    Folkesson, Joakim; Engholm, Gerda; Ehrnrooth, Eva

    2009-01-01

    The aim of this study was to present detailed population-based survival estimates for patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based on cancer register data, differences in rectal cancer survival have been reported between countries in Eur...... and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas........ Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland had lower 5-year relative survival and poorer stage distribution compared to Norway...

  14. Recent advances in robotic surgery for rectal cancer.

    Science.gov (United States)

    Ishihara, Soichiro; Otani, Kensuke; Yasuda, Koji; Nishikawa, Takeshi; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-08-01

    Robotic technology, which has recently been introduced to the field of surgery, is expected to be useful, particularly in treating rectal cancer where precise manipulation is necessary in the confined pelvic cavity. Robotic surgery overcomes the technical drawbacks inherent to laparoscopic surgery for rectal cancer through the use of multi-articulated flexible tools, three-dimensional stable camera platforms, tremor filtering and motion scaling functions, and greater ergonomic and intuitive device manipulation. Assessments of the feasibility and safety of robotic surgery for rectal cancer have reported similar operation times, blood loss during surgery, rates of postoperative morbidity, and circumferential resection margin involvement when compared with laparoscopic surgery. Furthermore, rates of conversion to open surgery are reportedly lower with increased urinary and male sexual functions in the early postoperative period compared with laparoscopic surgery, demonstrating the technical advantages of robotic surgery for rectal cancer. However, long-term outcomes and the cost-effectiveness of robotic surgery for rectal cancer have not been fully evaluated yet; therefore, large-scale clinical studies are required to evaluate the efficacy of this new technology.

  15. Changes in NAD/ADP-ribose metabolism in rectal cancer

    Directory of Open Access Journals (Sweden)

    L. Yalcintepe

    2005-03-01

    Full Text Available The extent of ADP-ribosylation in rectal cancer was compared to that of the corresponding normal rectal tissue. Twenty rectal tissue fragments were collected during surgery from patients diagnosed as having rectal cancer on the basis of pathology results. The levels of ADP-ribosylation in rectum cancer tissue samples (95.9 ± 22.1 nmol/ml was significantly higher than in normal tissues (11.4 ± 4 nmol/ml. The level of NAD+ glycohydrolase and ADP-ribosyl cyclase activities in rectal cancer and normal tissue samples were measured. Cancer tissues had significantly higher NAD+ glycohydrolase and ADP-ribosyl cyclase activities than the control tissues (43.3 ± 9.1 vs 29.2 ± 5.2 and 6.2 ± 1.6 vs 1.6 ± 0.4 nmol mg-1 min-1. Approximately 75% of the NAD+ concentration was consumed as substrate in rectal cancer, with changes in NAD+/ADP-ribose metabolism being observed. When [14C]-ADP-ribosylated tissue samples were subjected to SDS-PAGE, autoradiographic analysis revealed that several proteins were ADP-ribosylated in rectum tissue. Notably, the radiolabeling of a 113-kDa protein was remarkably greater than that in control tissues. Poly(ADP-ribosylation of the 113-kDa protein in rectum cancer tissues might be enhanced with its proliferative activity, and poly(ADP-ribosylation of the same protein in rectum cancer patients might be an indicator of tumor diagnosis.

  16. Preoperative chemoradiotherapy for locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Pepek Joseph M

    2013-01-01

    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  17. [Role of neoadjuvant radiotherapy for rectal cancer : Is MRI-based selection a future model?].

    Science.gov (United States)

    Kulu, Y; Hackert, T; Debus, J; Weber, M-A; Büchler, M W; Ulrich, A

    2016-07-01

    Following the introduction of total mesorectal excision (TME) in the curative treatment of rectal cancer, the role of neoadjuvant therapy has evolved. By improving the surgical technique the local recurrence rate could be reduced by TME surgery alone to below 8 %. Even if local control was further improved by additional preoperative irradiation this did not lead to a general survival benefit. Guidelines advocate that all patients in UICC stage II and III should be pretreated; however, the stage-based indications for neoadjuvant therapy have limitations. This is mainly attributable to the facts that patients with T3 tumors comprise a very heterogeneous prognostic group and preoperative lymph node diagnostics lack accuracy. In contrast, in recent years the circumferential resection margin (CRM) has become an important prognostic parameter. Patients with tumors that are very close to or infiltrate the pelvic fascia (positive CRM) have a higher rate of local recurrence and poorer survival. With high-resolution pelvic magnetic resonance imaging (MRI) examination in patients with rectal cancer, the preoperative CRM can be determined with a high sensitivity and specificity. Improved T staging and better prediction of the resection margins by pelvic MRI potentially facilitate the selection of patients for study-based treatment strategies omitting neoadjuvant radiotherapy.

  18. Three-dimensional Conformal Radiation Therapy Techniques for Rectal Cancer

    NARCIS (Netherlands)

    J.J.M.E. Nuyttens (Joost)

    2004-01-01

    markdownabstract__Abstract__ The third most common malignancy in the Netherlands is colorectal cancer. Rectal cancer affects every year around 2000 new patients. The highest incidence is found at an age above 70 years, and in men (sex ratio: 1.48). In Europe, the treatment of preference for locally

  19. Results of radical surgery for rectal cancer.

    Science.gov (United States)

    Heald, R J; Karanjia, N D

    1992-01-01

    This paper examines the hypothesis that a reduction in the distal mural margin during anterior resection for sphincter conservation in rectal cancer excision is safe, provided total mesorectal excision is undertaken with wash-out of the clamped rectum. One hundred ninety-two patients underwent anterior resection and 21 (less than 10%) patients underwent abdomino-perineal excision (APE) by one surgeon (RJH). Anterior resections were classified as "curative" (79%) and "non-curative" (21%); in the "curative" sub-group less than 4% of patients developed local recurrence. The series was retrospectively analyzed for the effect of mural margins on local recurrence with 152 patients undergoing "curative" anterior resections and 40 patients undergoing "non-curative" resections. In the 152 specimens from curative resections, 110 had a resection margin greater than 1 cm and 42 had a resection margin less than 1 cm. Four patients developed local recurrence in the greater than 1 cm margin group (95% confidence interval: 0.8%-7.8%) and no patients developed local recurrence in the less than or equal to 1 cm margin group (95% confidence interval: 0%-5.9%). In each patient with local recurrence a cause for failure was apparent. There was no statistically significant difference in local recurrence rate between the less than or equal to 1 cm margin group and the greater than 1 cm margin group. A reduction in resection margin therefore did not compromise survival after anterior resection. The significance of lateral resection margins is discussed. The role of deep radiotherapy and cytotoxics are considered.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. 直肠癌术前容积旋转调强放疗和五野静态调强放疗的剂量学比较%Dosimetric comparison between preoperative volumetric modulated arc therapy and five-field intensity modulated radiotherapy for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    汪琳; 张红雁; 钱立庭; 吴爱东; 方为; 闫冰

    2016-01-01

    目的:比较直肠癌术前患者应用五野静态调强放疗(5F-IMRT)和容积弧形调强放疗( VMAT)两种计划的剂量学差别。方法分别将16例术前行同期放化疗的直肠癌患者进行5F-IMRT和VMAT两种计划设计,应用剂量体积直方图比较分析靶区和危及器官的剂量学差异及治疗参数。结果两种治疗计划均能满足临床剂量要求。5F-IMRT计划的适形指数(CI)为0.88±0.04,VMAT计划的CI为0.90±0.03,两种计划均能很好满足95%等剂量曲线对100%PTV体积的完全覆盖;VMAT 和 IMRT 计划的均匀性指数(HI)分别为1.06±0.01和1.05±0.01,差异无统计学意义(t=1.37,P>0.05)。5F-IMRT和VMAT计划中重要的危及器官如小肠、膀胱和股骨头等的关键剂量评价指标( Dmean、Dmax)及受照射体积的关键评价指标( V20、V30、V40和V50)在两种放疗计划中差异无统计学意义( P >0.05)。VMAT计划组较5F-IMRT计划组机器跳数( MU)平均值减少39%(P=0.000)。结论直肠癌术前放疗中采用VMAT技术可获得等同于5F-IMRT计划的剂量分布,危及器官均能得到较好的保护, VMAT计划MU明显降低,治疗时间明显缩短。%Objective To compare the dosimetric characteristics of volumetric modulated arc therapy( VMAT) and five-field intensity modulated radiotherapy(5F-IMRT) in preoperative radiotherapy for rectal cancer. Methods Six-teen patients with rectal cancer who underwent preoperative chemo-radiotherapy were enrolled in this study. VMAT and 5F-IMRT plans were designed for each patient. The dose distribution in target volumes and organs at risk was e-valuated according to the dose-volume histogram. Results Both plans could meet target dose specifications and nor-mal tissue constraint. The CI was similar between the 5F-IMRT(0. 88 ± 0. 04) and VMAT plans (0. 90 ± 0. 03), which could satisfy 95% of prescribed dose for covered PTV. The HI of the VMAT plan was 1. 06 ± 0. 01 compared to 1. 05 ± 0. 01

  1. The rectal cancer microRNAome - microRNA expression in rectal cancer and matched normal mucosa

    DEFF Research Database (Denmark)

    Gaedcke, Jochen; Grade, Marian; Camps, Jordi

    2012-01-01

    PURPOSE: miRNAs play a prominent role in a variety of physiologic and pathologic biologic processes, including cancer. For rectal cancers, only limited data are available on miRNA expression profiles, whereas the underlying genomic and transcriptomic aberrations have been firmly established. We...... therefore, aimed to comprehensively map the miRNA expression patterns of this disease. EXPERIMENTAL DESIGN: Tumor biopsies and corresponding matched mucosa samples were prospectively collected from 57 patients with locally advanced rectal cancers. Total RNA was extracted, and tumor and mucosa mi......RNA expression profiles were subsequently established for all patients. The expression of selected miRNAs was validated using semi-quantitative real-time PCR. RESULTS: Forty-nine miRNAs were significantly differentially expressed (log(2)-fold difference >0.5 and P cancer and normal rectal...

  2. Intersphincteric Resection for Low Rectal Cancer – Case Report

    Directory of Open Access Journals (Sweden)

    Russu Cristian

    2016-03-01

    Full Text Available Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up. Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

  3. Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Michiya Kobayashi; Satoshi Morishita; Takehiro Okabayashi; Kana Miyatake; Ken Okamoto; Tsutomu Namikawa; Yasuhiro Ogawa; Keijiro Araki

    2006-01-01

    AIM: To determine the distance between the branching point of the left colic artery (LCA) and the inferior mesenteric artery (IMA) by computed tomography (CT) scanning, for preoperative evaluation before laparoscopic colorectal operation.METHODS: From February 2004 to May 2005, 100patients (63 men, 37 women) underwent angiography performed with a 16-scanner multi-detector row CT unit (Toshiba, Aquilion 16). All images were analyzed on a workstation (AZE Ltd, Virtual Place Advance 300). The distance from the root of the IMA to the bifurcation of the LCA was measured by curved multi-planar reconstruction on a workstation.RESULTS: The IMA could be visualized in all the cases,but the LCA was missing in two patients. The mean distance from the root of the IMA to the root of the LCA was 42.0 mm (range, 23.2-75.0 mm). There were no differences in gender, arterial branching types, body weight, height, and body mass index.CONCLUSION: Volume-rendered 3D-CT is helpful to assess the vascular branching anatomy for laparoscopic surgery.

  4. Evaluation of Sexual and Urinary Function After Implementation of Robot-assisted Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Schmiegelow, Amalie F T; Broholm, Malene; Gögenur, Ismail

    2016-01-01

    : Questionnaires were mailed to 184 patients who underwent laparoscopic rectal cancer surgery between January 2009 and May 2013. Single questions were used to retrospectively assess preoperative urogenital dysfunction. Surgical data were collected from hospital records. Postoperative urinary and sexual function...... was measured with validated questionnaires and the results were statistically analyzed. RESULTS: A total of 97 questionnaires were included in the study. Of those sexually active before the operation, 81% reported some degree of erectile dysfunction (ED). In total, 73% reported some degree of orgasmic...

  5. Comparison of Preoperative Administration of Rectal Diclofenac and Acetaminophen for Reducing Post Operative Pain in Septorhinoplastic Surgeries

    Directory of Open Access Journals (Sweden)

    E Allahyry

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Post operative pain is usually treated by opioids, which is expensive and may induce various side effects. Non steroidal anti-inflammatory drugs have been considered recently for controlling pain due to their cheapness, fewer side effects and availability. This study compares the analgesic efficacy of preoperative administration of single dose of rectally diclofenac and acetaminophen for post operative analgesia in septorhinoplasty, one of the most common head and neck surgeries. Materials & Methods: Sixty adult patients with ASA =1 underwent septorhinoplasty were randomly divided into two equal groups. Thirty minutes before induction of anesthesia, 100 mg diclofenac suppository and 325 mg of rectal acetaminophen were given to group I and group II respectively. Induction and maintenance of anesthesia were similar in all patients. Then the severity of pain was graded 1, 2 and 4 hours after operation according to Visual Analogue Scale. Also the first time of analgesic request and total administered dose of analgesics were assessed by another person in all patients. Results: Results revealed that severity of pain in diclofenac group in all three defined times was significantly less than that in the other group (p<0.05. Also the average of first time analgesic request in group 1 and 2 was 205 and 97 minutes respectively and the average dose of administered pehtidine was 12.25 mg in diclofenac and 37.15 mg in acetaminophen group. Conclusion: The pre-operative administration of rectal diclofenac was more effective for post septorhioplasty analgesia than the rectal acetaminophen and thus it could be used and recommended as a safe, compensive and effective method for post operative pain relief in this common surgery.

  6. Rectal cancer : developments in multidisciplinary treatment, quality control and European collaboration

    NARCIS (Netherlands)

    Gijn, Willem van

    2016-01-01

    In the last two decades, treatment of rectal cancer has considerably improved in Europe. Although this applies to most solid malignancies, improvements in the diagnosis and treatment of rectal cancer surpass virtually all others. In the early 1990s, outcome after rectal cancer treatment was poor,

  7. The prognostic value of lymph node ratio in a national cohort of rectal cancer patients

    DEFF Research Database (Denmark)

    Lykke, J; Jess, P; Roikjaer, O

    2016-01-01

    OBJECTIVE: To analyze the prognostic implications of the lymph node ratio (LNR) in curative resected rectal cancer. SUMMARY BACKGROUND DATA: It has been proposed that the LNR has a high prognostic impact in colorectal cancer, but the lymph node ratio has not been evaluated exclusively for rectal ...... that the introduction of LNR should be considered for rectal cancer in a revised TNM classification....

  8. 开塞露在直肠癌MRI术前T1和T2分期中的应用%The value of Enema Glycerine applying in preoperative MRI T1 staging and T2 staging of rectal cancer

    Institute of Scientific and Technical Information of China (English)

    李兆祥; 薛华丹; 秦明伟; 潘卫东

    2014-01-01

    目的:探讨使用开塞露进行肠道准备对直肠癌磁共振术前T1和T2分期的意义。材料与方法回顾经手术病理证实为T1或T2分期的直肠癌患者81例,男51例,女30例,平均年龄(64.2±12.2)岁。其中,45例(男30例,女15例)使用开塞露,36例(男21例,女15例)未使用开塞露。分别分析两组MRI术前分期与手术病理分期结果的一致性,计算并比较两组MRI T1、T2分期的敏感度、特异度、准确度、阳性预测值、阴性预测值和T1+T2分期的敏感度。结果 Kappa检验证实两组MRI术前分期与手术病理分期结果的一致性均为中等,K值分别为使用开塞露组0.693,未使用开塞露组0.537。使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:76.5%、92.9%、86.7%、86.7%、86.7%;T2分期:78.6%、76.5%、86.7%、84.5%、68.4%;T1+T2分期的敏感度为:77.8%。未使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:57.1%、95.5%、80.6%、88.9%、77.8%;T2分期:77.3%、57.1%、69.4%、73.9%、61.5%;T1+T2分期的敏感度为:69.4%。统计分析证实使用开塞露组T1分期的敏感度及T2分期的特异度、准确度高于未使用开塞露组(P<0.05,单侧)。结论使用开塞露进行肠道准备能够明显提高直肠癌磁共振T1分期的敏感度、T2分期特异度及准确度,同时在一定程度上提高T1和T1+T2分期的诊断准确性,建议作为直肠癌磁共振检查的肠道准备常规应用。%Objective: To evaluate the value of Enema Glycerine applied in preoperative MRI T1 staging and T2 staging of rectal cancer. Materials and Methods:The MRI datum of 81 cases of pathologically conifrmed T1 staging or T2 staging of rectal cancer suffers after operation (50 males and 31 females whose ages, 64.2±12.2 on average, range from 31 to 88

  9. Patient surveillance after curative-intent surgery for rectal cancer.

    Science.gov (United States)

    Johnson, Frank E; Longo, Walter E; Ode, Kenichi; Shariff, Umar S; Papettas, Trifonas; McGarry, Alaine E; Gammon, Steven R; Lee, Paul A; Audisio, Riccardo A; Grossmann, Erik M; Virgo, Katherine S

    2005-09-01

    The follow-up of patients with rectal cancer after potentially curative resection has significant financial and clinical implications for patients and society. The ideal regimen for monitoring patients is unknown. We evaluated the self-reported practice patterns of a large, diverse group of experts. There is little information available describing the actual practice of clinicians who perform potentially curative surgery on rectal cancer patients and follow them after recovery. The 1795 members of the American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first five post-treatment years. 566/1782 (32%) responded and 347 of the respondents (61%) provided evaluable data. Members of the American Society of Colon and Rectal Surgeons typically follow their own patients postoperatively rather than sending them back to their referral source. Office visit and serum CEA level are the most frequently requested items for each of the first five postoperative years. Endoscopy and imaging tests are also used regularly. Considerable variation exists among these highly experienced, highly credentialed experts. The surveillance strategies reported here rely most heavily on relatively simple and inexpensive tests. Endoscopy is employed frequently; imaging tests are employed less often. The observed variation in the intensity of postoperative monitoring is of concern.

  10. The influence of hormone therapies on colon and rectal cancer

    DEFF Research Database (Denmark)

    Mørch, Lina Steinrud; Lidegaard, Øjvind; Keiding, Niels;

    2016-01-01

    followed 1995-2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression...... analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68-0.86 and 0.88, 0.80-0.96) and rectal cancer (0......Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50-79 years old without previous cancer (n = 1,006,219) were...

  11. Treatment of lateral pelvic nodes metastases from rectal cancer: the future prospective.

    Science.gov (United States)

    Moriya, Y

    2013-01-01

    One feature of rectal cancer that remains controversial is the significance of lateral lymph node, because TME does not remove these nodes. We discussed the brief history of lateral nodes dissection and some problems in performing the extended surgery.In Japan, an ongoing prospective multicenter randomized trial comparing TME alone and TME with clearance of lateral node is progress. In the West, MERCURY study showed 11.7% of patients with rectal cancer had MRI-identified suspicious pelvic side wall nodes. Judging from incidence and prognosis, pelvic side wall nodes in the west are almost similar meaning as lateral nodes in Japan. There is long-standing controversy as to whether lateral lymph nodes metastasis represent systemic or localized disease. Though there has been reports suggesting effect of RT on lateral nodes metastases, the question remains whether preoperative CRT can fully sterilize lateral nodes deposits. Is it appropriate inspection assuming that positive CRM and bowel perforation is major cause of local recurrence after abdominoperineal resection? Some reports say that lateral node metastasis is major cause of local recurrence.We must share following views that the east and the west should join forces to improve selection criteria for lateral node dissection and neoadjuvant treatment to prevent overtreatment, and ultimately aim to improve quality of life and oncological outcome for patients with low rectal cancer.

  12. Anaesthetic management of laparoscopic surgery for rectal cancer in patients of dilated cardiomyopathy with poor ejection fraction: a case report

    Science.gov (United States)

    Wu, Yao-Hua; Hu, Liang; Xia, Jin; Hao, Quan-Shui; Feng, Li; Xiang, Hong-Bing

    2015-01-01

    A patient with dilated cardiomyopathy with poor ejection fraction posted for laparoscopic surgery for rectal cancer which was successfully performed under general anesthesia with endotracheal intubation and mechanical ventilation was reported. Our observations strongly indicate that detailed preoperative assessment, watchful intraoperative monitoring, and skillful optimization of fluid status and hemodynamic play important role in the high risk patient under general anesthesia with endotracheal intubation and mechanical ventilation. PMID:26309623

  13. The effectiveness of PET for the distinction of perirectal lymph node metastasis of rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Dae Yong; Choi, Chang Woon

    1999-12-01

    If the effectiveness for the distinction of perirectal lymph node metastasis is proved to be higher than the previous conventional detection methods, likewise CT and endorectal ultrasound, more precise and more specific information will be taken by this new modality. Preoperative biopsy-proven rectal adenocarcinoma patients with or without distant metastasis were included for this study. For the effectiveness of PET for the distinction of perirectal lymph node metastasis, CT and endorectal ultrasound versus findings of perirectal lymph node status were compared with permanent pathology results. The findings of preoperative conventional methods showed that 8 patients had not preirectal lymph node metastasis and 6 patients and perirectal lymph node metastasis. The accuracy of conventional methods was 50 % compared with 37.5 % of that of PET in the case of 8 patients. In the case of 6 patients, accuracy was 100 % in the conventional methods and 66.7 % in PET study. Overall sensitivity and specificity were 60 % and 100 % in the conventional methods and 40 % and 75 % in PET study respectively. Therefore, PET is not effective for the distinction of L/N metastasis of rectal cancer comparing with conventional methods such as CT and ERUS preoperatively.

  14. Long-Term Survival and Local Relapse Following Surgery Without Radiotherapy for Locally Advanced Upper Rectal Cancer: An International Multi-Institutional Study.

    Science.gov (United States)

    Park, Jun Seok; Sakai, Yoshiharu; Simon, Ng Siu Man; Law, Wai Lun; Kim, Hyeong Rok; Oh, Jae Hwan; Shan, Hester Cheung Yui; Kwak, Sang Gyu; Choi, Gyu-Seog

    2016-05-01

    Controversy remains regarding whether preoperative chemoradiation protocol should be applied uniformly to all rectal cancer patients regardless of tumor height. This pooled analysis was designed to evaluate whether preoperative chemoradiation can be safely omitted in higher rectal cancer.An international consortium of 7 institutions was established. A review of the database that was collected from January 2004 to May 2008 identified a series of 2102 patients with stage II/III rectal or sigmoid cancer (control arm) without concurrent chemoradiation. Data regarding patient demographics, recurrence pattern, and oncological outcomes were analyzed. The primary end point was the 5-year local recurrence rate.The local relapse rate of the sigmoid colon cancer (SC) and upper rectal cancer (UR) cohorts was significantly lower than that of the mid/low rectal cancer group (M-LR), with 5-year estimates of 2.5% for the SC group, 3.5% for the UR group, and 11.1% for the M-LR group, respectively. A multivariate analysis showed that tumor depth, nodal metastasis, venous invasion, and lower tumor level were strongly associated with local recurrence. The cumulative incidence rate of local failure was 90.6%, 92.5%, and 94.4% for tumors located within 5, 7, and 9 cm from the anal verge, respectively.Routine use of preoperative chemoradiation for stage II/III rectal tumors located more than 8 to 9 cm above the anal verge would be excessive. The integration of a more individualized approach focused on systemic control is warranted to improve survival in patients with upper rectal cancer.

  15. ACR Appropriateness Criteria®  Resectable Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Jones William E

    2012-09-01

    Full Text Available Abstract The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+ benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to

  16. The benchmark analysis of gastric, colorectal and rectal cancer pathways: toward establishing standardized clinical pathway in the cancer care.

    Science.gov (United States)

    Ryu, Munemasa; Hamano, Masaaki; Nakagawara, Akira; Shinoda, Masayuki; Shimizu, Hideaki; Miura, Takeshi; Yoshida, Isao; Nemoto, Atsushi; Yoshikawa, Aki

    2011-01-01

    Most clinical pathways in treating cancers in Japan are based on individual physician's personal experiences rather than on an empirical analysis of clinical data such as benchmark comparison with other hospitals. Therefore, these pathways are far from being standardized. By comparing detailed clinical data from five cancer centers, we have observed various differences among hospitals. By conducting benchmark analyses, providing detailed feedback to the participating hospitals and by repeating the benchmark a year later, we strive to develop more standardized clinical pathways for the treatment of cancers. The Cancer Quality Initiative was launched in 2007 by five cancer centers. Using diagnosis procedure combination data, the member hospitals benchmarked their pre-operative and post-operative length of stays, the duration of antibiotics administrations and the post-operative fasting duration for gastric, colon and rectal cancers. The benchmark was conducted by disclosing hospital identities and performed using 2007 and 2008 data. In the 2007 benchmark, substantial differences were shown among five hospitals in the treatment of gastric, colon and rectal cancers. After providing the 2007 results to the participating hospitals and organizing several brainstorming discussions, significant improvements were observed in the 2008 data study. The benchmark analysis of clinical data is extremely useful in promoting more standardized care and, thus in improving the quality of cancer treatment in Japan. By repeating the benchmark analyses, we can offer truly clinical evidence-based higher quality standardized cancer treatment to our patients.

  17. Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Samuelian, Jason M. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Callister, Matthew D., E-mail: Callister.matthew@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Ashman, Jonathan B. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Young-Fadok, Tonia M. [Division of Colorectal Surgery, Mayo Clinic, Scottsdale, AZ (United States); Borad, Mitesh J. [Division of Hematology-Oncology, Mayo Clinic, Scottsdale, AZ (United States); Gunderson, Leonard L. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2012-04-01

    Purpose: We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Methods and Materials: A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. Results: From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced {>=}Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, {>=}Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. Conclusions: In the management of rectal cancer, IMRT is associated with a

  18. Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Bao-Jun Zhou; Wei-Qing Song; Qing-Hui Yan; Jian-Hui Cai; Feng-An Wang; Jin Liu; Guo-Jian Zhang; Guo-Qiang Duan; Zhan-Xue Zhang

    2008-01-01

    AIM: To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US).METHODS: Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded.RESULTS: All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d1 and d3 WBC counts (P=0.493, P=0.375, P=0.559), operation time (P=0.235), blood loss (P=0.296), anal exhaust time (P=0.431), pelvic drainage volume and VAS in postoperative d1 (P=0.431, P=0.426) and d3 (P=0.844, P=0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and woundinfection was the same in the two groups.CONCLUSION: ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.

  19. Anastomotic leakage after anterior resection for rectal cancer: risk factors

    DEFF Research Database (Denmark)

    Bertelsen, C A; Andreasen, A H; Jørgensen, Torben;

    2010-01-01

    OBJECTIVE: The study aimed to identify risk factors for clinical anastomotic leakage (AL) after anterior resection for rectal cancer in a consecutive national cohort. METHOD: All patients with an initial first diagnosis of colorectal adenocarcinoma were prospectively registered in a national...

  20. Whither papillon? Future directions for contact radiotherapy in rectal cancer

    DEFF Research Database (Denmark)

    Lindegaard, J; Gerard, J P; Sun Myint, A;

    2007-01-01

    Although contact radiotherapy was developed 70 years ago, and is highly effective with cure rates of over 90% for early rectal cancer, there are few centres that offer this treatment today. One reason is the lack of replacement of ageing contact X-ray machines, many of which are now over 30 years...

  1. Sexual function in females after radiotherapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bruheim, Kjersti; Tveit, Kjell Magne; Guren, Marianne G. (The Cancer Centre, Oslo Univ. Hospital, Ullevaal, Oslo (Norway)), E-mail: Kjersti.bruheim@medisin.uio.no; Fossaa, Sophie D. (Faculty of Medicine, Univ. of Oslo, Oslo (Norway)); Skovlund, Eva (School of Pharmacy, Univ. of Oslo, Oslo (Norway)); Balteskard, Lise (Dept. of Oncology, Univ. Hospital of Northern Norway, Tromsoe (Norway)); Carlsen, Erik (Dept. of Clinical Cancer Research, Oslo Univ. Hospital, The Norwegian Radium Hospital, Oslo (Norway))

    2010-08-15

    Background. Knowledge about female sexual problems after pre- or postoperative (chemo-)radiotherapy and radical resection of rectal cancer is limited. The aim of this study was to compare self-rated sexual functioning in women treated with or without radiotherapy (RT+ vs. RT?), at least two years after surgery for rectal cancer. Methods and materials. Female patients diagnosed from 1993 to 2003 were identified from a national database, the Norwegian Rectal Cancer Registry. Eligible patients were without recurrence or metastases at the time of the study. The Sexual function and Vaginal Changes Questionnaire (SVQ) was used to measure sexual functioning. Results. Questionnaires were returned from 172 of 332 invited and eligible women (52%). The mean age was 65 years (range 42-79) and the time since surgery for rectal cancer was 4.5 years (range 2.6-12.4). Sexual interest was not significantly impaired in RT+ (n=62) compared to RT? (n=110) women. RT+ women reported more vaginal problems in terms of vaginal dryness (50% vs. 24%), dyspareunia (35% vs. 11%) and reduced vaginal dimension (35% vs. 6%) compared with RT? patients; however, they did not have significantly more worries about their sex life. Conclusion. An increased risk of dyspareunia and vaginal dryness was observed in women following surgery combined with (chemo-)radiotherapy compared with women treated with surgery alone. Further research is required to determine the effect of adjuvant therapy on female sexual function

  2. Multicenter evaluation of rectal cancer reimaging post neoadjuvant (MERRION) therapy.

    LENUS (Irish Health Repository)

    Hanly, Ann M

    2014-04-01

    The aim of this study was to evaluate the utility of reimaging rectal cancer post-CRT (chemoradiotherapy) with magnetic resonance (MR) imaging of the pelvis for local staging and computed tomography of thorax, abdomen, and pelvis (CT TAP) to identify distant metastases.

  3. Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer

    NARCIS (Netherlands)

    Dijk, T.H. van; Tamas, K.; Beukema, J.C.; Beets, G.L.; Gelderblom, A.J.; Jong, K.P. de; Nagtegaal, I.D.; Rutten, H.J.; Velde, C.J. van de; Wiggers, T.; Hospers, G.A.; Havenga, K.

    2013-01-01

    BACKGROUND: To evaluate the efficacy and tolerability of preoperative short-course radiotherapy followed by capecitabine and oxaliplatin treatment in combination with bevacizumab and subsequent radical surgical treatment of all tumor sites in patients with stage IV rectal cancer. PATIENTS AND

  4. Rectal cancer with synchronous liver metastases: Do we have a clear direction?

    Science.gov (United States)

    Pathak, S; Nunes, Q M; Daniels, I R; Smart, N J; Poston, G J; Påhlman, L

    2015-12-01

    Rectal cancer is a common entity and often presents with synchronous liver metastases. There are discrepancies in management guidelines throughout the world regarding the treatment of advanced rectal cancer, which are further compounded when it presents with synchronous liver metastases. The following article examines the evidence regarding treatment options for patients with synchronous rectal liver metastases and suggests potential treatment algorithms.

  5. Medical image of the week: pulmonary metastases of rectal cancer

    Directory of Open Access Journals (Sweden)

    Insel M

    2017-02-01

    Full Text Available A 51-year-old woman with known rectal cancer currently receiving systemic chemotherapy presented with 2 weeks of worsening dyspnea on exertion. The day prior to admission she developed persistent inspiratory and expiratory wheeze. CT scan demonstrated right main stem endobronchial mass and a heterogeneous mass comprising the entire left hemithorax (Figure 1. Flexible bronchoscopy demonstrated a fungating mass at the carina extending down both main stems (Figure 2. The mass was snared and removed with cryotherapy and pathology was consistent with metastatic rectal adenocarcinoma.

  6. Prognostic nomograms for predicting survival and distant metastases in locally advanced rectal cancers.

    Directory of Open Access Journals (Sweden)

    Junjie Peng

    Full Text Available To develop prognostic nomograms for predicting outcomes in patients with locally advanced rectal cancers who do not receive preoperative treatment.A total of 883 patients with stage II-III rectal cancers were retrospectively collected from a single institution. Survival analyses were performed to assess each variable for overall survival (OS, local recurrence (LR and distant metastases (DM. Cox models were performed to develop a predictive model for each endpoint. The performance of model prediction was validated by cross validation and on an independent group of patients.The 5-year LR, DM and OS rates were 22.3%, 32.7% and 63.8%, respectively. Two prognostic nomograms were successfully developed to predict 5-year OS and DM-free survival rates, with c-index of 0.70 (95% CI = [0.66, 0.73] and 0.68 (95% CI = [0.64, 0.72] on the original dataset, and 0.76 (95% CI = [0.67, 0.86] and 0.73 (95% CI = [0.63, 0.83] on the validation dataset, respectively. Factors in our models included age, gender, carcinoembryonic antigen value, tumor location, T stage, N stage, metastatic lymph nodes ratio, adjuvant chemotherapy and chemoradiotherapy. Predicted by our nomogram, substantial variability in terms of 5-year OS and DM-free survival was observed within each TNM stage category.The prognostic nomograms integrated demographic and clinicopathological factors to account for tumor and patient heterogeneity, and thereby provided a more individualized outcome prognostication. Our individualized prediction nomograms could help patients with preoperatively under-staged rectal cancer about their postoperative treatment strategies and follow-up protocols.

  7. Evaluation of Tumor Response after Short-Course Radiotherapy and Delayed Surgery for Rectal Cancer

    Science.gov (United States)

    Rega, Daniela; Pecori, Biagio; Scala, Dario; Avallone, Antonio; Pace, Ugo; Petrillo, Antonella; Aloj, Luigi; Tatangelo, Fabiana; Delrio, Paolo

    2016-01-01

    Purpose Neoadjuvant therapy is able to reduce local recurrence in rectal cancer. Immediate surgery after short course radiotherapy allows only for minimal downstaging. We investigated the effect of delayed surgery after short-course radiotherapy at different time intervals before surgery, in patients affected by rectal cancer. Methods From January 2003 to December 2013 sixty-seven patients with the following characteristics have been selected: clinical (c) stage T3N0 ≤ 12 cm from the anal verge and with circumferential resection margin > 5 mm (by magnetic resonance imaging); cT2, any N, CRM+ve who resulted unfit for chemo-radiation, were also included. Patients underwent preoperative short-course radiotherapy with different interval to surgery were divided in three groups: A (within 6 weeks), B (between 6 and 8 weeks) and C (after more than 8 weeks). Hystopatolgical response to radiotherapy was measured by Mandard’s modified tumor regression grade (TRG). Results All patients completed the scheduled treatment. Sixty-six patients underwent surgery. Fifty-three of which (80.3%) received a sphincter saving procedure. Downstaging occurred in 41 cases (62.1%). The analysis of subgroups showed an increasing prevalence of TRG 1–2 prolonging the interval to surgery (group A—16.7%, group B—36.8% and 54.3% in group C; p value 0.023). Conclusions Preoperative short-course radiotherapy is able to downstage rectal cancer if surgery is delayed. A higher rate of TRG 1–2 can be obtained if interval to surgery is prolonged to more than 8 weeks. PMID:27548058

  8. Conservative management of anal and rectal cancer. The role of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Gerard, J.P.; Romestaing, P.; Montbarbon, X. (Centre Hospitalier Lyon Sud, 69 - Pierre-Benite (France). Dept. of Radiotherapy)

    1989-01-01

    The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.).

  9. Gene expression profile is associated with chemoradiation resistance in rectal cancer.

    Science.gov (United States)

    Gantt, G A; Chen, Y; Dejulius, K; Mace, A G; Barnholtz-Sloan, J; Kalady, M F

    2014-01-01

    Patients with rectal cancer who achieve a complete pathological response after preoperative chemoradiation (CRT) have an improved oncological outcome. Identifying factors associated with a lack of response could help our understanding of the underlying biology of treatment resistance. This study aimed to develop a gene expression signature for CRT-resistant rectal cancer using high-throughput nucleotide microarrays. Pretreatment biopsies of rectal adenocarcinomas were prospectively collected and freshly frozen according to an institutional review board-approved protocol. Total tumour mRNA was extracted and gene expression levels were measured using microarrays. Patients underwent proctectomy after completing standard long-course CRT and the resected specimens were graded for treatment response. Gene expression profiles for nonresponders were compared with those of responders. Differentially expressed genes were analyzed for functional significance using the Ingenuity Pathway Analysis (IPA) software. Thirty-three patients treated between 2006 and 2009 were included. We derived 812-gene and 183-gene signatures separating nonresponders from responders. The classifiers were able to identify nonresponders with a sensitivity and specificity of 100% using the 812-gene signature, and sensitivity and specificity of 33% and 100% using the 183-gene signature. IPA canonical pathway analysis revealed a significant ratio of differentially expressed genes in the 'DNA double-strand break repair by homologous recombination' pathway. Certain rectal cancer gene profiles are associated with poor response to CRT. Alterations in the DNA double-strand break repair pathway could contribute to treatment resistance and provides an opportunity for further studies. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  10. Permanent stoma rates: a misleading marker of quality in rectal cancer surgery.

    Science.gov (United States)

    Codd, R J; Evans, M D; Davies, M; Harris, D A; Chandrasekaran, T V; Khot, U P; Morgan, A R; Beynon, J

    2014-04-01

    The latest National Bowel Cancer Audit Programme (NBOCAP) audit identified our colorectal unit as an outlier with regard to the high permanent stoma rate. The aim of this study was to perform an audit of the rationale for stoma formation in patients undergoing rectal cancer resection in our unit. A review was conducted of all rectal cancer operations between April 2011 and March 2013. Preoperative staging investigations and operation reports were reviewed to identify the reasons for nonrestorative surgery. Postoperative histology reports were used to identify circumferential resection margin (CRM) involvement and tumour height. One-hundred and twenty-five patients underwent surgery for rectal cancer, of whom 102 underwent elective resection with curative intent. The permanent stoma rate was 63.2% when emergency and palliative procedures were included and 54.9% when only elective curative cases were considered. Tertiary referrals made up 31.4% of elective cases. The main reasons for nonrestorative surgery included multivisceral resection (n = 24) for locally advanced cancer and operations for lesions close to the anal sphincter (n = 21). The median length of stay was 8 days, the 90-day mortality was 2.9% and the rate of CRM involvement was 2.0%. Our unit provides multivisceral surgery for locally advanced rectal cancer and receives a substantial number of tertiary referrals. Many of the rectal cancers referred are locally advanced or threaten the anal sphincter. This study demonstrates that the complexity of a unit's case-mix can have a profound effect on the permanent stoma rate. Stoma rates taken at face value do not therefore provide an accurate representation of surgical quality. What does this paper add to the literature? The study reviews the practice of a colorectal surgical unit with an interest in multivisceral surgery with regard to the permanent stoma rate. The reasons for nonrestorative surgery are analysed, and the problems associated with the use of

  11. The Clinical Significance of Cathepsin D and p53 Expression in Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun-Sang; Lee, Sheng-Jin; Kim, Jin-Man; Cho, Moon-June [Chungnam National University, Daejeon (Korea, Republic of)

    2008-03-15

    Cathepsin D (CD) is a lysosomal acid proteinase that is related to malignant progression, invasion, and a poor prognosis in several tumors. The aim of this study was to evaluate the prognostic clinical significance of CD and p53 expression in pretreatment biopsy specimens from patients with locally advanced rectal cancer who were treated with preoperative chemoradiation. Eighty-nine patients with locally advanced rectal cancer (cT3/T4 or N+) were included in this study. Preoperative chemoradiation consisted of a dose of 50.4 Gy of pelvic radiation and two concurrent cycles of administration of 5-fluorouracil and leucovorin. Surgery was performed six weeks after chemoradiation. CD and p53 expression in pretreatment formalin-fixed paraffin-embedded tumor biopsy specimens were assessed by immunohistochemical staining using a CD and p53 monoclonal antibodies. The threshold value for a positive stain in tumor tissue and stromal cells was 1+ intensity in 10% of the tumors or stromal cells, respectively. Positive CD expression was found in 57 (64%) of the tumors and 32 (35%) of the stromal cell specimens. There was no association with CD expression of the tumor or stromal cells and patient characteristics. There was a correlation between tumor CD expression with stromal cell CD expression (p=0.01). Overexpression of p53 was not a significant prognostic factor. The 5-year overall survival (OS) and disease-free survival (DFS) rates were not different between tumor CD-negative and positive patient biopsy samples (69% vs. 65%, 60% vs. 61%, respectively). The 5-year OS rates in the tumor-negative/stromal cell-negative, tumor-negative/stromal cell-positive, tumor-positive/stromal cell-negative and tumor-positive/ stromal cell-positive biopsy samples were 75%, 28%, 62%, and 73%, respectively. Stromal cell staining only without positive tumor staining demonstrated the worst overall survival prognosis for patients (p=0.013). Overexpression of p53 in rectal biopsy tissue was not

  12. The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer.

    Science.gov (United States)

    Shin, Dong Woo; Shin, Jin Yong; Oh, Sung Jin; Park, Jong Kwon; Yu, Hyeon; Ahn, Min Sung; Bae, Ki Beom; Hong, Kwan Hee; Ji, Yong Il

    2016-04-01

    The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a prospectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

  13. Rectal cancer survival in the Nordic countries and Scotland

    DEFF Research Database (Denmark)

    Folkesson, J.; Engholm, G.; Ehrnrooth, E.

    2009-01-01

    The aim of this study was to present detailed population-based survival estimates four patients with a rectal adenocarcinoma, using cancer register data supplemented with clinical data. Based oil cancer register data. differences in rectal cancer survival have been reported between countries ill ...... for high quality and detailed data in order to understand international survival differences, and cautions comparisons between large national samples and those of smaller areas. (C) 2009 UICC Udgivelsesdato: 2009/11/15...... included. Age standardized 5-year relative survival and multiplicative regression models for the relative excess mortality were calculated. 3888 patients were included in the survival study. Men in Denmark, Finland and Iceland hall lower 5-year relative survival and poorer stage distribution compared...

  14. Association between polycyclic aromatic hydrocarbons and human rectal tumor or liver cancer

    Institute of Scientific and Technical Information of China (English)

    Guohong Jiang; Limin Lun; Liyuan Cong

    2012-01-01

    Objective: The aim of this study was to investigate the effect of polycyclic aromatic hydrocarbons (PAHs) in rectal carcinoma and hepatocarcinoma genesis. Methods: The PAHs in the human rectal cancer and liver cancer tissues, the adjacent tissues and homologous tissues without rectal cancer or liver cancer were extracted by ultrasonic wave. The extracts were then cleaned up and enriched by solid phase extraction, analyzed by high performance liquid chromatography (HPLC) with fluorescence spectroscopy. Results: Four kinds of PAHs were detected in human rectal and hepatic tissues. The contents of pyrene, 2-methylanthracene and benzo (a) pyrene in both rectal cancer tissues and adjacent homologous tissues were higher than rectal tissues without rectal cancer, the differences were statistically significant (P 0.05). The differences of the content of each PAHs between rectal cancer and adjacent tissue were not significant (P > 0.05). The contents of the four PAHs in the three kinds of liver tis-sues were not statistically significant (P > 0.05). Conclusion: PAHs are found in human rectal tissues or hepatic tissues. The contents of PAHs in human rectal tissue may have an effect on the occurrence of human rectal cancer while the contents of PAHs in human hepatic tissues may have not ones.

  15. Advances in management of adjuvant chemotherapy in rectal cancer: Consequences for clinical practice.

    Science.gov (United States)

    Netter, Jeanne; Douard, Richard; Durdux, Catherine; Landi, Bruno; Berger, Anne; Taieb, Julien

    2016-11-01

    More than half the patients with rectal cancer present with locally advanced rectal disease at diagnosis with a high risk of recurrence. Preoperative chemoradiotherapy and standardized radical surgery with total mesorectal excision have been established as the 'gold standard' for treating these patients. Pathological staging using the ypTNM classification system to decide on adjuvant chemotherapy (ACT) is widely used in clinical practice, but the delivery of ACT is still controversial, as many discrepancies persist in the conclusions of different trials, due to heterogeneity of the inclusion criteria between studies, lack of statistical power, and variations in preoperative and adjuvant regimens. In 2014, a meta-analysis of four randomized phase-III trials (EORTC 22921, I-CNR-RT, PROCTOR-SCRIPT, CHRONICLE) failed to demonstrate any statistical efficacy of fluorouracil (5FU)-based ACT. Three recent randomized trials aimed to compare 5FU with 5FU plus oxaliplatin-based chemotherapy. Two of them (ADORE, CAO/ARO/AIO-04) appeared to find a disease-free survival benefit for patients treated with the combination therapy. Thus, while awaiting new data, it can be said that, as of 2015, patients with yp stage I tumors or histological complete response derived no benefit from adjuvant therapy. On the other hand, the FOLFOX chemotherapy regimen should be proposed for yp stage III patients, and may be considered for yp stage II tumors in fit patients with high-risk factors. Nevertheless, well-designed and sufficiently powered clinical trials dedicated to adjuvant treatments for rectal cancer remain justified in future to achieve a high level of proof in keeping with evidence-based medical standards.

  16. Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study

    DEFF Research Database (Denmark)

    Frederiksen, B L; Osler, M; Harling, Henrik

    2008-01-01

    among colon cancer patients. The social gradient found in rectal cancer patients was significantly different from the lack of association found among colon cancer patients. There are socioeconomic inequalities in the risk of being diagnosed with distant metastasis of a rectal, but not a colonic, cancer....... A reduction in the risk of being diagnosed with distant metastasis was seen in elderly rectal cancer patients with high income, living in owner-occupied housing and living with a partner. Among younger rectal cancer patients, a reduced risk was seen in those having long education. No social gradient was found...

  17. The association between preoperative concentration of soluble vascular endothelial growth factor, perioperative blood transfusion, and survival in patients with primary colorectal cancer

    DEFF Research Database (Denmark)

    Werther, K; Christensen, Ib Jarle; Nielsen, Hans Jørgen

    2001-01-01

    OBJECTIVE: To investigate a possible association between the preoperative concentration of soluble vascular endothelial growth factor (sVEGF), perioperative blood transfusion, and survival in patients operated on for colorectal cancer. DESIGN: Retrospective study. SETTING: University hospital......, Denmark. SUBJECTS: 614 patients operated on for primary colorectal cancer. MAIN OUTCOME MEASURES: Association between preoperative blood transfusion and preoperative concentration of sVEGF. Association between perioperative blood transfusion and survival. RESULTS: Blood transfused up to one month before...... preoperative serum samples were obtained was significantly (p = 0.02) associated with high preoperative concentrations of sVEGF. The frequency of perioperative blood transfusion was significantly (p = 0.0007) higher in patients with rectal cancer than in patients with colon cancer. A multivariate analysis...

  18. Irinotecan-Eluting Beads in Treating Patients With Refractory Metastatic Colon or Rectal Cancer That Has Spread to the Liver

    Science.gov (United States)

    2016-01-22

    Liver Metastases; Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Recurrent Colon Cancer; Recurrent Rectal Cancer; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Stage IVA Colon Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Rectal Cancer

  19. Performance of gadofosveset-enhanced MRI for staging rectal cancer nodes: can the initial promising results be reproduced?

    Energy Technology Data Exchange (ETDEWEB)

    Heijnen, Luc A.; Martens, Milou H. [Maastricht University Medical Center, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University Medical Center, Department of Surgery, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Lambregts, Doenja M.J.; Maas, Monique; Bakers, Frans C.H. [Maastricht University Medical Center, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Cappendijk, Vincent C. [Jeroen Bosch Ziekenhuis, Department of Radiology, ' s Hertogenbosch (Netherlands); Oliveira, Pedro [Instituto Portugues de Oncologia do Porto Francisco Gentil, Department of Radiology, Porto (Portugal); Lammering, Guido [Maastro Clinic, Radiation Oncology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Riedl, Robert G. [Maastricht University Medical Center, Department of Pathology, Maastricht (Netherlands); Beets, Geerard L. [Maastricht University Medical Center, Department of Surgery, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Beets-Tan, Regina G.H. [Maastricht University Medical Center, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands)

    2014-02-15

    A previous study showed promising results for gadofosveset-trisodium as a lymph node magnetic resonance imaging (MRI) contrast agent in rectal cancer. The aim of this study was to prospectively confirm the diagnostic performance of gadofosveset MRI for nodal (re)staging in rectal cancer in a second patient cohort. Seventy-one rectal cancer patients were prospectively included, of whom 13 (group I) underwent a primary staging gadofosveset MRI (1.5-T) followed by surgery (± preoperative 5 x 5 Gy) and 58 (group II) underwent both primary staging and restaging gadofosveset MRI after a long course of chemoradiotherapy followed by surgery. Nodal status was scored as (y)cN0 or (y)cN+ by two independent readers (R1, R2) with different experience levels. Results were correlated with histology on a node-by-node basis. Sensitivity, specificity and area under the receiver operating characteristics curve (AUC) were 94 %, 79 % and 0.89 for the more experienced R1 and 50 %, 83 % and 0.74 for the non-experienced R2. R2's performance improved considerably after a learning curve, to an AUC of 0.83. Misinterpretations mainly occurred in nodes located in the superior mesorectum, nodes located in between vessels and nodes containing micrometastases. This prospective study confirms the good diagnostic performance of gadofosveset MRI for nodal (re)staging in rectal cancer. (orig.)

  20. Impact of preoperative screening for rectal colonization with fluoroquinolone-resistant enteric bacteria on the incidence of sepsis following transrectal ultrasound guided prostate biopsy

    Directory of Open Access Journals (Sweden)

    Farrell JJ

    2017-02-01

    Full Text Available John J Farrell,1,2 Jennifer L Hicks,3 Stephanie E Wallace,2 Allen D Seftel4,5 1Department of Medicine, Division of Infectious Diseases, University of Illinois College of Medicine, 2Department of Laboratory Medicine, Division of Clinical Microbiology & Serology, OSF/Saint Francis Medical Center, 3Department of Urology, OSF /Saint Francis Medical Center, Peoria, IL, 4Department of Urology, Cooper University Hospital, 5Department of Surgery, Cooper University School of Medicine, Camden, NJ, USA Abstract: With the universal adoption of antibiotic prophylaxis prior to prostate biopsy, the current risk of post-biopsy infection (including sepsis is <2%. Preoperative prophylactic antibiotic regimens can vary, and although fluoroquinolones have emerged as the standard of care, there is no universally agreed upon preoperative antibiotic regimen. Recently, an increase in the proportion of postoperative infections caused by fluoroquinolone-resistant Escherichia coli (as well as other Enterobacteriaceae has led to the exploration of simple, practical, and cost-effective methods to minimize this postoperative infection risk. We performed a prospective, nonrandomized, controlled study of preoperative rectal cultures to screen for rectal colonization with fluoroquinolone-resistant bacteria using ciprofloxacin-supplemented MacConkey agar culture media. To evaluate the feasibility and practicality of this test, one provider used the results of rectal swab cultures collected during the preoperative outpatient evaluation to adjust each patient’s preoperative antibiotic prophylaxis when fluoroquinolone-resistant enteric bacteria were detected, whereas two other providers continued usual preoperative care and empiric antimicrobial prophylaxis. Rectal colonization with fluoroquinolone-resistant bacteria was detected in 19/152 (12.5% of patients. In our intention-to-treat analysis (N=268, the rate of post-biopsy sepsis was 3.6% lower in the group that was screened

  1. Health-Related Quality of Life after surgery for primary advanced rectal cancer and recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind; Jess, Per; Laurberg, Søren

    2012-01-01

    Aim: A review of the literature was undertaken to provide an overview of Health-related quality of life (HRQoL) after surgery for primary advanced or recurrent rectal cancer and to outline proposals for future HRQoL studies in this area. Method: A systematic literature search was undertaken. Only...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...... cancer. Larger prospective longitudinal studies are needed to improve information on the effects of this extensive surgery on quality of life....

  2. Locally advanced rectal cancer: the importance of a multidisciplinary approach.

    Science.gov (United States)

    Berardi, Rossana; Maccaroni, Elena; Onofri, Azzurra; Morgese, Francesca; Torniai, Mariangela; Tiberi, Michela; Ferrini, Consuelo; Cascinu, Stefano

    2014-12-14

    Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.

  3. Ostomies in rectal cancer patients: what is their psychosocial impact?

    Science.gov (United States)

    Kenderian, S; Stephens, E K; Jatoi, A

    2014-05-01

    The resection of a low-lying rectal cancer can lead to the creation of an ostomy to discharge fecal material. In view of this reconfiguration of anatomy and life-changing modification of daily bodily functions, it is not surprising that a rapidly growing literature has examined ostomy patients' psychosocial challenges. The current study was designed (1) to systematically review the published literature on these psychosocial challenges and (2) to explore, in a single-institution setting, whether medical oncologists appear to acknowledge the existence of an ostomy during their post-operative evaluations of rectal cancer patients. This systematic review identified that social isolation, sleep deprivation; financial concerns; sexual inhibition; and other such issues are common among patients. Surprisingly, however, in our review of 66 consecutive rectal cancer patients, in 17%, the ostomy was not mentioned at all in the medical record during the first medical oncology visit; and, in one patient, it was never mentioned at all during months of adjuvant chemotherapy. Even in the setting of ostomy complications, the ostomy was not always mentioned. This study underscores the major psychosocial issues cancer patients confront after an ostomy and suggests that healthcare providers of all disciplines should work to remain sensitive to such issues.

  4. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer

    DEFF Research Database (Denmark)

    Pommergaard, Hans-Christian; Gessler, B; Burcharth, Jakob

    2014-01-01

    for cancer. The meta-analyses found that a low rectal anastomosis [OR = 3.26 (95% CI: 2.31-4.62)], male gender [OR = 1.48 (95% CI: 1.37-1.60)] and preoperative radiotherapy [OR = 1.65 (95% CI: 1.06-2.56)] may be risk factors for anastomotic leakage. Primarily as a result of observational design, the quality...... was used for bias assessment within studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS: This review included 23 studies evaluating 110,272 patients undergoing colorectal resection......AIM: Colorectal anastomotic leakage is a serious complication. Despite extensive research, no consensus on the most important preoperative risk factors exists. The aim of this systematic review and meta-analysis was to evaluate risk factors for anastomotic leakage in patients operated...

  5. Second primary cancers after anogenital, skin, oral, esophageal and rectal cancers: etiological links?

    Science.gov (United States)

    Hemminki, K; Jiang, Y; Dong, C

    2001-07-15

    The Swedish Family-Cancer Database was used to analyze second cancers after oral, esophageal, rectal, cervical, genital and skin (squamous cell carcinoma) cancers. A strong and consistent association of second cancers was observed at all these sites, in men and women. As a novel finding, an association of rectal cancer with the human papillomavirus (HVP)-related cancers was shown. New evidence on an excess of skin cancer with the HPV-related cancers was also provided. As an epidemiological study, the associations were strong and often supported by a number of comparisons. These could not be explained by bias or long-term treatment related effects. However, whether the findings on rectal and skin cancer are due to HPV or other infections, transient or inherited depressed immune function or other constitutional factors remains to be established. Copyright 2001 Wiley-Liss, Inc.

  6. Correlation of chromosomal instability, telomere length and telomere maintenance in microsatellite stable rectal cancer: a molecular subclass of rectal cancer.

    Directory of Open Access Journals (Sweden)

    Lisa A Boardman

    Full Text Available INTRODUCTION: Colorectal cancer (CRC tumor DNA is characterized by chromosomal damage termed chromosomal instability (CIN and excessively shortened telomeres. Up to 80% of CRC is microsatellite stable (MSS and is historically considered to be chromosomally unstable (CIN+. However, tumor phenotyping depicts some MSS CRC with little or no genetic changes, thus being chromosomally stable (CIN-. MSS CIN- tumors have not been assessed for telomere attrition. EXPERIMENTAL DESIGN: MSS rectal cancers from patients ≤50 years old with Stage II (B2 or higher or Stage III disease were assessed for CIN, telomere length and telomere maintenance mechanism (telomerase activation [TA]; alternative lengthening of telomeres [ALT]. Relative telomere length was measured by qPCR in somatic epithelial and cancer DNA. TA was measured with the TRAPeze assay, and tumors were evaluated for the presence of C-circles indicative of ALT. p53 mutation status was assessed in all available samples. DNA copy number changes were evaluated with Spectral Genomics aCGH. RESULTS: Tumors were classified as chromosomally stable (CIN- and chromosomally instable (CIN+ by degree of DNA copy number changes. CIN- tumors (35%; n=6 had fewer copy number changes (<17% of their clones with DNA copy number changes than CIN+ tumors (65%; n=13 which had high levels of copy number changes in 20% to 49% of clones. Telomere lengths were longer in CIN- compared to CIN+ tumors (p=0.0066 and in those in which telomerase was not activated (p=0.004. Tumors exhibiting activation of telomerase had shorter tumor telomeres (p=0.0040; and tended to be CIN+ (p=0.0949. CONCLUSIONS: MSS rectal cancer appears to represent a heterogeneous group of tumors that may be categorized both on the basis of CIN status and telomere maintenance mechanism. MSS CIN- rectal cancers appear to have longer telomeres than those of MSS CIN+ rectal cancers and to utilize ALT rather than activation of telomerase.

  7. Rectal bleeding and its management after irradiation for cervix cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae [School of Medicine, Ajou University, Suwon (Korea, Republic of); Jung, Hye Young [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    2002-12-15

    Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 {approx} 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor ({rho} > 0.0432). The

  8. Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management

    OpenAIRE

    SMITH, J. JOSHUA; Chow, Oliver S; Gollub, Marc J.; Nash, Garrett M.; Temple, Larissa K.; Weiser, Martin R.; Guillem, José G.; Paty, Philip B.; Avila, Karin; Garcia-Aguilar, Julio; ,

    2015-01-01

    Background Treatment of patients with non-metastatic, locally advanced rectal cancer (LARC) includes pre-operative chemoradiation, total mesorectal excision (TME) and post-operative adjuvant chemotherapy. This trimodality treatment provides local tumor control in most patients; but almost one-third ultimately die from distant metastasis. Most survivors experience significant impairment in quality of life (QoL), due primarily to removal of the rectum. A current challenge lies in identifying pa...

  9. Management of stage Ⅳ rectal cancer:Palliative options

    Institute of Scientific and Technical Information of China (English)

    Sean M Ronnekleiv-Kelly; Gregory D Kennedy

    2011-01-01

    Approximately 30% of patients with rectal cancer present with metastatic disease.Many of these patients have symptoms of bleeding or obstruction.Several treatment options are available to deal with the various complications that may afflict these patients.Endorectal stenting,laser ablation,and operative resection are a few of the options available to the patient with a malignant large bowel obstruction.A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity.In this review,we describe various options for palliation of symptoms in patients with metastatic rectal cancer.Additionally,we briefly discuss treatment for asymptomatic patients with metastatic disease.

  10. Treatment tactics in patient with rectal cancer complicating ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Yu. A. Barsukov

    2012-01-01

    Full Text Available A successful treatment of a young patient with a 15-year anamnesis of ulcerative colitis, who has been diagnosed with rectal cancer, is presented in this case report. A non-standard surgical intervention has been performed following all principles of oncologic surgery. A subtotal colectomy has been performed with ultra-low anterior resection of rectum. Ascendoanal anastomosis has been performed forming the neo-rectum. There were no complications in postoperative period. Considering disease stage (T3N1M0 adjuvant XELOX was administered for 6 months along with 2 cycles of prophylactic treatment with 5-aminosalycilic acid. During 2-years follow-up there are no signs of rectal cancer and ulcerative colitis progression. After pelvic electrostimulation defecation frequency decreased to 3–4 times per day, a patient has complete social rehabilitation.

  11. Robotic Surgery for Rectal Cancer: An Update in 2015

    OpenAIRE

    Kwak, Jung Myun; Kim, Seon Hahn

    2016-01-01

    During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic sur...

  12. Critical appraisal of laparoscopic vs open rectal cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Winson Jianhong Tan; Min Hoe Chew; Angela Renayanti Dharmawan; Manraj Singh; Sanchalika Acharyya; Carol Tien Tau Loi; Choong Leong Tang

    2016-01-01

    AIM:To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection(LRR) and the impact of conversion in patients with rectal cancer.METHODS:An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection.Patients were compared in three groups:Open surgery(OP),laparoscopic surgery,and converted laparoscopic surgery.Short-term outcomes,long-term outcomes,and survival analysis were compared.RESULTS:Among 633 patients studied,200 patients had successful laparoscopic resections with a conversion rate of 11.1%(25 out of 225).Factors predictive of survival on univariate analysis include the laparoscopic approach(P = 0.016),together with factors such as age,ASA status,stage of disease,tumor grade,presence of perineural invasion and vascular emboli,circumferential resection margin < 2 mm,and postoperative adjuvant chemotherapy.The survival benefit of laparoscopic surgery was no longer significant on multivariateanalysis(P = 0.148).Neither 5-year overall survival(70.5% vs 61.8%,P = 0.217) nor 5-year cancer free survival(64.3% vs 66.6%,P = 0.854) were significantly different between the laparoscopic group and the converted group.CONCLUSION:LRR has equivalent long-term oncologic out c ome s w he n c ompare d t o OP.Laparos c opic conversion does not confer a worse prognosis.

  13. Preoperative PET/CT in early-stage breast cancer

    DEFF Research Database (Denmark)

    Bernsdorf, M; Berthelsen, A K; Wielenga, V T;

    2012-01-01

    The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.......The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer....

  14. Cruciferous vegetables and colo-rectal cancer.

    OpenAIRE

    Lynn, Anthony; Collins, Andrew; Fuller, Zoë; Hillman, Kevin; Ratcliffe, Brian

    2006-01-01

    KEYWORDS - CLASSIFICATION: administration & dosage;Anticarcinogenic Agents;Apoptosis;Brassicaceae;chemically induced;chemistry;Cell Division;Colorectal Neoplasms;drug effects;dietary modulation of cancer & cancer biomarkers;Evaluation;Food Handling;Glucosinolates;Glycoside Hydrolases;Humans;Hydrolases;Isothiocyanates;metabolism;methods;pharmacology;prevention & control;Research. Cruciferous vegetables have been studied extensively for their chemoprotective effects. Although they contain ma...

  15. Immunohistochemical detection of CD133 is associated with tumor regression grade after chemoradiotherapy in rectal cancer.

    Science.gov (United States)

    Hongo, Kumiko; Kazama, Shinsuke; Sunami, Eiji; Tsuno, Nelson H; Takahashi, Koki; Nagawa, Hirokazu; Kitayama, Joji

    2012-12-01

    CD133 has been identified as a putative cancer stem cell (CSC) marker in various cancers including colorectal cancer. The relation between CD133 expression and biological characteristics of colorectal cancer remains to be clarified. Protein expression of CD133 was immunohistochemically evaluated in surgical specimens of 225 patients with colorectal cancer who were treated by surgery, as well as those of 78 patients with rectal cancer who received preoperative chemoradiotherapy (CRT) followed by curative resection. The correlation between CD133 expression and clinicopathological features, tumor recurrence and overall survival was analyzed in both populations. Among 225 colorectal cancers without CRT, 93 (41.3%) were positive for CD133 expression, which was enhanced in cases with advanced T stage and venous invasion. Moreover, CD133 was positive in 47 (60.3%) of 78 cases with CRT, which was significantly higher than the CD133-positive rate in non-CRT specimens (P=0.05). Expression of CD133 was independently correlated with the histological tumor regression grade (P<0.01). These results suggest that CD133 is not a distinctive colorectal CSC marker; expression of CD133 is suggested to be one of the key factors associated with resistance to CRT in colorectal cancer.

  16. Cetuximab and chemoradiation for rectal cancer - is the water getting muddy?

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    Glynne-Jones, Rob; Mawdsley, Suzy; Harrison, Mark (Mount Vernon Cancer Centre, Northwood, Middlesex (United Kingdom)), E-mail: Rob.glynnejones@nhs.net

    2010-04-15

    The epidermal growth factor receptor (EGFR) inhibitor cetuximab has been successfully combined with radical radiotherapy in head and neck cancer. In colorectal cancer, increased response rates are achieved by cetuximab and panitumumab within standard chemotherapy schedules, but not in chemoradiation regimens. This review examines the clinical evidence and potential mechanisms for an interaction when EGFR inhibitors are added to fluoropyrimidine-based chemoradiation in rectal adenocarcinoma. Methods. This review was compiled by searching PubMed and Medline for English language articles published until 2009 with established search strategies, supplemented by hand searching of abstracts from the proceedings of relevant international meetings. The primary outcome measure was pathological complete response (pCR). Results. Only 13 publications and three presentations in abstract of 13 phase I/II trials of preoperative chemoradiation with cetuximab in rectal cancer were identified. A total of 316 patients were identified who received cetuximab in combination with radiotherapy and 5-fluorouracil or capecitabine preoperatively. One hundred and thirty eight of these patients received either additional irinotecan or oxaliplatin. One study with panitumumab with safety but no efficacy results was identified, and two studies with gefinitib. The pCR rate ranged from 0-20%. The overall pooled pCR for cetuximab based chemoradiation was 9.1% (29/316). The rate of G3/G4 gastrointestinal toxicity, in terms of diarrhoea, varied from 5-30%, with an overall pooled rate of 47/313 (15%). Discussion. Potential reasons for the disappointing results of EGFR inhibition with fluoropyrimidine-based preoperative chemoradiation include a less critical role of repopulation in rectal adenocarcinoma using a non-curative radiation dose; or antagonistic effects on 5FU-based chemoradiation and oxaliplatin, if some cells arrest in G1 or G2-M and fail to pass through S phase. Conclusion. Cetuximab

  17. Colon and rectal cancer survival by tumor location and microsatellite instability: the Colon Cancer Family Registry.

    Science.gov (United States)

    Phipps, Amanda I; Lindor, Noralane M; Jenkins, Mark A; Baron, John A; Win, Aung Ko; Gallinger, Steven; Gryfe, Robert; Newcomb, Polly A

    2013-08-01

    Cancers in the proximal colon, distal colon, and rectum are frequently studied together; however, there are biological differences in cancers across these sites, particularly in the prevalence of microsatellite instability. We assessed the differences in survival by colon or rectal cancer site, considering the contribution of microsatellite instability to such differences. This is a population-based prospective cohort study for cancer survival. This study was conducted within the Colon Cancer Family Registry, an international consortium. Participants were identified from population-based cancer registries in the United States, Canada, and Australia. Information on tumor site, microsatellite instability, and survival after diagnosis was available for 3284 men and women diagnosed with incident invasive colon or rectal cancer between 1997 and 2002, with ages at diagnosis ranging from 18 to 74. Cox regression was used to calculate hazard ratios for the association between all-cause mortality and tumor location, overall and by microsatellite instability status. Distal colon (HR, 0.59; 95% CI, 0.49-0.71) and rectal cancers (HR, 0.68; 95% CI, 0.57-0.81) were associated with lower mortality than proximal colon cancer overall. Compared specifically with patients with proximal colon cancer exhibiting no/low microsatellite instability, patients with distal colon and rectal cancers experienced lower mortality, regardless of microsatellite instability status; patients with proximal colon cancer exhibiting high microsatellite instability had the lowest mortality. Study limitations include the absence of stage at diagnosis and cause-of-death information for all but a subset of study participants. Some patient groups defined jointly by tumor site and microsatellite instability status are subject to small numbers. Proximal colon cancer survival differs from survival for distal colon and rectal cancer in a manner apparently dependent on microsatellite instability status. These

  18. Differences of protein expression profiles, KRAS and BRAF mutation, and prognosis in right-sided colon, left-sided colon and rectal cancer.

    Science.gov (United States)

    Gao, Xian Hua; Yu, Guan Yu; Gong, Hai Feng; Liu, Lian Jie; Xu, Yi; Hao, Li Qiang; Liu, Peng; Liu, Zhi Hong; Bai, Chen Guang; Zhang, Wei

    2017-08-11

    To compare protein expression levels, gene mutation and survival among Right-Sided Colon Cancer (RSCC), Left-Sided Colon Cancer (LSCC) and rectal cancer patients, 57 cases of RSCC, 87 LSCC and 145 rectal cancer patients were included retrospectively. Our results demonstrated significant differences existed among RSCC, LSCC and rectal cancer regarding tumor diameter, differentiation, invasion depth and TNM stage. No significant difference was identified in expression levels of MLH1, MSH2, MSH6, PMS2, β-Tubulin III, P53, Ki67 and TOPIIα, and gene mutation of KRAS and BRAF among three groups. Progression Free Survival (PFS) of RSCC was significantly lower than that of LRCC and rectal cancer. In univariate analyses, RSCC, preoperative chemoradiotherapy, poor differentiation, advanced TNM stage, elevated serum CEA and CA19-9 level, tumor deposit, perineural and vascular invasion were found to be predictive factors of shorter PFS. In multivariate analyses, only differentiation and TNM stages were found to be independent predictors of PFS. In conclusion, compared with LSCC and rectal cancer, RSCC has larger tumor size, poor differentiation, advanced TNM stage and shorter survival. The shorter survival in RSCC might be attributed to the advanced tumor stage caused by its inherent position feature of proximal colon rather than genetic difference.

  19. Feasibility of transanal endoscopic total mesorectal excision for rectal cancer: results of a pilot study

    Science.gov (United States)

    Oh, Jae Hwan; Park, Sung Chan; Kim, Min Jung; Park, Byung Kwan; Hyun, Jong Hee; Chang, Hee Jin; Han, Kyung Su

    2016-01-01

    Purpose To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer. Methods This study enrolled 12 patients with clinically node negative rectal cancer located 4–12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027). Results The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/m2. Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1. Conclusion This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications. PMID:27757396

  20. Clinical application of multimodality imaging in radiotherapy treatment planning for rectal cancer.

    Science.gov (United States)

    Wang, Yan Yang; Zhe, Hong

    2013-12-11

    Radiotherapy plays an important role in the treatment of rectal cancer. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are mainstay techniques of radiotherapy for rectal cancer. However, the success of these techniques is heavily reliant on accurate target delineation and treatment planning. Computed tomography simulation is a cornerstone of rectal cancer radiotherapy, but there are limitations, such as poor soft-tissue contrast between pelvic structures and partial volume effects. Magnetic resonance imaging and positron emission tomography (PET) can overcome these limitations and provide additional information for rectal cancer treatment planning. PET can also reduce the interobserver variation in the definition of rectal tumor volume. However, there is a long way to go before these image modalities are routinely used in the clinical setting. This review summarizes the most promising studies on clinical applications of multimodality imaging in target delineation and treatment planning for rectal cancer radiotherapy.

  1. URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER

    Directory of Open Access Journals (Sweden)

    Fernando Bray BERALDO

    2015-09-01

    Full Text Available BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19% participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001. None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy, and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

  2. Metachronous penile metastasis from rectal cancer after total pelvic exenteration

    Institute of Scientific and Technical Information of China (English)

    Yuta Kimura; Dai Shida; Keiichi Nasu; Hiroki Matsunaga; Masahiro Warabi; Satoru Inoue

    2012-01-01

    Despite its abundant vascularization and extensive circulatory communication with neighboring organs,metastases to the penis are a rare event.A 57-yearold male,who had undergone total pelvic exenteration for rectal cancer sixteen months earlier,demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography.A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia.No other obvious recurrent site was noted except the penile lesion.Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer.A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor.The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7,which strongly supported a diagnosis of penile metastasis from the rectum.The patient is alive more than two years without any recurrence.

  3. Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extraperitoneal rectal cancer.

    Science.gov (United States)

    Coco, Claudio; Valentini, Vincenzo; Manno, Alberto; Mattana, Claudio; Verbo, Alessandro; Cellini, Numa; Gambacorta, Maria Antonietta; Covino, Marcello; Mantini, Giovanna; Miccichè, Francesco; Pedretti, Giorgio; Petito, Luigi; Rizzo, Gianluca; Cosimelli, Maurizio; Impiombato, Fabrizio Ambesi; Picciocchi, Aurelio

    2006-03-01

    This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy. Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemotherapy followed by surgery, including total mesorectal excision. Median follow-up was 108 (range, 10-169) months. The living patients underwent complete follow-up of, at least, nine years. Fourteen patients developed local recurrence. The time to detection was longer than two years in eight cases and longer than five years in four. Twenty-one patients developed metastases, 19 within the first five years from surgery. At the univariate analysis, clinical stage at presentation, lymph node involvement at clinical restaging after neoadjuvant therapy, and pT and pN stage were found positively correlated to the incidence of metastases. At the multivariate analysis, the only factors which confirmed a positive correlation were pT stage and pN stage. The actuarial overall survival at five, seven, and ten years was 75.5, 67.8, and 60.4 percent, respectively. The same figures for cancer-related survival were 77.9, 70, and 65.8 percent. At the univariate analysis, factors directly correlated with worse survival were: TNM stage at clinical restaging after neoadjuvant therapy (in particular lymph node involvement) pTNM, pT, and pN. At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM, pT, and pN. Long- term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery. Postoperative stage is highly predictive of prognosis.

  4. Impact of diabetes on oncologic outcome of colorectal cancer patients: colon vs. rectal cancer.

    Directory of Open Access Journals (Sweden)

    Justin Y Jeon

    Full Text Available BACKGROUND: To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum. PATIENTS AND METHODS: This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints. RESULTS: Colorectal cancer patients with DM had significantly worse disease-free survival (DFS [hazard ratio (HR 1.17, 95% confidence interval (CI: 1.00-1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS (HR: 1.46, 95% CI: 1.11-1.92, DFS (HR: 1.45, 95% CI: 1.15-1.84 and recurrence-free survival (RFS (HR: 1.32, 95% CI: 0.98-1.76 in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer with DM on OS (P = 0.009 and DFS (P = 0.007. CONCLUSIONS: This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.

  5. Watch and wait approach to rectal cancer: A review

    Institute of Scientific and Technical Information of China (English)

    Marcos; E; Pozo; Sandy; H; Fang

    2015-01-01

    In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leadingcause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage Ⅲ(node-positive) disease. For stage Ⅱ and Ⅲ colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluationthis is known as complete clinical response(cC R). The "watch and wait" approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with c CR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the "watch and wait" approach and its outcomes.

  6. Robotic anterior resection of rectal cancer: technique and early outcome

    Institute of Scientific and Technical Information of China (English)

    DU Xiao-hui; SHEN Di; LI Rong; LI Song-yan; NING Ning; ZHAO Yun-shan; ZOU Zhen-yu

    2013-01-01

    Background The Da Vinci system is a newly developed device for colorectal surgery.With advanced stereoscopic vision,lack of tremor,and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools.Since conventional laparoscopic total mesorectal excision is a challenging procedure,we have sought to assess the utility of the Da Vinci robotic system in anterior resections for rectal cancer.Methods Between November 2010 and December 2011,a total of 22 patients affected by rectal cancer were operated on with robotic technique,using the Da Vinci robot.Data regarding the outcome and pathology reports were prospectively collected in a dedicated database.Results There were no conversions to open surgery and no postoperative mortality of any patient.Mean operative time was (220±46) minutes (range,152-286 minutes).The median number of lymph nodes harvested was (14.6±6.5) (range,8-32),and the circumferential margin was negative in all cases.The distal margin was (2.6±1.2) cm (range,1.0-5.5 cm).The mean length of hospital stay was (7.8+2.6) days (range,7.0-13.0 days).Macroscopic grading of the specimen was complete in 19 cases and neady complete in three patients.Conclusions Robotic anterior resection for rectal surgery is safe and feasible in experienced hands.Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.This technique may facilitate minimally invasive radical rectal surgery.

  7. Preoperative Chemoradiotheraph for Inflammatory Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    Hongbo Ren; Qi Wang; Yaoxiong Yan; Shaolin Li; Biyou Huang

    2006-01-01

    OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer.METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3~4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped.RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage ⅢB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage Ⅳ, the 3 and 5-year survival rates were both 0.0%.There was a significant difference between the 2 stage groups (P<0.05,X2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both0.0%, There was a significant difference between the operated and nonoperated groups (P<0.05, X2=11.64).CONCLUSION The prognosis of inflammatory breast carcinoma is poor

  8. Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging.

    Science.gov (United States)

    Dieguez, Adriana

    2013-07-22

    High-resolution (HR) magnetic resonance imaging (MRI) has become an indispensable tool for multidisciplinary teams (MDTs) addressing rectal cancer. It provides anatomic information for surgical planning and allows patients to be stratified into different groups according to the risk of local and distant recurrence. One of the objectives of the MDT is the preoperative identification of high-risk patients who will benefit from neoadjuvant treatment. For this reason, the correct evaluation of the circumferential resection margin (CRM), the depth of tumor spread beyond the muscularis propria, extramural vascular invasion and nodal status is of the utmost importance. Low rectal tumors represent a special challenge for the MDT, because decisions seek a balance between oncologic safety, in the pursuit of free resection margins, and the patient's quality of life, in order to preserve sphincter function. At present, the exchange of information between the different specialties involved in dealing with patients with rectal cancer can rank the contribution of colleagues, auditing their work and incorporating knowledge that will lead to a better understanding of the pathology. Thus, beyond the anatomic description of the images, the radiologist's role in the MDT makes it necessary to know the prognostic value of the findings that we describe, in terms of recurrence and survival, because these findings affect decision making and, therefore, the patients' life. In this review, the usefulness of HR MRI in the initial staging of rectal cancer and in the evaluation of neoadjuvant treatment, with a focus on the prognostic value of the findings, is described as well as the contribution of HR MRI in assessing patients with suspected or confirmed recurrence of rectal cancer.

  9. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer

    DEFF Research Database (Denmark)

    Wille-Jørgensen, Peer; Pilsgaard, B.; Moller, P.

    2009-01-01

    The aim of the study is to describe the results of reconstruction of the pelvic floor by using an absorbable biological mesh after having performed an abdomino-perineal resection with excision of whole of the pelvic floor for rectal cancer Eleven consecutive patients had reconstruction...... of the pelvic floor after abdominoperineal excision (APR) with a biological mesh. The peri- and postoperative courses were registered in a prospective database. Six patients received preoperative radiochemotherapy. One patient had the mesh removed due to infection and later developed local recurrence. The rest...... had an uneventful postoperative course despite more pain than is usually experienced in the perineal wound after traditional APR. The use of a biological mesh for pelvic floor reconstruction is feasible with satisfactory results. A randomised trial is warranted in order to evaluate this technique...

  10. Potential Prognostic Benefit of Lateral Pelvic Node Dissection for Rectal Cancer Located Below the Peritoneal Reflection

    Science.gov (United States)

    Ueno, Hideki; Mochizuki, Hidetaka; Hashiguchi, Yojiro; Ishiguro, Megumi; Miyoshi, Masayoshi; Kajiwara, Yoshiki; Sato, Taichi; Shimazaki, Hideyuki; Hase, Kazuo

    2007-01-01

    Objective: To identify the parameters related to the effective selection of patients who could receive prognostic benefit from lateral pelvic node dissection. Background: Accurate preoperative diagnosis of lateral nodal involvement (LNI) remains difficult, and the indications for lateral lymph node dissection have been controversial. Patients and Methods: A total of 244 consecutive patients who underwent potentially curative surgery with lateral dissection for advanced lower rectal cancer (1985–2000) were reviewed. Patients were stratified into groups based on various parameters, and the therapeutic value index for survival benefit was compared among groups. The therapeutic index of lateral dissection was calculated by multiplying the frequency of metastasis to the lateral area and the cancer-related 5-year survival rate of patients with metastasis to the lateral area, irrespective of metastasis to other areas (mesorectal, superior rectal artery [SRA], and inferior mesenteric artery [IMA] areas). Results: LNI was observed in 41 patients (17%); and 88% of them had nodal involvement in the region along the internal iliac/pudendal artery or in the obturator region (“vulnerable field”). The cancer-related 5-year survival rate among the patients with LNI was 42%; the therapeutic index for lateral dissection was calculated as 7.0 patients, which was much higher than that of lymphadenectomy of the SRA area (1.6 patients) and the IMA area (0.4 patients), and almost comparable to that of lymphadenectomy of the upward mesorectal area (6.9 patients). Although it was possible to select groups at high and low risk for LNI based on several parameters related to tumor aggressiveness, such as tumor differentiation in biopsy specimens, the therapeutic value index was not significantly different between these groups. Unlike these parameters, the diameter of the largest lymph node in the “vulnerable field,” which was positively correlated with the rate of LNI but irrelevant

  11. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study

    Directory of Open Access Journals (Sweden)

    Sperduti Isabella

    2009-09-01

    Full Text Available Abstract Background Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. Methods We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR, pudendal somatosensory evoked potentials (PEPs, motor evoked potential (MEPs and sympathetic skin responses (SSRs. The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. Results 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Conclusion Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  12. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study.

    Science.gov (United States)

    Pietrangeli, Alberto; Pugliese, Patrizia; Perrone, Maria; Sperduti, Isabella; Cosimelli, Maurizio; Jandolo, Bruno

    2009-09-17

    Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  13. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    Science.gov (United States)

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise

    2013-03-01

    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer.

  14. Study protocol: multi-parametric magnetic resonance imaging for therapeutic response prediction in rectal cancer.

    Science.gov (United States)

    Pham, Trang Thanh; Liney, Gary; Wong, Karen; Rai, Robba; Lee, Mark; Moses, Daniel; Henderson, Christopher; Lin, Michael; Shin, Joo-Shik; Barton, Michael Bernard

    2017-07-04

    Response to neoadjuvant chemoradiotherapy (CRT) of rectal cancer is variable. Accurate imaging for prediction and early assessment of response would enable appropriate stratification of management to reduce treatment morbidity and improve therapeutic outcomes. Use of either diffusion weighted imaging (DWI) or dynamic contrast enhanced (DCE) imaging alone currently lacks sufficient sensitivity and specificity for clinical use to guide individualized treatment in rectal cancer. Multi-parametric MRI and analysis combining DWI and DCE may have potential to improve the accuracy of therapeutic response prediction and assessment. This protocol describes a prospective non-interventional single-arm clinical study. Patients with locally advanced rectal cancer undergoing preoperative CRT will prospectively undergo multi-parametric MRI pre-CRT, week 3 CRT, and post-CRT. The protocol consists of DWI using a read-out segmented sequence (RESOLVE), and DCE with pre-contrast T1-weighted (VIBE) scans for T1 calculation, followed by 60 phases at high temporal resolution (TWIST) after gadoversetamide injection. A 3-dimensional voxel-by-voxel technique will be used to produce colour-coded ADC and K(trans) histograms, and data evaluated in combination using scatter plots. MRI parameters will be correlated with surgical histopathology. Histopathology analysis will be standardized, with chemoradiotherapy response defined according to AJCC 7th Edition Tumour Regression Grade (TRG) criteria. Good response will be defined as TRG 0-1, and poor response will be defined as TRG 2-3. The combination of DWI and DCE can provide information on physiological tumour factors such as cellularity and perfusion that may affect radiotherapy response. If validated, multi-parametric MRI combining DWI and DCE can be used to stratify management in rectal cancer patients. Accurate imaging prediction of patients with a complete response to CRT would enable a 'watch and wait' approach, avoiding surgical morbidity

  15. Causes and outcomes of emergency presentation of rectal cancer.

    Science.gov (United States)

    Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Haase, Trutz; Johnson, Howard; Pratschke, Jonathan

    2016-09-01

    Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation.

  16. Differences in Survival between Colon and Rectal Cancer from SEER Data

    OpenAIRE

    Yen-Chien Lee; Yen-Lin Lee; Jen-Pin Chuang; Jenq-Chang Lee

    2013-01-01

    BACKGROUND: Little is known about colorectal cancer or colon and rectal cancer. Are they the same disease or different diseases? OBJECTIVES: The aim of this epidemiology study was to compare the features of colon and rectal cancer by using recent national cancer surveillance data. DESIGN AND SETTING: Data included colorectal cancer (1995-2008) from the Surveillance, Epidemiology, and End Results Program (SEER) database. Only adenocarcinoma was included for analysis. PATIENTS: A total of 372,1...

  17. Transanal vs laparoscopic total mesorectal excision for rectal cancer

    DEFF Research Database (Denmark)

    Perdawood, Sharaf; Al Khefagie, Ghalib Ali Abod

    2016-01-01

    BACKGROUND: Laparoscopic total mesorectal excision (LaTME) has improved short-term outcomes of rectal cancer surgery with comparable oncological results to open approach. LaTME can be difficult in the lower most part of the rectum, leading potentially to higher rates of complications, conversion...... to open surgery and probably suboptimal oncological quality. Transanal TME (TaTME) can potentially solve these problems. The aim of this study was to compare the short-term results after TaTME with those after LaTME. METHODS: A prospectively collected database of consecutive patients who underwent Ta...

  18. Systematic review of outcomes after intersphincteric resection for low rectal cancer.

    LENUS (Irish Health Repository)

    Martin, S T

    2012-05-01

    For a select group of patients proctectomy with intersphincteric resection (ISR) for low rectal cancer may be a viable alternative to abdominoperineal resection, with good oncological outcomes while preserving sphincter function. The purpose of this systematic review was to evaluate the current evidence regarding oncological outcomes, morbidity and mortality, and functional outcomes after ISR for low rectal cancer.

  19. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer

    NARCIS (Netherlands)

    Peeters, KCMJ; Tollenaar, RAEM; Marijnen, CAM; Kranenbarg, EK; Steup, WH; Wiggers, T; Rutten, HJ; van de Velde, CJH

    2005-01-01

    Background: Anastomotic leakage is a major complication of rectal cancer surgery. The aim of this study was to investigate risk factors associated with symptomatic anastomotic leakage after total mesorectal excision (TME). Methods: Between 1996 and 1999, patients with operable rectal cancer were ran

  20. The "liver-first approach" for patients with locally advanced rectal cancer and synchronous liver metastases.

    NARCIS (Netherlands)

    Verhoef, C.; Pool, A.E. van der; Nuyttens, J.J.; Planting, A.S.; Eggermont, A.M.M.; Wilt, J.H.W. de

    2009-01-01

    PURPOSE: This study was designed to investigate the outcome of "the liver-first" approach in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS: Patients with locally advanced rectal cancer and synchronous liver metastases were primarily treated for their liver me

  1. Single nucleotide polymorphisms in the HIF-1α gene and chemoradiotherapy of locally advanced rectal cancer

    DEFF Research Database (Denmark)

    Havelund, Birgitte Mayland; Spindler, Karen-Lise Garm; Ploen, John

    2012-01-01

    The aim of this study was to investigate the predictive impact of polymorphisms in the HIF-1α gene on the response to chemoradiotherapy (CRT) in rectal cancer. This study included two cohorts of patients with locally advanced rectal cancer receiving long-course CRT. The HIF-1α C1772T (rs11549465...

  2. Laparoscopic surgery for rectal cancer: a single-centre experience of 120 cases.

    LENUS (Irish Health Repository)

    Good, Daniel W

    2011-10-01

    For colorectal surgeons, laparoscopic rectal cancer surgery poses a new challenge. The defence of the questionable oncological safety tempered by the impracticality of the long learning curve is rapidly fading. As a unit specialising in minimally invasive surgery, we have routinely undertaken rectal cancer surgery laparoscopically since 2005.

  3. Acute myelogenous leukemia following chemotherapy and radiation for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Aso, Teijiro; Hirota, Yuichi; Kondou, Seiji; Matsumoto, Isao; Matsuzaka, Toshimitsu; Iwashita, Akinori

    1989-03-01

    In August 1982, a 44-year-old man was diagnosed as having rectal cancer, histologically diagnosed as well differentiated adenocarcinoma, and abdominoperineal resection and colostomy were performed. Postoperatively, he received chemotherapy with mitomycin C up to a total dose of 100 mg. In September 1986, lung metastasis occurred and he was treated with a combination chemotherapy consisting of cisplatin, pirarubicin and 5-fluorouracil. In the following year, radiation treatment (total: 6900 rad) was given for a recurrent pelvic lesion. Peripheral blood on April 30, 1988, showed anemia, thrombocytopenia and appearance of myeloblasts, and a diagnosis of acute myelogenous leukemia (FAB: M1) was made. Combination chemotherapy (including aclarubicin, vincristine, behenoyl ara-C, daunorubicin, 6-mercaptopurine, cytarabine, etoposide and prednisolone) failed to induce remission and the patient died in June 1988. This case was thought to be one of secondary leukemia occurring after chemotherapy and radiation treatment for rectal cancer. This case clearly indicates the need for a careful follow-up of long-term survivors who have received cancer therapy. (author).

  4. Differences in survival between colon and rectal cancer from SEER data.

    Directory of Open Access Journals (Sweden)

    Yen-Chien Lee

    Full Text Available BACKGROUND: Little is known about colorectal cancer or colon and rectal cancer. Are they the same disease or different diseases? OBJECTIVES: The aim of this epidemiology study was to compare the features of colon and rectal cancer by using recent national cancer surveillance data. DESIGN AND SETTING: Data included colorectal cancer (1995-2008 from the Surveillance, Epidemiology, and End Results Program (SEER database. Only adenocarcinoma was included for analysis. PATIENTS: A total of 372,130 patients with a median follow-up of 32 months were analyzed. MAIN OUTCOME MEASURES: Mean survival of patients with the same stage of colon and rectal cancer was evaluated. RESULTS: Around 35% of patients had stage information. Among them, colon cancer patients had better survival than those with rectal cancer, by a margin of 4 months in stage IIB. In stage IIIC and stage IV, rectal cancer patients had better survival than colon cancer patients, by about 3 months. Stage IIB colorectal cancer patients had a poorer prognosis than those with stage IIIA and IIIB colorectal cancer. After adjustment of age, sex and race, colon cancer patients had better survival than rectal cancer of stage IIB, but in stage IIIC and IV, rectal cancer patients had better survival than colon cancer. LIMITATIONS: The study is limited by its retrospective nature. CONCLUSION: This was a population-based study. The prognosis of rectal cancer was not worse than that of colon cancer. Local advanced colorectal cancer had a poorer prognosis than local regional lymph node metastasis. Stage IIB might require more aggressive chemotherapy, and no less than that for stage III.

  5. Perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging in patients with rectal cancer: Correlation with microvascular density and vascular endothelial growth factor expression

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Eun [Dept. of Radiology, Seoul Medical Center, Seoul (Korea, Republic of); Lim, Joon Seok; Kim, Myeong Jin; Kim, Ki Whang; Choi, Jun Jeong [Yonsei University Health System, Seoul (Korea, Republic of); Kim, Dae Hong [Molecular Imaging and Therapy Branch, National Cancer Center, Goyang (Korea, Republic of); Myoung, Sung Min [Dept. of Medical Information, Jungwon University, Goesan (Korea, Republic of)

    2013-12-15

    To determine whether quantitative perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) correlate with immunohistochemical markers of angiogenesis in rectal cancer. Preoperative DCE-MRI was performed in 63 patients with rectal adenocarcinoma. Transendothelial volume transfer (K{sup trans}) and fractional volume of the extravascular-extracellular space (Ve) were measured by Interactive Data Language software in rectal cancer. After surgery, microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression scores were determined using immunohistochemical staining of rectal cancer specimens. Perfusion parameters (K{sup trans}, Ve) of DCE-MRI in rectal cancer were found to be correlated with MVD and VEGF expression scores by Spearman's rank coefficient analysis. T stage and N stage (negative or positive) were correlated with perfusion parameters and MVD. Significant correlation was not found between any DCE-MRI perfusion parameters and MVD (rs = -0.056 and p 0.662 for K{sup trans}; rs = -0.103 and p = 0.416 for Ve), or between any DCE-MRI perfusion parameters and the VEGF expression score (rs = -0.042, p 0.741 for K{sup trans}; r = 0.086, p = 0.497 for Ve) in rectal cancer. TN stage showed no significant correlation with perfusion parameters or MVD (p > 0.05 for all). DCE-MRI perfusion parameters, K{sup trans} and Ve, correlated poorly with MVD and VEGF expression scores in rectal cancer, suggesting that these parameters do not simply denote static histological vascular properties.

  6. Robotic Surgery for Colon and Rectal Cancer.

    Science.gov (United States)

    Park, Eun Jung; Baik, Seung Hyuk

    2016-01-01

    Robotic surgery, used generally for colorectal cancer, has the advantages of a three-dimensional surgical view, steadiness, and seven degrees of robotic arms. However, there are disadvantages, such as a decreased sense of touch, extra time needed to dock the robotic cart, and high cost. Robotic surgery is performed using various techniques, with or without laparoscopic surgery. Because the results of this approach are reported to be similar to or less favorable than those of laparoscopic surgery, the learning curve for robotic colorectal surgery remains controversial. However, according to short- and long-term oncologic outcomes, robotic colorectal surgery is feasible and safe compared with conventional surgery. Advanced technologies in robotic surgery have resulted in favorable intraoperative and perioperative clinical outcomes as well as functional outcomes. As the technical advances in robotic surgery improve surgical performance as well as outcomes, it increasingly is being regarded as a treatment option for colorectal surgery. However, a multicenter, randomized clinical trial is needed to validate this approach.

  7. Anastomotic leakage in rectal cancer surgery: The role of blood perfusion

    Institute of Scientific and Technical Information of China (English)

    Martin; Ruteg?rd; J?rgen; Ruteg?rd

    2015-01-01

    Anastomotic leakage after anterior resection for rectal cancer remains a common and often devastating complication. Preoperative risk factors for anastomotic leakage have been studied extensively and are used for patient selection, especially whether to perform a diverting stoma or not. From the current literature,data suggest that perfusion in the rectal stump rather than in the colonic limb may be more important for the integrity of the colorectal anastomosis. Moreover, available research suggests that the mid and upper rectum is considerably more vascularized than the lower part, in which the posterior compartment seems most vulnerable. These data fit neatly with the observation that anastomotic leaks are far more frequent in patients undergoing total compared to partial mesorectal excision, and also that most leaks occur dorsally. Clinical judgment has been shown to ineffectively assess anastomotic viability, while promising methods to measure blood perfusion are evolving. Much interest has recently been turned to near-infrared light technology, enhanced with fluorescent agents, which enables intraoperative perfusion assessment. Preliminary data are promising, but large-scale controlled trials are lacking. With maturation of such technology, perfusion measurements may in the future inform the surgeon whether anastomoses are at risk. In high colorectal anastomoses, anastomotic revision might be feasible, while a diverting stoma could be fashioned selectively instead of routinely for low anastomoses.

  8. EVALUATION OF PHYSIOLOGIC FUNCTION OF COLONIC POUCH ANASTOMOSES AFTER EXCISION FOR RECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    HUANG Zhongrong

    1999-01-01

    Objective: To study the physiology value of colonic pouch anastomosis after rectal cancer excision. Methods:Forty-six patients with total mesonectal excision for carcinoma were randomized to either a straight (GroupA, n=23) or a colonic pouch anastomosis (Group B,n=23). The neorectal physiologic function of patients in both groups was evaluated, which included laboratory studies. Results: Sphincter pressures in both groups were similar. Preoperative compliance of the rectum was restored after surgery in the Group B, 0.296 (0.224-0.347) L/Kpa, but there was a significant decrease after surgery in the Group A, 0.194 (0.112-0.235) L/Kpa P<0.001. By a multiple regression analysis, neo-rectal compliance was associated with favorable clinical function, and hypermotility of the canal was associated with adverse clinical function. Conclusion: Colonic pouch-anastomosis restores neorectal compliance, which is important for good function after iow anterior resection.

  9. Prognostic significance of preoperative fibrinogen in patients with colon cancer.

    Science.gov (United States)

    Sun, Zhen-Qiang; Han, Xiao-Na; Wang, Hai-Jiang; Tang, Yong; Zhao, Ze-Liang; Qu, Yan-Li; Xu, Rui-Wei; Liu, Yan-Yan; Yu, Xian-Bo

    2014-07-14

    To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients. A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1(st) 2005 to June 1(st) 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS). The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P TNM stage, mGPS score, CEA, and AFP levels correlated with both OS and DFS. Preoperative fibrinogen levels can serve as an independent prognostic marker to evaluate patient response to colon cancer treatment.

  10. Preoperative evaluation of synchronous colorectal cancer using MR colonography

    DEFF Research Database (Denmark)

    Achiam, Michael P; Andersen, Lars Peter Holst; Klein, Mads

    2009-01-01

    it is noninvasive, and most of the colon can be evaluated. Furthermore, it has higher patient acceptance, and no sedation or radiation is used. The purpose of this study was to determine the feasibility of performing MRC preoperatively in an everyday clinical situation in a group of patients who were not offered......RATIONALE AND OBJECTIVES: It is well known that synchronous cancers (incidence, 2%-11%) and polyps (incidence, 12%-58%) occur in patients with colorectal cancer. Magnetic resonance colonography (MRC) seems like the obvious choice as a diagnostic tool in preoperative evaluation, because...

  11. Choroidal metastasis from early rectal cancer: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Mitsuyoshi Tei

    2014-01-01

    CONCLUSION: This is the first report of choroidal metastasis from early rectal cancer. We consider it important to enforce systemic chemotherapy in addition to radiotherapy for choroidal metastasis from colorectal cancer.

  12. Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer: A Phase II Open Label Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Kim, Min Jung; Park, Sung Chan; Park, Ji Won; Chang, Hee Jin; Kim, Dae Yong; Nam, Byung-Ho; Sohn, Dae Kyung; Oh, Jae Hwan

    2017-05-25

    The phase II randomized controlled trial aimed to compare the outcomes of robot-assisted surgery with those of laparoscopic surgery in the patients with rectal cancer. The feasibility of robot-assisted surgery over laparoscopic surgery for rectal cancer has not been established yet. Between February 21, 2012 and March 11, 2015, patients with rectal cancer (cT1-3NxM0) were enrolled. Patients were randomized 1:1 to either robot-assisted or laparoscopic surgery, and stratified per sex and administration of preoperative chemoradiotherapy. The primary outcome was the quality of total mesorectal excision (TME) specimen. Secondary outcomes were the circumferential and distal resection margins, the number of harvested lymph nodes, morbidity, bowel function recovery, and quality of life. A total of 163 patients were randomly assigned to the robot-assisted (n = 81) and laparoscopic (n = 82) surgery groups, and 139 patients were eligible for the analyses (73 vs 66, respectively). One patient (1.2%) in the robot-assisted group was converted to open surgery. The TME quality did not differ between the robot-assisted and laparoscopic groups (80.3% vs 78.1% complete TME, respectively; 18.2% vs 21.9% nearly complete TME, respectively; P = 0.599). The resection margins, number of harvested lymph nodes, morbidity, and bowel function recovery also were not significantly different. On analyzing quality of life, scores of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C30) and EORTC QLQ CR38 were similar in the 2 groups, but in the EORTC QLQ CR 38 questionnaire, sexual function 12 months postoperatively was better in the robot-assisted group than in the laparoscopic group (P = 0.03). Robot-assisted surgery in rectal cancer showed TME quality comparable with that of laparoscopic surgery, and it demonstrated similar postoperative morbidity, bowel function recovery, and quality of life.

  13. The predicting value of postoperative body temperature on long-term survival in patients with rectal cancer.

    Science.gov (United States)

    Yu, Huichuan; Luo, Yanxin; Peng, Hui; Kang, Liang; Huang, Meijin; Luo, Shuangling; Chen, Wenhao; Yang, Zihuan; Wang, Jianping

    2015-09-01

    This study aimed to assess the association between postoperative body temperature and prognosis in patients with rectal cancer. Five hundred and seven patients with stage I to III rectal cancers were enrolled in the current study. Basal body temperature (BBT, measured at 6 am) and maximal body temperature (MBT) on each day after surgery were analyzed retrospectively. Patients were divided into two equal groups according to the median of BBT and MBT at each day. The primary end points were disease-free survival (DFS) and overall survival (OS). The univariate and multivariate analyses showed that patients with low D0-MBT (37.4 °C). In the subset of 318 patients with T3 stage tumor and the subgroup of 458 patients without blood transfusion as well, low D0-MBT continues to be an independent predictor of DFS/OS with an adjusted HR equal to 1.48 (95 % CI 1.02-2.24, P = 0.046)/1.68 (95 % CI 1.04-2.99, P = 0.048) and 1.45 (95 % CI 1.02-2.13, P = 0.048)/1.59 (95 % CI 1.01-2.74, P = 0.049), respectively. In addition, we found that patients have higher risk of 1-year recurrence if those were exhibiting low preoperative BBT (temperature (D0-MBT rectal cancer.

  14. Preoperative assessment and optimization in periampullary and pancreatic cancer

    Directory of Open Access Journals (Sweden)

    S Myatra

    2011-01-01

    Full Text Available Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign, stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections.

  15. Presacral venous bleeding during mobilization in rectal cancer

    Science.gov (United States)

    Casal Núñez, Jose Enrique; Vigorita, Vincenzo; Ruano Poblador, Alejandro; Gay Fernández, Ana María; Toscano Novella, Maria Ángeles; Cáceres Alvarado, Nieves; Pérez Dominguez, Lucinda

    2017-01-01

    AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined. RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication. CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

  16. A randomized phase II study of capecitabine-based chemoradiation with or without bevacizumab in resectable locally advanced rectal cancer: clinical and biological features

    OpenAIRE

    Salazar, Ramon; Capdevila, Jaume; Laquente, Berta; Manzano, Jose Luis; Pericay, Carles; Villacampa, Mercedes Mart?nez; L?pez, Carlos; Losa, Ferran; Safont, Maria Jose; G?mez, Auxiliadora; Alonso, Vicente; Escudero, Pilar; Gallego, Javier; Sastre, Javier; Gr?valos, Cristina

    2015-01-01

    Background Perioperatory chemoradiotherapy (CRT) improves local control and survival in patients with locally advanced rectal cancer (LARC). The objective of the current study was to evaluate the addition of bevacizumab (BEV) to preoperative capecitabine (CAP)-based CRT in LARC, and to explore biomarkers for downstaging. Methods Patients (pts) were randomized to receive 5?weeks of radiotherapy 45?Gy/25 fractions with concurrent CAP 825?mg/m2 twice daily 5?days per week and BEV 5?mg/kg once ev...

  17. Significance of preoperative thrombocytosis in epithelial ovarian cancer

    Directory of Open Access Journals (Sweden)

    Crasta Julian

    2010-01-01

    Full Text Available Background: Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer and identified it as a marker of aggressive tumor biology. Aim: To study the incidence of preoperative thrombocytosis (platelets greater than 400x10 in epithelial ovarian cancer and its association with other clinicopathologic factors. Materials and Methods: Sixty-five patients with invasive ovarian epithelial cancer were retrospectively reviewed and analyzed for the association preoperative thrombocytosis with other clinical and histopathological prognostic factors. Means were analyzed by Student′s t test; proportions were determined by Chi-square analysis. Results: Twenty of 65 (37.5% patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have lower hemoglobin (P < 0.0002, more advanced stage disease (P < 0.05 and higher grade tumors (P < 0.02. Patients with thrombocytosis had greater likelihood of subpotimal cytoreduction. Conclusions: Preoperative thrombocytosis is a frequent finding in ovarian carcinomas and their association with advanced stage disease and higher grade denotes that platelets play a role in the tumor growth and progression.

  18. Preoperative radiological approach for hilar lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ohno, Yoshiharu; Higashino, Takanori; Watanabe, Hirokazu; Yoshimura, Masahiro; Sugimura, Kazuro [Kobe Univ. (Japan). Graduate School of Medicine; Takenaka, Daisuke [Kobe Ekisaikai Hospital (Japan)

    2003-05-01

    Recent advances in CT, MR, and nuclear medicine have made it possible to evaluate morphological and functional information in hilar lung cancer patients more accurately and quantitatively. In this review, we describe recent advances in the radiological approach to hilar lung cancer, focusing on mediastinal invasion, lymph node metastasis, and pulmonary functional imaging. We believe that further basic studies as well as clinical applications of newer MR techniques will play an important role in the management of patients with lung cancer. (author)

  19. Irradiation of low rectal cancers; Radiotherapie des carcinomes du bas rectum

    Energy Technology Data Exchange (ETDEWEB)

    Ardiet, J.M.; Coquard, R.; Romestaing, P.; Fric, D.; Baron, M.H.; Rocher, F.P.; Sentenac, I.; Gerard, J.P. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

    1994-12-31

    The low rectal cancers are treated by anorectal amputation and pose the problem of the sphincter conservation. Some authors extend the clinical definition to developed injuries until 12 cm from the anal margin. The rectal cancer is a frequent tumour which remains serious. When the tumour is low, the treatment consists in an anorectal amputation with a permanent colostomy. The radical non preserving surgery is the usual treatment of these injuries. Until 1960 the rectal adenocarcinoma was considered as a radioresistant tumour because of the impossibility to deliver an enough dose to the tumour by external radiotherapy. But other studies showed that those lesions were radiosensitive and often radiocurable. The medical treatments haven`t yet demonstrated their efficiency in the treatment of the rectal cancer. We`ll study the radiotherapy in the treatment of the low rectal cancer, solely radiotherapy, radiosurgical associations. 32 refs., 5 tabs.

  20. Proteogenomic characterization of human colon and rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Bing; Wang, Jing; Wang, Xiaojing; Zhu, Jing; Liu, Qi; Shi, Zhiao; Chambers, Matthew C.; Zimmerman, Lisa J.; Shaddox, Kent F.; Kim, Sangtae; Davies, Sherri; Wang, Sean; Wang, Pei; Kinsinger, Christopher; Rivers, Robert; Rodriguez, Henry; Townsend, Reid; Ellis, Matthew; Carr, Steven A.; Tabb, David L.; Coffey, Robert J.; Slebos, Robbert; Liebler, Daniel

    2014-09-18

    We analyzed proteomes of colon and rectal tumors previously characterized by the Cancer Genome Atlas (TCGA) and performed integrated proteogenomic analyses. Protein sequence variants encoded by somatic genomic variations displayed reduced expression compared to protein variants encoded by germline variations. mRNA transcript abundance did not reliably predict protein expression differences between tumors. Proteomics identified five protein expression subtypes, two of which were associated with the TCGA "MSI/CIMP" transcriptional subtype, but had distinct mutation and methylation patterns and associated with different clinical outcomes. Although CNAs showed strong cis- and trans-effects on mRNA expression, relatively few of these extend to the protein level. Thus, proteomics data enabled prioritization of candidate driver genes. Our analyses identified HNF4A, a novel candidate driver gene in tumors with chromosome 20q amplifications. Integrated proteogenomic analysis provides functional context to interpret genomic abnormalities and affords novel insights into cancer biology.

  1. The early response of p53-dependent proteins during radiotherapy in human rectal carcinoma and in adjacent normal tissue

    NARCIS (Netherlands)

    Stift, A; Prager, G; Selzer, E; Widder, J; Kandioler, D; Friedl, J; Teleky, B; Herbst, F; Wrba, F; Bergmann, M

    2003-01-01

    The aim of this study was to investigate the activation of the p53 pathway and the induction of apoptosis during preoperative radiotherapy in normal human rectal tissue and in rectal carcinoma. Twelve patients with rectal cancer of the lower third were enrolled in this study. Tumor specimens and adj

  2. Response to chemoradiotherapy and lymph node involvement in locally advanced rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Luis; J; García-Flórez; Guillermo; Gómez-álvarez; Ana; M; Frunza; Luis; Barneo-Serra; Manuel; F; Fresno-Forcelledo

    2015-01-01

    AIM: To establish the association between lymph node involvement and the response to neoadjuvant therapy in locally advanced rectal cancer.METHODS: Data of 130 patients with mid and low locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation followed by radical surgery over a 5-year period were reviewed. Tumor staging was done by endorectal ultrasound and/or magnetic resonance imaging. Tumor response to neoadjuvant therapy was determined by T-downstaging and tumor regression grading(TRG). Pathologic complete response(p CR) is defined as the absence of tumor cells in the surgical specimen(yp T0N0). The varying degrees TRG were classified according to Mandard’s scoring system. The evaluation of the response is based on the comparison between previous clinico-radiological staging and the results of pathological evaluation. χ2 and Spearman’s correlation tests were used for the comparison of variables. RESULTS: Pathologic complete response(p CR, yp T0N0, TRG1) was observed in 19 cases(14.6%), and other 18(13.8%) had only very few residual malignant cells in the rectal wall(TRG2). T-downstaging was found in 63(48.5%). Mean lymph node retrieval was 9.4(range0-38). In 37 cases(28.5%) more than 12 nodes were identified in the surgical specimen. Preoperative lymph node involvement was seen in 77 patients(59.2%), 71 N1 and 6 N2. Postoperative lymph node involvement was observed in 41 patients(31.5%), 29 N1 and 12 N2, while the remaining 89 were N0(68.5%). In relation to yp T stage, we found nodal involvement of 9.4% in yp T0-1, 22.2% in yp T2 and 43.7% in yp T3-4. Of the 37 patients considered "responders" to neoadjuvant therapy(TRG1 and 2), there were only 4 N+(10.8%) and the remainder N0(89.2%). In the "non responders" group(TRG 3, 4 and 5), 37 cases were N+(39.8%) and 56(60.2%) were N0(P < 0.001).CONCLUSION: Response to neoadjuvant chemoradiation in rectal cancer is associated with lymph node involvement.

  3. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer.

    Science.gov (United States)

    Dent, O F; Chapuis, P H; Haboubi, N; Bokey, L

    2011-09-01

    Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. The study design and methodology of studies on this topic were critically examined. Features identified as affecting the efficacy of these studies were: representativeness of patients, definition of the margin assessed by MRI and by histology, lack of blinding of surgeons and pathologists to MRI results, effect of neoadjuvant treatment, and number of patients studied. Because of methodological inadequacies in studies completed to date, there is insufficient evidence of the ability of a positive MRI result to predict an involved CRM. Although MRI may be able to identify a tumour that has extended to the mesorectal fascia and/or intersphincteric plane, logically, it cannot indicate where the surgical boundary of the resection will ultimately lie, and therefore cannot validly predict an involved CRM and should not be relied upon for this purpose. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  4. Addition of Bevacizumab to XELOX Induction Therapy Plus Concomitant Capecitabine-Based Chemoradiotherapy in Magnetic Resonance Imaging–Defined Poor-Prognosis Locally Advanced Rectal Cancer: The AVACROSS Study

    OpenAIRE

    Nogué, Miguel; Salud, Antonieta; Vicente, Pilar; Arriví, Antonio; Roca, José María; Losa, Ferran; Ponce, José; Safont, María José; Guasch, Inmaculada; Moreno, Isabel; Ruiz, Ana; Pericay, Carles

    2011-01-01

    The objective of the current study was to assess the efficacy and toxicity of adding bevacizumab to induction chemotherapy followed by preoperative bevacizumab-based chemoradiotherapy in patients with locally advanced rectal cancer. Addition of bevacizumab to induction chemotherapy and chemoradiotherapy is feasible, with impressive activity and manageable toxicity. However, caution is recommended regarding surgical complications.

  5. Phase I/II trial evaluating carbon ion radiotherapy for the treatment of recurrent rectal cancer: the PANDORA-01 trial

    Directory of Open Access Journals (Sweden)

    Combs Stephanie E

    2012-04-01

    Full Text Available Abstract Background Treatment standard for patients with rectal cancer depends on the initial staging and includes surgical resection, radiotherapy as well as chemotherapy. For stage II and III tumors, radiochemotherapy should be performed in addition to surgery, preferentially as preoperative radiochemotherapy or as short-course hypofractionated radiation. Advances in surgical approaches, especially the establishment of the total mesorectal excision (TME in combination with sophisticated radiation and chemotherapy have reduced local recurrence rates to only few percent. However, due to the high incidence of rectal cancer, still a high absolute number of patients present with recurrent rectal carcinomas, and effective treatment is therefore needed. Carbon ions offer physical and biological advantages. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increase relative biological effectiveness (RBE, which can be calculated between 2 and 5 depending on the cell line as well as the endpoint analyzed. Japanese data on the treatment of patients with recurrent rectal cancer previously not treated with radiation therapy have shown local control rates of carbon ion treatment superior to those of surgery. Therefore, this treatment concept should also be evaluated for recurrences after radiotherapy, when dose application using conventional photons is limited. Moreover, these patients are likely to benefit from the enhanced biological efficacy of carbon ions. Methods and design In the current Phase I/II-PANDORA-01-Study the recommended dose of carbon ion radiotherapy for recurrent rectal cancer will be determined in the Phase I part, and feasibilty and progression-free survival will be assessed in the Phase II part of the study. Within the Phase I part, increasing doses from 12 × 3 Gy E to 18

  6. Correlation of SATB1 overexpression with the progression of human rectal cancer.

    Science.gov (United States)

    Meng, Wen-Jian; Yan, Hui; Zhou, Bin; Zhang, Wei; Kong, Xiang-Heng; Wang, Rong; Zhan, Lan; Li, Yuan; Zhou, Zong-Guang; Sun, Xiao-Feng

    2012-02-01

    To date, the association between special AT-rich sequence-binding protein 1 (SATB1) and colorectal cancer (CRC) has not been reported. This study was aimed at investigating the expression and potential role of SATB1 in human rectal cancers. Ninety-three paired samples of rectal cancer and distant normal rectal tissue were analyzed by quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC), and the correlations between SATB1 expression and clinicopathological parameters were evaluated. The expression profiles of SATB1 were also investigated in a panel of five human colon carcinoma cell lines. The general level of SATB1 mRNA in rectal cancer tissues was statistically significantly higher than that in normal mucosa (P = 0.043). The rate of positive SATB1 protein expression in rectal cancers (44.1%) was significantly higher than that in normal tissues (25.8%) by IHC analysis (P = 0.009). Overexpression of SATB1 mRNA was more predominant in patients with earlier onset of rectal cancer (P = 0.033). SATB1 expression correlated with invasive depth and tumor node metastasis (TNM) stage at both protein and mRNA levels (P rectal cancer, which represents a possible new mechanism underlying CRC.

  7. Associations between birth weight and colon and rectal cancer risk in adulthood

    DEFF Research Database (Denmark)

    Smith, Natalie R; Jensen, Britt W; Zimmermann, Esther;

    2016-01-01

    BACKGROUND: Birth weight has inconsistent associations with colorectal cancer, possibly due to different anatomic features of the colon versus the rectum. The aim of this study was to investigate the association between birth weight and colon and rectal cancers separately. METHODS: 193,306 children......, born from 1936 to 1972, from the Copenhagen School Health Record Register were followed prospectively in Danish health registers. Colon and rectal cancer cases were defined using the International Classification of Disease version 10 (colon: C18.0-18.9, rectal: 19.9 and 20.9). Only cancers classified....... No significant sex differences were observed; therefore combined results are presented. Birth weight was positively associated with colon cancers with a HR of 1.14 (95% CI, 1.04-1.26) per kilogram of birth weight. For rectal cancer a significant association was not observed for birth weights below 3.5kg. Above 3...

  8. Prognostic Aspects of DCE-MRI in Recurrent Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gollub, M.J.; Gultekin, D.H.; Sohn, M. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Cao, K. [Peking University Cancer Hospital and Institute, Department of Radiology, Beijing (China); Kuk, D.; Gonen, M. [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Schwartz, L.H. [Columbia University Medical Center/New York Presbyterian Hospital, Department of Radiology, New York, NY (United States); Weiser, M.R.; Temple, L.K.; Nash, G.M.; Guillem, J.G.; Garcia-Aguilar, J.; Paty, P.B. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, New York, NY (United States); Wang, M. [Fudan University Shanghai Cancer Center, Department of Colorectal Surgery, Shanghai (China); Goodman, K. [Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY (United States)

    2013-12-15

    To explore whether pre-reoperative dynamic contrast-enhanced (DCE)-MRI findings correlate with clinical outcome in patients who undergo surgical treatment for recurrent rectal carcinoma. A retrospective study of DCE-MRI in patients with recurrent rectal cancer was performed after obtaining an IRB waiver. We queried our PACS from 1998 to 2012 for examinations performed for recurrent disease. Two radiologists in consensus outlined tumour regions of interest on perfusion images. We explored the correlation between K{sup trans}, K{sub ep}, V{sub e}, AUC90 and AUC180 with time to re-recurrence of tumour, overall survival and resection margin status. Univariate Cox PH models were used for survival, while univariate logistic regression was used for margin status. Among 58 patients with pre-treatment DCE-MRI who underwent resection, 36 went directly to surgery and 18 had positive margins. K{sup trans} (0.55, P = 0.012) and K{sub ep} (0.93, P = 0.04) were inversely correlated with positive margins. No significant correlations were noted between K{sup trans}, K{sub ep}, V{sub e}, AUC90 and AUC180 and overall survival or time to re-recurrence of tumour. K{sup trans} and K{sub ep} were significantly associated with clear resection margins; however overall survival and time to re-recurrence were not predicted. Such information might be helpful for treatment individualisation and deserves further investigation. (orig.)

  9. The Preoperative Peripheral Blood Monocyte Count Is Associated with Liver Metastasis and Overall Survival in Colorectal Cancer Patients.

    Science.gov (United States)

    Hu, Shidong; Zou, Zhenyu; Li, Hao; Zou, Guijun; Li, Zhao; Xu, Jian; Wang, Lingde; Du, Xiaohui

    2016-01-01

    Colorectal cancer (CRC) is the third most common malignancy in males and the second most common in females worldwide. Distant metastases have a strong negative impact on the prognosis of CRC patients. The most common site of CRC metastases is the liver. Both disease progression and metastasis have been related to the patient's peripheral blood monocyte count. We therefore performed a case-control study to assess the relationship between the preoperative peripheral blood monocyte count and colorectal liver metastases (CRLM). Clinical data from 117 patients with colon cancer and 93 with rectal cancer who were admitted to the Chinese People's Liberation Army General Hospital (Beijing, China) between December 2003 and May 2015 were analysed retrospectively, with the permission of both the patients and the hospital. Preoperative peripheral blood monocyte counts, the T and N classifications of the primary tumour and its primary site differed significantly between the two groups (P rectal versus colon cancer (OR: 0.078, 95%CI: 0.020~0.309, P TNM staging and preoperative monocyte counts (P 0.505 × 109 cells/L, high T classification and liver metastasis were independent risk factors for 5-year OS (RR: 2.737, 95% CI: 1.573~ 4.764, P <0.001; RR: 2.687, 95%CI: 1.498~4.820, P = 0.001; RR: 4.928, 95%CI: 2.871~8.457, P < 0.001). The demonstrated association between preoperative peripheral blood monocyte count and liver metastasis in patients with CRC recommends the former as a useful predictor of postoperative prognosis in CRC patients.

  10. Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer

    DEFF Research Database (Denmark)

    Danielsen, Anne K; Park, Jennifer; Jansen, Jens E;

    2016-01-01

    .0001. CONCLUSIONS: It is safe to close a temporary ileostomy 8 to 13 days after rectal resection and anastomosis for rectal cancer in selected patients without clinical or radiological signs of anastomotic leakage.This is an open-access article distributed under the terms of the Creative Commons Attribution...

  11. A COX-2 inhibitor combined with chemoradiation of locally advanced rectal cancer

    DEFF Research Database (Denmark)

    Jakobsen, Anders; Mortensen, John Pløen; Bisgaard, Claus;

    2008-01-01

    BACKGROUND AND AIM: The aim of this study was to investigate the possible effect of a COX-2 inhibitor in addition to chemoradiation of locally advanced rectal cancer. MATERIALS AND METHODS: The study included 35 patients with rectal adenocarcinoma. All patients had a tumor localised....

  12. Level of arterial ligation in rectal cancer surgery: Low tie preferred over high tie. A review

    NARCIS (Netherlands)

    M.M. Lange (Marilyne); M. Buunen (Mark); C.J.H. van de Velde (Cornelis)

    2008-01-01

    textabstractConsensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just cau

  13. Quality of life estimate in stomach, colon, and rectal cancer patients in a hospital in China.

    Science.gov (United States)

    Deng, Muhong; Lan, Yanhong; Luo, Shali

    2013-10-01

    The objective of this study was to investigate the outcome and coping patterns of patients with stomach, colon, and rectal cancer in a hospital in China. Health-related quality of life was assessed in 118 stomach, colon, and rectal cancer patients in Chinese People's Liberation Army General Hospital, Beijing, China, using the generic version of the European Organization for Research and Treatment of Cancer Quality of Life (QOL) Questionnaire Core 30 Items, Self-rated Anxiety Scores (SAS), Self-rated Depression Scores (SDS), Medical Coping Modes of Questionnaire (MCMQ), and Social Support Requirement Scale (SSRS) questionnaires. The overall QOL was 50.7 ± 6.5, 48.1 ± 7.7, and 47.6 ± 6.4, respectively, for stomach, colon, and rectal cancer groups. Correlations between QOL and SAS and SDS in stomach cancer patients were significantly higher than observed in the cohort of colon or rectal cancer patients (Spearman coefficient of 0.366 and 0.129, respectively). Cluster analysis of MCMQ data revealed four identifiable patterns (resign, confront, avoid-confront, and avoid-resign) of coping in the study group. Subjective support was significantly higher than objective support (p Stomach, colon, and rectal cancer patients had anxiety and depression stemming from their cancer diagnosis and postdiagnosis treatment, and sex dependency was prevalent in SSRS response. Coping patterns were reliable indicators of psychosocial side effects in patients with stomach, colon, and rectal cancers.

  14. 局部晚期中低位直肠癌术前螺旋断层同期加量放疗并同步口服卡培他滨化疗的效果%Chemoradiation effect of combined preoperative intensity-modulated radiotherapy with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost of tomotherapy

    Institute of Scientific and Technical Information of China (English)

    许卫东; 高军茂; 赵一虹; 陈纲; 杜峻峰; 张富利

    2015-01-01

    Objective To assess the safety and efficacy of preoperative intensity-modulated radiotherapy(IMRT) with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost (SIB) of tomotherapy.Methods Total 16 patients with resectable locally advanced mid-low rectal cancer (patients with T3 to T4 and/or N ± rectal cancer) were enroll in current study.Patients were received IMRT to 2 dose levels simultaneously (55 and 47.5 Gy in 25 fractions) with concurrent capecitabine 825 mg/m2 twice daily,5 days/week.Total mesorectal excision was performed at 8 to 9 week after the completion of chemoradiation.The primary end point included side effect,the rate of sphinctersparing,postoperative complication and pathological complete response rate (pCR) were observed.Side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0.Results All patients were received chemoradiotion therapy without any break.Tomotherapy showed superiority with respect to target coverage,homogeneity and conformality.Two patients refused to perform radical surgery because of almost complete primary tumor regression and complete symptom relief after neoadjuvant therapy.Fourteen patients underwent surgical resection and 11 patients (78.6%) underwent sphincter-sparing lower anterior resection.Four patients(28.6%) had a pathological complete response.The incidence of grade 1-2 hematologic,gastro-intestinal toxicities were 62.5% (10/16) and 18.8% (3/16).The incidence of grade 3 skin toxicities were 68.8%(10/16).Grade Ⅳ side effect was not observed.Surgical complications (incisional infection on thirteen after surgery) were observed in 1 patient.Conclusion Preoperative simultaneous integrated boost of tomotherapy with concurrent oral capecitabine is safe and well tolerated in patients with a promising local control.However,a larger number of patients and a long follow-up are required to assess its

  15. Dual-Energy CT of Rectal Cancer Specimens

    DEFF Research Database (Denmark)

    Al-Najami, Issam; Beets-Tan, Regina G H; Madsen, Gunvor

    2016-01-01

    BACKGROUND: An accurate method to assess malignant lymph nodes in the mesorectum is needed. Dual-energy CT scans simultaneously with 2 levels of energy and thereby provides information about tissue composition based on the known effective Z value of different tissues. Each point investigated...... is represented by a certain effective Z value, which allows for information on its composition. OBJECTIVE: We wanted to standardize a method for dual-energy scanning of rectal specimens to evaluate the sensitivity and specificity of benign versus malignant lymph node differentiation. Histopathological evaluation...... cancer. MAIN OUTCOME MEASURES: We measured accuracy of differentiating benign from malignant lymph nodes by investigating the following: 1) gadolinium, iodine, and water concentrations in lymph nodes; 2) dual-energy ratio; 3) dual-energy index; and 4) effective Z value. RESULTS: Optimal discriminations...

  16. Digital rectal examination and transrectal ultrasonography in staging of rectal cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus

    1994-01-01

    Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated depth of penetration in 3 of 33 patients and overes......Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated depth of penetration in 3 of 33 patients...... and overestimation resulted in 9 of 74. The figures for digital examination were 5 of 18 and 20 of 76, respectively. Penetration of the rectal wall was correctly identified in 56 of 61 patients by digital examination and in 59 of 61 by TRUS. Specimens without penetration of the rectal wall were identified in 26...... of 33 patients by TRUS, but in not more than 13 of 33 by digital examination. Regional lymph node metastases were present in 19 patients; none were diagnosed by digital examination, but TRUS identified 11 of the 19. It is concluded that TRUS will result in more patients having the possibility of local...

  17. Minilaparotomy to rectal cancer has higher overall survival rate and earlier short-term recovery.

    Science.gov (United States)

    Wang, Xiao-Dong; Huang, Ming-Jun; Yang, Chuan-Hua; Li, Ka; Li, Li

    2012-10-07

    To report our experience using mini-laparotomy for the resection of rectal cancer using the total mesorectal excision (TME) technique. Consecutive patients with rectal cancer who underwent anal-colorectal surgery at the authors' hospital between March 2001 and June 2009 were included. In total, 1415 patients were included in the study. The cases were divided into two surgical procedure groups (traditional open laparotomy or mini-laparotomy). The mini-laparotomy group was defined as having an incision length ≤ 12 cm. Every patient underwent the TME technique with a standard operation performed by the same clinical team. The multimodal preoperative evaluation system and postoperative fast track were used. To assess the short-term outcomes, data on the postoperative complications and recovery functions of these cases were collected and analysed. The study included a plan for patient follow-up, to obtain the long-term outcomes related to 5-year survival and local recurrence. The mini-laparotomy group had 410 patients, and 1015 cases underwent traditional laparotomy. There were no differences in baseline characteristics between the two surgical procedure groups. The overall 5-year survival rate was not different between the mini-laparotomy and traditional laparotomy groups (80.6% vs. 79.4%, P = 0.333), nor was the 5-year local recurrence (1.4% vs. 1.5%, P = 0.544). However, 1-year mortality was decreased in the mini-laparotomy group compared with the traditional laparotomy group (0% vs. 4.2%, P 8 d vs 3.9 ± 2.3 d, P = 0.000) and passing of gas (3.5 ± 1.1 d vs. 4.3 ± 1.8 d, P = 0.000), length of hospital stay (6.4 ± 1.5 d vs 9.7 ± 2.2 d, P = 0.000), anastomotic leakage (0.5% vs. 4.8%, P = 0.000), and intestinal obstruction (2.2% vs 7.3%, P = 0.000) were decreased in the mini-laparotomy group compared with the traditional laparotomy group. The results for other postoperative recovery function indicators, such as days to oral feeding and defecation, were similar, as

  18. Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy.

    Science.gov (United States)

    Barbaro, Brunella; Vitale, Renata; Valentini, Vincenzo; Illuminati, Sonia; Vecchio, Fabio M; Rizzo, Gianluca; Gambacorta, Maria Antonietta; Coco, Claudio; Crucitti, Antonio; Persiani, Roberto; Sofo, Luigi; Bonomo, Lorenzo

    2012-06-01

    To prospectively monitor the response in patients with locally advanced nonmucinous rectal cancer after chemoradiotherapy (CRT) using diffusion-weighted magnetic resonance imaging. The histopathologic finding was the reference standard. The institutional review board approved the present study. A total of 62 patients (43 men and 19 women; mean age, 64 years; range, 28-83) provided informed consent. T(2)- and diffusion-weighted magnetic resonance imaging scans (b value, 0 and 1,000 mm(2)/s) were acquired before, during (mean 12 days), and 6-8 weeks after CRT. We compared the median apparent diffusion coefficients (ADCs) between responders and nonresponders and examined the associations with the Mandard tumor regression grade (TRG). The postoperative nodal status (ypN) was evaluated. The Mann-Whitney/Wilcoxon two-sample test was used to evaluate the relationships among the pretherapy ADCs, extramural vascular invasion, early percentage of increases in ADCs, and preoperative ADCs. Low pretreatment ADCs (23% ADC increase had a 96.3% negative predictive value for TRG 4. In 9 of 16 complete responders, CRT-related tumor downsizing prevented ADC evaluations. The preoperative ADCs were significantly different (p = .0012) between the patients with and without downstaging (preoperative ADC ≥1.4 × 10(-3)mm(2)/s showed a positive and negative predictive value of 78.9% and 61.8%, respectively, for response assessment). The TRG 1 and TRG 2-4 groups were not significantly different. Diffusion-weighted magnetic resonance imaging seems to be a promising tool for monitoring the response to CRT. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Panitumumab as a radiosensitizing agent in KRAS wild-type locally advanced rectal cancer.

    Science.gov (United States)

    Mardjuadi, Feby Ingriani; Carrasco, Javier; Coche, Jean-Charles; Sempoux, Christine; Jouret-Mourin, Anne; Scalliet, Pierre; Goeminne, Jean-Charles; Daisne, Jean-François; Delaunoit, Thierry; Vuylsteke, Peter; Humblet, Yves; Meert, Nicolas; van den Eynde, Marc; Moxhon, Anne; Haustermans, Karin; Canon, Jean-Luc; Machiels, Jean-Pascal

    2015-09-01

    Our goal was to optimize the radiosensitizing potential of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, when given concomitantly with preoperative radiotherapy in KRAS wild-type locally advanced rectal cancer (LARC). Based on pre-clinical studies conducted by our group, we designed a phase II trial in which panitumumab (6 mg/kg/q2 weeks) was combined with preoperative radiotherapy (45 Gy in 25 fractions) to treat cT3-4/N + KRAS wild-type LARC. The primary endpoint was complete pathologic response (pCR) (H0 = 5%, H1 = 17%, α = 0.05, β = 0.2). From 19 enrolled patients, 17 (89%) were evaluable for pathology assessment. Although no pCR was observed, seven patients (41%) had grade 3 Dworak pathological tumor regression. The regimen was safe and was associated with 95% of sphincter-preservation rate. No NRAS, BRAF, or PI3KCA mutation was found in this study, but one patient (5%) showed loss of PTEN expression. The quantification of plasma EGFR ligands during treatment showed significant upregulation of plasma TGF-α and EGF following panitumumab administration (p < 0.05). At surgery, patients with important pathological regression (grade 3 Dworak) had higher plasma TGF-α (p = 0.03) but lower plasma EGF (p = 0.003) compared to those with grade 0-2 Dworak. Our study suggests that concomitant panitumumab and preoperative radiotherapy in KRAS wild-type LARC is feasible and results in some tumor regression. However, pCR rate remained modest. Given that the primary endpoint of our study was not reached, we remain unable to recommend the use of panitumumab as a radiosensitizer in KRAS wild-type LARC outside a research setting.

  20. Preoperative staging of nodal status in gastric cancer

    Science.gov (United States)

    Berlth, Felix; Chon, Seung-Hun; Chevallay, Mickael; Jung, Minoa Karin

    2017-01-01

    An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of false-positive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods. PMID:28217758

  1. Early prediction of histopathological response of rectal tumors after one week of preoperative radiochemotherapy using 18 F-FDG PET-CT imaging. A prospective clinical study

    Directory of Open Access Journals (Sweden)

    Goldberg Natalia

    2012-08-01

    Full Text Available Abstract Background Preoperative radiochemotherapy (RCT is standard in locally advanced rectal cancer (LARC. Initial data suggest that the tumor’s metabolic response, i.e. reduction of its 18 F-FDG uptake compared with the baseline, observed after two weeks of RCT, may correlate with histopathological response. This prospective study evaluated the ability of a very early metabolic response, seen after only one week of RCT, to predict the histopathological response to treatment. Methods Twenty patients with LARC who received standard RCT regimen followed by radical surgery participated in this study. Maximum standardized uptake value (SUV-MAX, measured by PET-CT imaging at baseline and on day 8 of RCT, and the changes in FDG uptake (ΔSUV-MAX, were compared with the histopathological response at surgery. Response was classified by tumor regression grade (TRG and by achievement of pathological complete response (pCR. Results Absolute SUV-MAX values at both time points did not correlate with histopathological response. However, patients with pCR had a larger drop in SUV-MAX after one week of RCT (median: -35.31% vs −18.42%, p = 0.046. In contrast, TRG did not correlate with ΔSUV-MAX. The changes in FGD-uptake predicted accurately the achievement of pCR: only patients with a decrease of more than 32% in SUV-MAX had pCR while none of those whose tumors did not show any decrease in SUV-MAX had pCR. Conclusions A decrease in ΔSUV-MAX after only one week of RCT for LARC may be able to predict the achievement of pCR in the post-RCT surgical specimen. Validation in a larger independent cohort is planned.

  2. Microarray profiling of mononuclear peripheral blood cells identifies novel candidate genes related to chemoradiation response in rectal cancer.

    Directory of Open Access Journals (Sweden)

    Pablo Palma

    Full Text Available Preoperative chemoradiation significantly improves oncological outcome in locally advanced rectal cancer. However there is no effective method of predicting tumor response to chemoradiation in these patients. Peripheral blood mononuclear cells have emerged recently as pathology markers of cancer and other diseases, making possible their use as therapy predictors. Furthermore, the importance of the immune response in radiosensivity of solid organs led us to hypothesized that microarray gene expression profiling of peripheral blood mononuclear cells could identify patients with response to chemoradiation in rectal cancer. Thirty five 35 patients with locally advanced rectal cancer were recruited initially to perform the study. Peripheral blood samples were obtained before neaodjuvant treatment. RNA was extracted and purified to obtain cDNA and cRNA for hybridization of microarrays included in Human WG CodeLink bioarrays. Quantitative real time PCR was used to validate microarray experiment data. Results were correlated with pathological response, according to Mandard´s criteria and final UICC Stage (patients with tumor regression grade 1-2 and downstaging being defined as responders and patients with grade 3-5 and no downstaging as non-responders. Twenty seven out of 35 patients were finally included in the study. We performed a multiple t-test using Significance Analysis of Microarrays, to find those genes differing significantly in expression, between responders (n = 11 and non-responders (n = 16 to CRT. The differently expressed genes were: BC 035656.1, CIR, PRDM2, CAPG, FALZ, HLA-DPB2, NUPL2, and ZFP36. The measurement of FALZ (p = 0.029 gene expression level determined by qRT-PCR, showed statistically significant differences between the two groups. Gene expression profiling reveals novel genes in peripheral blood samples of mononuclear cells that could predict responders and non-responders to chemoradiation in patients with

  3. [A Case of Brain Metastasis from Rectal Cancer with Synchronous Liver and Lung Metastases after Multimodality Treatment--A Case Report].

    Science.gov (United States)

    Udagawa, Masaru; Tominaga, Ben; Kobayashi, Daisuke; Ishikawa, Yuuya; Watanabe, Shuuichi; Adikrisna, Rama; Okamoto, Hiroyuki; Yabata, Eiichi

    2015-11-01

    We report a case of brain metastasis from rectal cancer a long time after the initial resection. A 62-year-old woman, diagnosed with lower rectal cancer with multiple synchronous liver and lung metastases, underwent abdominoperineal resection after preoperative radiochemotherapy (40 Gy at the pelvis, using the de Gramont regimen FL therapy: 1 kur). The histological diagnosis was a moderately differentiated adenocarcinoma. Various regimens of chemotherapy for unresectable and metastatic colorectal cancer were administered, and a partial response was obtained; thereby, the metastatic lesions became resectable. The patient underwent partial resection of the liver and lung metastases. Pathological findings confirmed that both the liver and lung lesions were metastases from the rectal cancer. A disease-free period occurred for several months; however, there were recurrences of the lung metastases, so we started another round of chemotherapy. After 8 months, she complained of vertigo and dizziness. A left cerebellar tumor about 3 cm in diameter was revealed by MRI and neurosurgical excision was performed. Pathological findings confirmed a cerebellar metastasis from the rectal cancer. Twenty months after resection of the brain tumor, the patient complained of a severe headache. A brain MRI showed hydrocephalia, and carcinomatous meningitis from rectal cancer was diagnosed by a spinal fluid cytology test. A ventriculo-peritoneal shunt was inserted, but the cerebrospinal pressure did not decreased and she died 20 months after the first surgery. Although brain metastasis from colorectal cancer is rare, the number of patients with brain metastasis is thought to increase in the near future. Chemotherapy for colorectal cancer is effective enough to prolong the survival period even if multiple metastases have occurred. However, after a long survival period with lung metastases such as in our case, there is a high probability of developing brain metastases.

  4. A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report

    Directory of Open Access Journals (Sweden)

    Zhan Tiancheng

    2012-10-01

    Full Text Available Abstract Introduction Rectal cancer with rectovesical fistula is a rare and difficult to treat entity. Here, we describe a case of rectal cancer with rectovesical fistula successfully managed by multimodality treatment. To the best of our knowledge, this is the first such case report in the literature. Case presentation A 51-year-old Chinese man was diagnosed as having rectal cancer accompanied by rectovesical fistula. He underwent treatment with neoadjuvant radiochemotherapy combined with total pelvic excision and adjuvant chemotherapy, as recommended by a multimodality treatment team. Post-operative pathology confirmed the achievement of pathological complete response. Conclusions This case suggests that a proactive multidisciplinary treatment is needed to achieve complete cure of locally advanced rectal cancer even in the presence of rectovesical fistula.

  5. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de

    2015-01-01

    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  6. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer.

    Science.gov (United States)

    Ratto, C; Ricci, R; Rossi, C; Morelli, U; Vecchio, F M; Doglietto, G B

    2002-06-01

    Mesorectal involvement is a common feature in rectal tumors. Neoplastic foci can be identified at pathologic examination of the mesorectum, but their incidence and prognostic significance remain to be defined. A series of 77 patients with extraperitoneal rectal cancer, resected with total mesorectal excision, entered the study. After fixation, the excised specimens were submitted to serial transverse sections and staining. Direct tumor infiltration, lymph node involvement, and neoplastic microfoci in the mesorectum were investigated. Patients with mesorectal foci were compared with those without deposits with regard to clinical and pathologic parameters; different patterns of foci (endovasal, endolymphatic, perineural, isolated) were also considered. Univariate and multivariate analyses were used to evaluate the impact on survival rate. Neoplastic mesorectal involvement was found in 64 patients (83.1 percent). Direct tumor infiltration was detected in 66.2 percent, node involvement in 28.6 percent, microscopic foci in 44.2 percent of cases (endovasal in 11.7 percent, endolymphatic in 15.7 percent, perineural in 26 percent, isolated in 14.3 percent). In 7 cases (10.9 percent) microfoci alone (without any kind of other mesorectal involvement) were detected. Deposits were found in 18.8 percent of TNM Stage I tumors, in 46.9 percent of Stage II and in 59.3 percent of Stage III cancers. Similar incidence was found in patients treated with integrated therapies and surgery alone (43.3 vs. 44.7 percent, P = not significant). Poorer median (44.5 vs. 57 months, P = 0.04) five-year overall survival rate (43.4 vs. 63.3 percent, P = 0.016) and disease-free survival rate (43.3 vs. 57.7 percent, P = 0.048) were observed in patients with microscopic foci compared with those without deposits. Tumor configuration was found to be a independent prognostic factor for both overall and disease-free survival rates; furthermore, endolymphatic, perineural, and isolated foci significantly

  7. SUCCESSFUL TREATMENT OF SQUAMOUS-CELL RECTAL CANCER: А CASE REPORT

    Directory of Open Access Journals (Sweden)

    Yu. A. Barsukov

    2015-01-01

    Full Text Available Long-term results of conservative squamous-cell rectal cancer treatment (12 cm above anal verge are presented in the article. Squamous-cell rectal cancer is a rare disease with only 73 cases described in the literature. Patient received a novel chemoradiotherapy scheme. Complete response was achieved and no surgery performed. Patient is disease-free and has good quality of life with 4 years followup.

  8. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study

    OpenAIRE

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2016-01-01

    Purpose - Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Methods - Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum o...

  9. Preoperative Chemotherapy in Patients With Intermediate-Risk Rectal Adenocarcinoma Selected by High-Resolution Magnetic Resonance Imaging: The GEMCAD 0801 Phase II Multicenter Trial

    Science.gov (United States)

    Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V.; Santos, Jesus; Pericay, Carles

    2014-01-01

    Background. The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. Methods. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). Results. On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%–89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9–33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%–85%), and the 2-year local relapse rate was 2% (95% CI: 0%–11%). Conclusion. In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. PMID:25209376

  10. Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial.

    Science.gov (United States)

    Fernandez-Martos, Carlos; Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V; Santos, Jesus; Pericay, Carles

    2014-10-01

    The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%-89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9-33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%-85%), and the 2-year local relapse rate was 2% (95% CI: 0%-11%). In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. ©AlphaMed Press; the data published online to support this summary is the property of the authors.

  11. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    E S Adarsh

    2012-01-01

    Full Text Available Background: Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect. Objective: To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements. Study Design: A randomized clinical trial. Methods: After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group and group C (Conventional group. Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted. Results: We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002. There was no evidence of any increased perioperative bleeding in the diclofenac group. Conclusion: Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

  12. Lymphovascular invasion in rectal cancer following neoadjuvant radiotherapy: A retrospective cohort study

    Institute of Scientific and Technical Information of China (English)

    Chang-Zheng Du; Wei-Cheng Xue; Yong Cai; Ming Li; Jin Gu

    2009-01-01

    AIM: To investigate the meaning of lymphovascular invasion (LVI) in rectal cancer after neoadjuvant radiotherapy. METHODS: A total of 325 patients who underwent radical resection using total mesorectal excision (TME) from January 2000 to January 2005 in Beijing cancer hospital were included retrospectively, divided into a preoperative radiotherapy (PRT) group and a control group, according to whether or not they underwent preoperative radiation. Histological assessments of tumor specimens were made and the correlation of LVI and prognosis were evaluated by univariate and multivariate analysis. RESULTS: The occurrence of LVI in the PRT and control groups was 21.4% and 26.1% respectively. In the control group, LVI was significantly associated with histological differentiation and pathologic TNM stage, whereas these associations were not observed in the PRT group. LVI was closely correlated to disease progression and 5-year overall survival (OS) in both groups. Among the patients with disease progression, LVI positive patients in the PRT group had a significantly longer median disease-free period (22.5 mo vs 11.5 mo, P = 0.023) and overall survival time (42.5 mo vs 26.5 mo, P = 0.035) compared to those in the control group, despite the fact that no significant difference in 5-year OS rate was observed (54.4% vs 48.3%, P = 0.137). Multivariate analysis showed the distance of tumor from the anal verge, pretreatment serum carcinoembryonic antigen level, pathologic TNM stage and LVI were the major factors affecting OS. CONCLUSION: Neoadjuvant radiotherapy does not reduce LVI significantly; however, the prognostic meaning of LVI has changed. Patients with LVI may benefit from neoadjuvant radiotherapy.

  13. Interleukin genes and associations with colon and rectal cancer risk and overall survival.

    Science.gov (United States)

    Bondurant, Kristina L; Lundgreen, Abbie; Herrick, Jennifer S; Kadlubar, Susan; Wolff, Roger K; Slattery, Martha L

    2013-02-15

    Interleukins are a group of cytokines that contribute to growth and differentiation, cell migration, and inflammatory and anti-inflammatory responses by the immune system. In our study, we examined genetic variation in genes from various anti-inflammatory and proinflammatory interleukins to determine association with colon and rectal cancer risk and overall survival. Data from two population-based incident studies of colon cancer (1,555 cases and 1,956 controls) and rectal cancer (754 cases and 954 controls) were used. After controlling for multiple comparisons, single nucleotide polymorphisms (SNPs) from four genes, IL3, IL6R, IL8, IL15, were associated with increased colon cancer risk, and CXCR1 and CXCR2 were significantly associated with increased rectal cancer risk. Only SNPs from genes within the IL-8 pathway (IL8, CXCR1 and CXCR2) showed a significant association with both colon and rectal cancer risk. Several SNPs interacted significantly with IL8 and IFNG SNPs and with aspirin/non-steroidal anti-inflammatory drug (NSAID), cigarette smoking, estrogen use and BMI. For both colon and rectal cancer, increasing numbers of risk alleles were associated with increased hazard of death from cancer; the estimated hazard of death for colon cancer for the highest category of risk alleles was 1.74 (95% confidence interval [CI] 1.18-2.56) and 1.96 (95% CI 1.28-2.99) for rectal cancer. These data suggest that interleukin genes play a role in risk and overall survival for colon and rectal cancer. Copyright © 2012 UICC.

  14. Preoperative thrombocytosis predicts prognosis in stage II colorectal cancer patients

    Science.gov (United States)

    Lee, Yong Sun; Suh, Kwang Wook

    2016-01-01

    Purpose Thrombocytosis is known to be a poor prognostic factor in several types of solid tumors. The prognostic role of preoperative thrombocytosis in colorectal cancer remains limited. The aim of this study is to investigate the prognostic role of preoperative thrombocytosis in stage II colorectal cancer. Methods Two hundred eighty-four patients with stage II colorectal cancer who underwent surgical resection between December 2003 and December 2009 were retrospectively reviewed. Thrombocytosis was defined as platelet > 450 × 109/L. We compared patients with thrombocytosis and those without thrombocytosis in terms of survival. Results The 5-year disease-free survival (DFS) rates were lower in patients with thrombocytosis compared to those without thrombocytosis in stage II colorectal cancer (73.3% vs. 89.6%, P = 0.021). Cox multivariate analysis demonstrated that thrombocytosis (hazard ratio, 2.945; 95% confidence interval, 1.127–7.697; P = 0.028) was independently associated with DFS in patients with stage II colorectal cancer. Conclusion This study showed that thrombocytosis is a prognostic factor predicting DFS in stage II colorectal cancer patients. PMID:27274508

  15. Transabdominal ultrasonography in preoperative staging of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng-Ri Liao; Ying Dai; Ling Huo; Kun Yan; Lin Zhang; Hui Zhang; Wen Gao; Min-Hua Chen

    2004-01-01

    AIM: To investigate the value of transabdominal ultrasonography (US) in the preoperative staging of gastric cancer.METHODS: A total of 198 patients with gastric cancer underwent preoperatively transabdominal US, depth of tumor infiltration was assessed in 125 patients, and lymph node metastasis was assessed in 106 patients.RESULTS: The staging accuracy of transabdominal US was 55.6%, 75.0%, 87.3% and 71.1% in T1, T2, T3 and T4 carcinomas, respectively. The overall accuracy was 77.6%.The detection rate for pancreatic invasion and liver invasion was 77.4%, 71.4%, respectively. The sensitivity, specificity,accuracy of transabdominal US in assessment of lymph node metastasis were 77.6%, 64.1%, 72.6%, respectively.Various shapes such as round, ovoid, spindle were encountered in benign and malignant lymph nodes. Majority of both benign and malignant lymph nodes were hyperechoic and had a distinct border. Benign lymph nodes were smaller than malignant lymph nodes in length and width (P = 0.000,0.005). Irregular shape, fusional shape, infiltrative signs,inhomogenous echo were seen mainly in malignant lymph nodes (P = 0.045, 0.006, 0.027, 0.006).CONCLUSION: Transabdominal US is useful for preoperative staging in gastric cancer, although it is difficult to differentiate benign from malignant lymph nodes.

  16. Identification of the differential expressive tumor associated genes in rectal cancers by cDNA microarray

    Institute of Scientific and Technical Information of China (English)

    Xue-Qin Gao; Jin-Xiang Han; Zhong-Fa Xu; Wei-Dong Zhang; Hua-Ning Zhang; Hai-Yan Huang

    2007-01-01

    AIM: To identify tumor associated genes of rectal cancer and to probe the application possibility of gene expression profiles for the classification of tumors.METHODS: Rectal cancer tissues and their paired normal mucosa were obtained from patients undergoing surgical resection of rectal cancer. Total RNA was extracted using Trizol reagents. First strand cDNA synthesis was indirectly labeled with aminoallyl-dUTP and coupled with Cy3 or Cy5 dye NHS mono-functional ester. After normalization to total spots, the genes which background subtracted intensity did not exceed 2 SD above the mean blank were excluded. The data were then sorted to obtain genes differentially expressed by≥ 2 fold up or down in at least 5 of the 21 patients.RESULTS: In the 21 rectal cancer patients, 23 genes were up-regulated in at least 5 samples and 15 genes were down-regulated in at least 5 patients. Hierachical cluster analysis classified the patients into two groups according to the clinicopathological stage, with one group being all above stage Ⅱ and one group all below stage Ⅱ.CONCLUSION: The up-regulated genes and downregulated genes may be molecular markers of rectal cancer. The expression profiles can be used for classification of rectal cancer.

  17. A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer.

    Science.gov (United States)

    Takahashi, Rina; Ichikawa, Ryosuke; Ito, Singo; Mizukoshi, Kosuke; Ishiyama, Shun; Sgimoto, Kiichi; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Yao, Takashi; Sakamoto, Kazuhiro

    2015-12-01

    This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery.

  18. Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer. Is it time for a randomized phase III trial?

    Energy Technology Data Exchange (ETDEWEB)

    Roedel, Claus [Frankfurt Univ. (Germany). Klinik fuer Strahlentherapie und Onkologie; Arnold, Dirk [Halle Univ. (Germany). Klinik und Poliklinik fuer Innere Medizin IV; Becker, Heinz; Ghadimi, Michael; Liersch, Torsten [Goettingen Univ. (Germany). Klinik fuer Allgemein- und Visceralchirurgie; Fietkau, Rainer; Sauer, Rolf [Erlangen Univ. (Germany). Strahlenklinik; Graeven, Ullrich [Kliniken Maria Hilf GmbH, Moenchengladbach (Germany). Klinik fuer Haematologie, Onkologie und Gastroenterologie; Hess, Clemens [Goettingen Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie; Hofheinz, Ralf [Universitaetsmedizin Mannheim (Germany). III. Medizinische Klinik Haematologie und Internistische Onkologie; Hohenberger, Werner [Erlangen Univ. (Germany). Chirurgische Klinik; Post, Stefan [Universitaetsmedizin Mannheim (Germany). Chirurgische Klinik; Raab, Rudolf [Klinikum Oldenburg (Germany). Klinik fuer Allgemein- und Visceralchirurgie; Wenz, Frederick [Universitaetsmedizin Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2010-12-15

    Background: In the era of preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME), the development of distant metastases is the predominant mode of failure in rectal cancer patients today. Integrating more effective systemic therapy into combined modality programs is the challenge. The question that needs to be addressed is how and when to apply systemic treatment with adequate dose and intensity. Material and Methods: This review article focuses on phase II-III trials designed to improve 5-fluorouracil (5-FU)-based combined modality treatment for rectal cancer patients through the inclusion of concurrent, adjuvant or, most recently, induction combination chemotherapy. Computerized bibliographic searches of PubMed were supplemented with hand searches of reference lists and abstracts of ASCO/ASTRO/ESTRO meetings. Results: After preoperative CRT and surgical resection, approximately one third of patients do not receive adjuvant chemotherapy, mainly due to surgical complications, patients' refusal, or investigator's discretion. In order to be able to apply chemotherapy with sufficient dose and intensity, an innovative approach is to deliver systemic therapy prior to preoperative CRT rather than adjuvant chemotherapy. Emerging evidence from several phase II trials and, recently, randomized phase II trials indicate that induction chemotherapy is feasible, does not compromise CRT or surgical resection, and enables the delivery of chemotherapy in adequate dose and intensity. Although this approach did not increase local efficacy in recent trials (e.g., pathological complete response rates, tumor regression, R0 resection rates, local control), it may help to improve control of distant disease. Conclusion: Whether this improvement in applicability and dose density of chemotherapy will ultimately translate into improved disease-free survival will have to be tested in a larger phase III trial. (orig.)

  19. [Self-evaluation of a clinical pathway to improve the results of rectal cancer].

    Science.gov (United States)

    Sancho, Cristina; Villalba, Francisco L; García-Coret, M José; Vázquez, Antonio; Safont, M José; Hernández, Ana; Martínez, Encarnación; Martínez-Sanjuán, Vicente; García-Armengol, Juan; Roig, José V

    2010-04-01

    To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment. Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators. 166 patients: Group A: 2002-3 n=50, B: 2004-5 n=53 and C: 2006-7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan: 76% in Group C vs. 6% in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84% in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42% (Group A) to 17% (Group C); (P=0.007) and about 48% of surgeons in Group A vs. 94% in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was: Group A=6.2+/-4.5 vs. 13+/-6.5 in the C and circumferential margin analysis was reported in 24% of Group A vs. 76% in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7% and anastomotic leaks from 24% to 9.5% with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029). Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process.

  20. Is rectal cancer prone to metastasize to lymph nodes than colon cancer?

    Institute of Scientific and Technical Information of China (English)

    Takashi Akiyoshi; Toshiaki Watanabe; Masashi Ueno; Tetsuichiro Muto

    2011-01-01

    The biology of colorectal cancer differs according to itsitss location within the large intestine. A report publishedinpublished inin a previous issue of World Journal of Gastroenterology (November 2010) evaluated the importance of tumor location as a risk factor for lymph node metastasis in colorectal cancer, and showed that rectal cancer is prone to metastasize to lymph nodes as compared with colon cancer. However, in order to conclude that the tumor location is independently associated with the occurrence of lymph node metastasis, it is necessary to consider a selection bias or other patient- and tumor-related factors carefully.

  1. Inadequate preoperative colonic evaluation for synchronous colorectal cancer

    DEFF Research Database (Denmark)

    Achiam, M P; Burgdorf, S K; Wilhelmsen, M

    2009-01-01

    BACKGROUND AND AIMS: Synchronous cancers (SC) are well known (2-11%) in patients with colorectal carcinoma (CRC). One study has shown that intraoperative palpation can miss up to 69% of the SC while other studies have shown altered planned surgical procedure due to preoperatively diagnosed......-operation and one patient had pulmonary embolism as a complication to re-operation. CONCLUSIONS: The results show that many patients (78%) never underwent FPCE, but also that many of these patients never had a full postoperative colonic evaluation. SC being overlooked can lead to increased morbidity...... and the possibility of advanced staging of the cancer which is also exemplified in this study....

  2. Preoperative thrombocytosis and poor prognostic factors in endometrial cancer.

    Science.gov (United States)

    Heng, Suttichai; Benjapibal, Mongkol

    2014-01-01

    This study aimed to evaluate the prevalence of preoperative thrombocytosis and its prognostic significance in Thai patients with endometrial cancer. We retrospectively reviewed the medical records of 238 cases who had undergone surgical staging procedures between January 2005 and December 2008. Associations between clinicopathological variables and preoperative platelet counts were analyzed using Pearson's chi square or two- tailed Fisher's exact tests. Survival analysis was performed with Kaplan-Meier estimates. Univariate and Cox- regression models were used to evaluate the prognostic impact of various factors including platelet count in terms of disease-free survival and overall survival. The mean preoperative platelet count was 315,437/μL (SD 100,167/ μL). Patients who had advanced stage, adnexal involvement, lymph node metastasis, and positive peritoneal cytology had significantly higher mean preoperative platelet counts when compared with those who had not. We found thrombocytosis (platelet count greater than 400,000/μL) in 18.1% of our patients with endometrial cancer. These had significant higher rates of advanced stage, cervical involvement, adnexal involvement, positive peritoneal cytology, and lymph node involvement than patients with a normal pretreatment platelet count. The 5-year disease-free survival and overall survival were significantly lower in patients who had thrombocytosis compared with those who had not (67.4% vs. 85.1%, p=0.001 and 86.0% vs. 94.9%, p=0.034, respectively). Thrombocytosis was shown to be a prognostic factor in the univariate but not the multivariate analysis. In conclusion, presence of thrombocytosis is not uncommon in endometrial cancer and may reflect unfavorable prognostic factors but its prognostic impact on survival needs to be clarified in further studies.

  3. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer

    DEFF Research Database (Denmark)

    Waage, Jo Erling Riise; Bach, Simon P; Pfeffer, Frank

    2015-01-01

    AIM: Strain elastography is a novel approach to rectal tumour evaluation. Primary aim of this study was to correlate elastography to pT-stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1-2). Secondary aims were...... to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. METHOD: 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neo-adjuvant radiotherapy were...... included (n=59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. RESULTS: Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography...

  4. Robotic versus conventional laparoscopic rectal cancer surgery in obese patients.

    Science.gov (United States)

    Gorgun, E; Ozben, V; Costedio, M; Stocchi, L; Kalady, M; Remzi, F

    2016-11-01

    Obesity adds to the technical difficulty of laparoscopic colorectal surgery. The robotic approach has the potential to overcome this limitation because of its proposed technical advantages over laparoscopy. The aim of this retrospective study was to compare the short-term outcomes of robotic surgery (RS) vs conventional laparoscopy surgery (LS) in this patient population. Patients with a body mass index ≥ 30 kg/m(2) undergoing RS or LS for rectal cancer between January 2011 and June 2014 were identified from an institutional database. Perioperative parameters, oncological findings and postoperative 30-day short-term outcomes were compared between the RS and LS groups. The RS and LS groups included 29 and 27 patients, respectively. Groups were comparable in terms of patient demographics, body mass index (34.9 ± 7.2 vs 35.2 ± 5.0 kg/m(2) , P = 0.71), comorbidities, surgical and tumour characteristics. Comparison of the intra-operative findings revealed no significant differences between the groups including operative time (329.0 ± 102.2 vs 294.6 ± 81.1 min, P = 0.13), blood loss (434.0 ± 612.4 vs 339.4 ± 271.9 ml, P = 0.68), resection margin involvement (6.9% vs 7.4%, P = 0.99), conversions (3.4% vs 18.5%, P = 0.09) and complications (6.9% vs 0%, P = 0.49). Regarding postoperative outcomes, there were no significant differences in morbidity except that robotic surgery was associated with a quicker return of bowel function (median 3 vs 4 days, P = 0.01) and shorter hospital stay (median 6 vs 7 days, P = 0.02). Robotic surgery for rectal cancer in obese patients has short-term outcomes similar to laparoscopy, but accelerated postoperative recovery. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  5. Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

    OpenAIRE

    Bordeianou, Liliana; Maguire, Lillias Holmes; Alavi, Karim; Sudan, Ranjan; Wise, Paul E.; Kaiser, Andreas M

    2014-01-01

    Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity...

  6. The Preoperative Peripheral Blood Monocyte Count Is Associated with Liver Metastasis and Overall Survival in Colorectal Cancer Patients.

    Directory of Open Access Journals (Sweden)

    Shidong Hu

    Full Text Available Colorectal cancer (CRC is the third most common malignancy in males and the second most common in females worldwide. Distant metastases have a strong negative impact on the prognosis of CRC patients. The most common site of CRC metastases is the liver. Both disease progression and metastasis have been related to the patient's peripheral blood monocyte count. We therefore performed a case-control study to assess the relationship between the preoperative peripheral blood monocyte count and colorectal liver metastases (CRLM.Clinical data from 117 patients with colon cancer and 93 with rectal cancer who were admitted to the Chinese People's Liberation Army General Hospital (Beijing, China between December 2003 and May 2015 were analysed retrospectively, with the permission of both the patients and the hospital.Preoperative peripheral blood monocyte counts, the T and N classifications of the primary tumour and its primary site differed significantly between the two groups (P 0.505 × 109 cells/L, high T classification and liver metastasis were independent risk factors for 5-year OS (RR: 2.737, 95% CI: 1.573~ 4.764, P <0.001; RR: 2.687, 95%CI: 1.498~4.820, P = 0.001; RR: 4.928, 95%CI: 2.871~8.457, P < 0.001.The demonstrated association between preoperative peripheral blood monocyte count and liver metastasis in patients with CRC recommends the former as a useful predictor of postoperative prognosis in CRC patients.

  7. Preoperative treatment with radiochemotherapy for locally advanced gastroesophageal junction cancer and unresectable locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Ratosa Ivica

    2015-06-01

    Full Text Available Background. To purpose of the study was to analyze the results of preoperative radiochemotherapy in patients with unresectable gastric or locoregionally advanced gastroesophageal junction (GEJ cancer treated at a single institution.

  8. Vitamin D receptor gene polymorphisms, dietary promotion of insulin resistance, and colon and rectal cancer.

    OpenAIRE

    Murtaugh, Maureen A.; Sweeney, Carol; Ma, Khe-ni; Potter, John D.; Caan, Bette J.; Wolff, Roger K.; Slattery, Martha L

    2006-01-01

    Biomarkers of individual susceptibility: field studies. Biomarker: vitamin D receptor (VDR) gene polymorphisms Effect studied: colon and rectal cancer risk. Tissue/biological material/sample size: colon, rectum. Method of analysis: genotyping of the VDR gene Study design: case-control studyStudy size: colon cancer (1,698 cases and 1,861 controls); rectal cancer (752 cases and 960 controls) Impact on outcome (including dose-response): The lowest colon cancer risk was observed with the Ff/ff Fo...

  9. No Increased Risk of Second Cancer After Radiotherapy in Patients Treated for Rectal or Endometrial Cancer in the Randomized TME, PORTEC-1, and PORTEC-2 Trials.

    Science.gov (United States)

    Wiltink, Lisette M; Nout, Remi A; Fiocco, Marta; Meershoek-Klein Kranenbarg, Elma; Jürgenliemk-Schulz, Ina M; Jobsen, Jan J; Nagtegaal, Iris D; Rutten, Harm J T; van de Velde, Cornelis J H; Creutzberg, Carien L; Marijnen, Corrie A M

    2015-05-20

    This study investigated the long-term probability of developing a second cancer in a large pooled cohort of patients treated with surgery with or without radiotherapy (RT). All second cancers diagnosed in patients included in the TME, PORTEC-1, and PORTEC-2 trials were analyzed. In the TME trial, patients with rectal cancer (n = 1,530) were randomly allocated to preoperative external-beam RT (EBRT; 25 Gy in five fractions) or no RT. In the PORTEC trials, patients with endometrial cancer were randomly assigned to postoperative EBRT (46 Gy in 2-Gy fractions) versus no RT (PORTEC-1; n = 714) or EBRT versus vaginal brachytherapy (VBT; PORTEC-2; n = 427). A total of 2,554 patients were analyzed (median follow-up, 13.0 years; range 1.8 to 21.2 years). No differences were found in second cancer probability between patients who were treated without RT (10- and 15-year rates, 15.8% and 26.5%, respectively) and those treated with EBRT (10- and 15-year rates, 15.4% and 25.6%, respectively) or VBT (10-year rate, 14.9%). In the individual trials, no significant differences were found between treatment arms. All cancer survivors had a higher risk of developing a second cancer compared with an age- and sex-matched general population. The standardized incidence ratio for any second cancer was 2.98 (95% CI, 2.82 to 3.14). In this pooled trial cohort of > 2,500 patients with pelvic cancers, those who underwent EBRT or VBT had no higher probability of developing a second cancer than patients who were treated with surgery alone. However, patients with rectal or endometrial cancer had an increased probability of developing a second cancer compared with the general population. © 2014 by American Society of Clinical Oncology.

  10. Development of a clinically-precise mouse model of rectal cancer.

    Directory of Open Access Journals (Sweden)

    Hiroyuki Kishimoto

    Full Text Available Currently-used rodent tumor models, including transgenic tumor models, or subcutaneously growing tumors in mice, do not sufficiently represent clinical cancer. We report here development of methods to obtain a highly clinically-accurate rectal cancer model. This model was established by intrarectal transplantation of mouse rectal cancer cells, stably expressing green fluorescent protein (GFP, followed by disrupting the epithelial cell layer of the rectal mucosa by instilling an acetic acid solution. Early-stage tumor was detected in the rectal mucosa by 6 days after transplantation. The tumor then became invasive into the submucosal tissue. The tumor incidence was 100% and mean volume (±SD was 1232.4 ± 994.7 mm(3 at 4 weeks after transplantation detected by fluorescence imaging. Spontaneous lymph node metastasis and lung metastasis were also found approximately 4 weeks after transplantation in over 90% of mice. This rectal tumor model precisely mimics the natural history of rectal cancer and can be used to study early tumor development, metastasis, and discovery and evaluation of novel therapeutics for this treatment-resistant disease.

  11. The value of metabolic imaging to predict tumour response after chemoradiation in locally advanced rectal cancer

    Directory of Open Access Journals (Sweden)

    Gómez-Río Manuel

    2010-12-01

    Full Text Available Abstract Background We aim to investigate the possibility of using 18F-positron emission tomography/computer tomography (PET-CT to predict the histopathologic response in locally advanced rectal cancer (LARC treated with preoperative chemoradiation (CRT. Methods The study included 50 patients with LARC treated with preoperative CRT. All patients were evaluated by PET-CT before and after CRT, and results were compared to histopathologic response quantified by tumour regression grade (patients with TRG 1-2 being defined as responders and patients with grade 3-5 as non-responders. Furthermore, the predictive value of metabolic imaging for pathologic complete response (ypCR was investigated. Results Responders and non-responders showed statistically significant differences according to Mandard's criteria for maximum standardized uptake value (SUVmax before and after CRT with a specificity of 76,6% and a positive predictive value of 66,7%. Furthermore, SUVmax values after CRT were able to differentiate patients with ypCR with a sensitivity of 63% and a specificity of 74,4% (positive predictive value 41,2% and negative predictive value 87,9%; This rather low sensitivity and specificity determined that PET-CT was only able to distinguish 7 cases of ypCR from a total of 11 patients. Conclusions We conclude that 18-F PET-CT performed five to seven weeks after the end of CRT can visualise functional tumour response in LARC. In contrast, metabolic imaging with 18-F PET-CT is not able to predict patients with ypCR accurately.

  12. Comparison between CT volume measurement and histopathological assessment of response to neoadjuvant therapy in rectal cancer

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    Pomerri, Fabio, E-mail: fabio.pomerri@unipd.it [Veneto Institute of Oncology IOV-IRCCS, via Gattamelata 64, 35128 Padua (Italy); Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padua (Italy); Pucciarelli, Salvatore, E-mail: puc@unipd.it [Department of Oncological and Surgical Sciences, University of Padua, via Giustiniani 2, 35128 Padua (Italy); Gennaro, Gisella, E-mail: gisella.gennaro@pd.infn.it [Veneto Institute of Oncology IOV-IRCCS, via Gattamelata 64, 35128 Padua (Italy); Maretto, Isacco, E-mail: isac77@gmail.com [Veneto Institute of Oncology IOV-IRCCS, via Gattamelata 64, 35128 Padua (Italy); Nitti, Donato, E-mail: donato.nitti@unipd.it [Department of Oncological and Surgical Sciences, University of Padua, via Giustiniani 2, 35128 Padua (Italy); Muzzio, Pier Carlo, E-mail: pcmuzzio@unipd.it [Veneto Institute of Oncology IOV-IRCCS, via Gattamelata 64, 35128 Padua (Italy)

    2012-12-15

    Objectives: The aim of this study was to compare volume measurements on computed tomography (CT) images with histopathological assessments of chemoradiotherapy (CRT)-induced tumor regression in locally advanced rectal cancer (RC). Methods: In 25 patients (13 males, 12 females; median age, 63 years; age range, 44–79 years) with locally advanced RC treated with preoperative CRT and surgery, two radiologists measured tumor volume on CT images before and after CRT. CT-based tumor volumetry and the modified response evaluation criteria in solid tumors (mRECISTs) were compared with T and N downstaging after CRT, and with the tumor regression grade (TRG). Results: Tumor volumes were significantly smaller on CT images after CRT. The tumors regressed in 52% (13/25), 36% (9/25) and 40% (10/25) of patients, based on T downstaging, TRG and mRECIST findings, respectively. In terms of T downstaging, the pre- and post-CRT tumor volumes of responders and non-responders to the treatment differed statistically, while their tumor volume reduction rates and volume reductions according to the 65% mRECIST threshold did not. In terms of N downstaging and TRG, the differences between the responders’ and the non-responders’ pre- and post-CRT tumor volumes, tumor volume reduction rates, and mRECIST thresholds were never statistically significant. Conclusion: Measuring tumor size on CT images is of limited value in predicting the histopathological response to preoperative CRT in RC patients, so it may be unwise to select surgical treatment strategies based on CT volumetry.

  13. Intratumoral Heterogeneity of MicroRNA Expression in Rectal Cancer

    DEFF Research Database (Denmark)

    Eriksen, Anne Haahr Mellergaard; Andersen, Rikke Fredslund; Nielsen, Boye Schnack

    2016-01-01

    INTRODUCTION: An increasing number of studies have investigated microRNAs (miRNAs) as potential markers of diagnosis, treatment and prognosis. So far, agreement between studies has been minimal, which may in part be explained by intratumoral heterogeneity of miRNA expression. The aim of the present...... study was to assess the heterogeneity of a panel of selected miRNAs in rectal cancer, using two different technical approaches. MATERIALS AND METHODS: The expression of the investigated miRNAs was analysed by real-time quantitative polymerase chain reaction (RT-qPCR) and in situ hybridization (ISH...... using Spearman's correlation. RESULTS: ICCsingle (one sample from each patient) was higher than 50% for miRNA-21 and miRNA-31. For miRNA-125b, miRNA-145, and miRNA-630, ICCsingle was lower than 50%. The ICCmean (mean of three samples from each patient) was higher than 50% for miRNA-21(RT-qPCR and ISH...

  14. A predictive genetic signature for response to fluoropyrimidine-based neoadjuvant chemoradiation in clinical Stage II and III rectal cancer

    Directory of Open Access Journals (Sweden)

    Jason eChan

    2013-11-01

    Full Text Available PurposePreoperative chemoradiation is currently the standard of care for patients with clinical stage II and III rectal cancer but only about 45% of patients achieve tumor downstaging and less than 20% of patients achieve a pathologic complete response. Better methods to stratify patients according to potential neoadjuvant treatment response are needed. We used microarray analysis to identify a genetic signature that correlates with a pathological complete response to neoadjuvant chemoradiation. We performed a gene network analysis to identify potential signaling pathways involved in determining response to neoadjuvant treatment.Patients and MethodsWe identified 31 T3-4 N0-1 rectal cancer patients who were treated with neoadjuvant fluorouracil-based chemoradiation. 8 patients were identified to have achieved a pathological complete response to treatment while 23 patients did not. mRNA expression was analyzed using cDNA microarrays. The correlation between mRNA expression and pathological complete response from pre-treatment tumor biopsies was determined. Gene network analysis was performed for the genes represented by the predictive signature.ResultsA genetic signature represented by expression levels of the 3 genes EHBP1, STAT1, and GAPDH was found to correlate with a pathological complete response to neoadjuvant treatment. The difference in expression levels between patients who achieved a pathological complete response and those who did not was greatest for EHBP1. Gene network analysis showed that the 3 genes can be connected by the gene UBC. ConclusionThis study identifies a 3-gene signature expressed in pre-treatment tumor biopsies that correlates with a pathological complete response to neoadjuvant chemoradiation in patients with clinical stage II and III rectal cancer. These 3 genes can be connected by the gene UBC, suggesting that ubiquination is a molecular mechanism involved in determining response to treatment. Validating this genet

  15. Complete Response after Chemoradiotherapy in Rectal Cancer (Watch-and-Wait): Have we Cracked the Code?

    Science.gov (United States)

    Glynne-Jones, R; Hughes, R

    2016-02-01

    Patients with locally advanced rectal cancer receive preoperative chemoradiation as the standard of care, producing a pathological complete response in 10-20% and a complete clinical response (CCR) in 20-30%. Small observational studies suggest a selective non-operative management with rigorous surveillance is an option and is increasingly being advocated in many parts of the world for patients who achieve a CCR or near CCR. The assumption is that oncological outcomes for good responders, who are observed, compare favourably with patients subjected to radical surgery. Late regrowth of the primary is rare, almost invariably endoluminal and, hence, can be salvaged. However, concerns remain among some surgeons and oncologists regarding the reproducibility of published results in routine practice. We have previously reviewed this topic. The aim of this brief overview was to re-assess the feasibility and safety of a non-operative approach based on the currently available literature. We make recommendations as to the quality of care required to undertake this management. Significant heterogeneity remains in the initial inclusion criteria, staging and restaging methods, study design, timing of assessment, duration and rigour of follow-up of the trials reviewed - all of which obscure the validity of the results.

  16. Predictive Response Value of Pre- and Postchemoradiotherapy Variables in Rectal Cancer: An Analysis of Histological Data.

    Science.gov (United States)

    Santos, Marisa D; Silva, Cristina; Rocha, Anabela; Nogueira, Carlos; Matos, Eduarda; Lopes, Carlos

    2016-01-01

    Background. Neoadjuvant chemoradiotherapy (nCRT) followed by curative surgery in locally advanced rectal cancer (LARC) improves pelvic disease control. Survival improvement is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. Potential predictive factors for Mandard response are analyzed. Materials and Methods. 167 patients with LARC were treated with nCRT and curative surgery. Tumor biopsies and surgical specimens were reviewed and analyzed regarding mitotic count, necrosis, desmoplastic reaction, and inflammatory infiltration grade. Surgical specimens were classified according to Mandard TRG. The patients were divided as "good responders" (Mandard TRG1-2) and "bad responders" (Mandard TRG3-5). According to results from our previous data, good responders have better prognosis than bad responders. We examined predictive factors for Mandard response and performed statistical analysis. Results. In univariate analysis, distance from anal verge and ten other postoperative variables related with nCRT tumor response had predictive value for Mandard response. In multivariable analysis only mitotic count, necrosis, and differentiation grade in surgical specimen had predictive value. Conclusions. There is a lack of clinical and pathological preoperative variables able to predict Mandard response. Only postoperative pathological parameters related with nCRT response have predictive value.

  17. Dietary folate intake and K-ras mutations in sporadic colon and rectal cancer in the Netherlands Cohort Study

    NARCIS (Netherlands)

    Brink, M.; Weijenberg, M.P.; Goeij, A.F.P.M. de; Roemen, G.M.J.M.; Lentjes, M.H.F.M.; Bruïne, A.P. de; Engeland, M. van; Goldbohm, R.A.; Brandt, P.A. van den

    2005-01-01

    We studied the association between dietary folate and specific K-ras mutations in colon and rectal cancer in The Netherlands Cohort Study on diet and cancer. After 7.3 years of follow-up, 448 colon and 160 rectal cancer patients and 3,048 sub-cohort members (55-69 years at baseline) were available f

  18. A Comparative Study on the Efficacy of Rectal Diazepam and Midazolam for Reduction of Pre-Operative Anxiety in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Mohammad-Esmaiel Darabi

    2007-05-01

    Full Text Available Objective: Children, due to their great parental dependency, are amongst the cases that should receive preoperatively medication to reduce their fear and anxiety. The objective of this study was to compare the efficacy of rectal diazepam and midazolam for this purpose in pediatric patients scheduled for elective surgery. Material & Methods: 60 children, aged between 1 and 6 years, scheduled for elective surgery, were included in this double blind, randomized controlled trial. Patients were randomly allocated into three equal groups. Patients in midazolam and diazepam groups received the drugs 0.3 mg/kg and 0.5 mg/kg respectively (in normal saline at a final volume of 2.5 ml and placebo group received only 2.5 ml of normal saline 20 min before arriving operation room through rectal applicator. Sedation and anxiety scores at the time of separation from their parents before arriving operating room were recorded for all groups. Findings: There was a significant reduction in anxiety level in midazolam and diazepam groups as compared to placebo group (P<0.001. Sedation rate was 65% for midazolam, 60% for diazepam, and 15% for placebo group (P=0.007. There were no significant changes in hemodynamic parameters in the three study groups. Conclusion: With respect to effective anxiolytic and sedative activity, rectal midazolam (0.3 mg/Kg and diazepam (0.5 mg/Kg can be used as an anesthetic premedicant for children at pre-operative period and their use is safe regarding hemodynamic variables and related side-effects.

  19. NPTX2 is associated with neoadjuvant therapy response in rectal cancer.

    Science.gov (United States)

    Karagkounis, Georgios; Thai, Leo; DeVecchio, Jennifer; Gantt, Gerald A; Duraes, Leonardo; Pai, Rish K; Kalady, Matthew F

    2016-05-01

    Neoadjuvant chemoradiation (CRT) is recommended for locally advanced rectal cancer. Tumor response varies from pathologic complete response (pCR) to no tumor regression. The mechanisms behind CRT resistance remain undefined. In our previously generated complementary DNA microarrays of pretreatment biopsies from rectal cancer patients, neuronal pentraxin 2 (NPTX2) expression discriminated patients with pCR from those with residual tumor. As tumor response is prognostic for survival, we sought to evaluate the clinical relevance of NPTX2 in rectal cancer. Real-time quantitative polymerase chain reaction was used to evaluate NPTX2 messenger RNA expression in individual rectal cancers before CRT. Tumors with NPTX2 expression 50% were defined as NPTX2-high. NPTX2 levels were compared to response to therapy and oncologic outcomes using Mann-Whitney, Kruskal-Wallis, chi-square, and Mantel-Cox (log-rank) tests, as appropriate. Rectal cancers from 40 patients were included. The mean patient age was 56.8 years, and 30% were female. pCR was achieved in eight of 40 patients (20%). In these patients, messenger RNA NPTX2 levels were significantly decreased compared to those with residual cancer (fold change 30.4, P = 0.017). Patients with NPTX2-low tumors (n = 13) achieved improved response to treatment (P = 0.012 versus NPXT2-high tumors), with 38.5% and 46.1% of patients achieving complete or moderate response, respectively. Of patients with NPTX2-high tumors (n = 27), 11.1% and 18.5% achieved complete or moderate response, respectively. No recurrence or death was recorded in patients with NPTX2-low tumors, reflecting more favorable disease-free survival (P = 0.045). Decreased NPTX2 expression in rectal adenocarcinomas is associated with improved response to CRT and improved prognosis. Further studies to validate these results and elucidate the biological role of NPTX2 in rectal cancer are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Selection Criteria for the Radical Treatment of Locally Advanced Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Mansel Leigh Davies

    2011-01-01

    Full Text Available There are over 14,000 newly diagnosed rectal cancers per year in the United Kingdom of which between 50 and 64 percent are locally advanced (T3/T4 at presentation. Pelvic exenterative surgery was first described by Brunschwig in 1948 for advanced cervical cancer, but early series reported high morbidity and mortality. This approach was later applied to advanced primary rectal carcinomas with contemporary series reporting 5-year survival rates between 32 and 66 percent and to recurrent rectal carcinoma with survival rates of 22–42%. The Swansea Pelvic Oncology Group was established in 1999 and is involved in the assessment and management of advanced pelvic malignancies referred both regionally and UK wide. This paper will set out the selection, assessment, preparation, surgery, and outcomes from pelvic exenterative surgery for locally advanced primary rectal carcinomas.

  1. Association of pretreatment serum carcinoembryonic antigen levels with chemoradiation-induced downstaging and downsizing of rectal cancer.

    Science.gov (United States)

    Yeo, Seung-Gu

    2016-04-01

    The aim of this study was to identify pretreatment clinical parameters associated with preoperative chemoradiotherapy (CRT)-induced downstaging and downsizing of locally advanced rectal cancer (LARC T3-4 or N+). Data from 51 LARC patients, who received preoperative CRT and radical surgery between 2010 and 2013, were retrospectively analyzed. Rectal adenocarcinoma was histologically confirmed in all patients, who ranged in age between 41 and 81 years (median, 64 years). CRT consisted of 50.4 Gy pelvic radiotherapy with concurrent chemotherapy using 5-fluorouracil and leucovorin. After a median interval of 7 weeks post-CRT, the patients underwent total mesorectal excision. Downstaging was defined as the transition from cStage II-III to ypStage 0-I. The longest tumor diameter was measured pre- and post-CRT using computed tomography or magnetic resonance imaging, and based on the surgical specimen, respectively. Downstaging was observed in 16 (31.4%) patients, including 5 (9.8%) with a pathological complete response. The median downsizing rate was 60%. The serum carcinoembryonic antigen (CEA) levels were 0.8-153.9 ng/ml (median, 4.4 ng/ml). The maximum standardized uptake value was 4.7-33.9 (median, 10.8). On univariate analysis, cT stage, tumor size and CEA level were associated with downstaging. On multivariate analysis, only CEA level (≤5 ng/ml) was a significant predictor of downstaging (odds ratio = 16.0; 95% confidence interval: 1.8-146.7; P=0.014). CEA level was the only factor significantly associated with downsizing (>60%) in the univariate analysis. These results demonstrated that pretreatment serum CEA levels are significantly associated with downstaging as well as downsizing of LARC following preoperative CRT. Therefore, this parameter may be useful in personalizing the management of LARC patients.

  2. Incidence and mortality from colon and rectal cancer in Midwestern Brazil

    Directory of Open Access Journals (Sweden)

    Anderson Gomes de Oliveira

    Full Text Available ABSTRACT: Objective: To describe the incidence and mortality rates from colon and rectal cancer in Midwestern Brazil. Methods: Data for the incidence rates were obtained from the Population-Based Cancer Registry (PBCR according to the available period. Mortality data were obtained from the Mortality Information System (SIM for the period between 1996 and 2008. Incidence and mortality rates were calculated by gender and age groups. Mortality trends were analyzed by the Joinpoint software. The age-period-cohort effects were calculated by the R software. Results: The incidence rates for colon cancer vary from 4.49 to 23.19/100,000, while mortality rates vary from 2.85 to 14.54/100,000. For rectal cancer, the incidence rates range from 1.25 to 11.18/100,000 and mortality rates range between 0.30 and 7.90/100,000. Colon cancer mortality trends showed an increase among males in Cuiabá, Campo Grande, and Goiania. For those aged under 50 years, the increased rate was 13.2% in Campo Grande. For those aged over 50 years, there was a significant increase in the mortality in all capitals. In Goiânia, rectal cancer mortality in males increased 7.3%. For females below 50 years of age in the city of Brasilia, there was an increase of 8.7%, while females over 50 years of age in Cuiaba showed an increase of 10%. Conclusion: There is limited data available on the incidence of colon and rectal cancer for the Midwest region of Brazil. Colon cancer mortality has generally increased for both genders, but similar data were not verified for rectal cancer. The findings presented herein demonstrate the necessity for organized screening programs for colon and rectal cancer in Midwestern Brazil.

  3. Pre-surgery radiotherapy of rectal cancer; Radioterapia pre-operatoria no cancer de reto

    Energy Technology Data Exchange (ETDEWEB)

    Lopes-Paulo, Francisco [Universidade do Estado do Rio de Janeiro, (UERJ), RJ (Brazil)

    2005-04-15

    High indexes of loco-regional recurrence in patients with rectal cancer have stimulated the search of complementary therapy. Since the sixties, neo adjuvant radiotherapy has gained space in order to reduce local recurrence and to increase the survival of these patients. Recently some publications have pointed out the importance of associating chemotherapy and total excision of mesorectum to the radiotherapy in the same way. The results of large prospective researches are expected to determine the exact role of this association. (author)

  4. Results of Neoadjuvant Short-Course Radiation Therapy Followed by Transanal Endoscopic Microsurgery for T1-T2 N0 Extraperitoneal Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Arezzo, Alberto, E-mail: alberto.arezzo@unito.it [General Surgery I, Department of Surgical Sciences, University of Torino, Torino (Italy); Arolfo, Simone; Allaix, Marco Ettore [General Surgery I, Department of Surgical Sciences, University of Torino, Torino (Italy); Munoz, Fernando [Radiation Oncology, Department of Oncology, University of Torino, Torino (Italy); Cassoni, Paola [Pathology Unit, Department of Medical Sciences, University of Torino, Torino (Italy); Monagheddu, Chiara [Clinical Epidemiology Unit, Piedmont Reference Centre for Epidemiology and Cancer Prevention, City of Health and Science Hospital of Torino, Torino (Italy); Ricardi, Umberto [Radiation Oncology, Department of Oncology, University of Torino, Torino (Italy); Ciccone, Giovannino [Clinical Epidemiology Unit, Piedmont Reference Centre for Epidemiology and Cancer Prevention, City of Health and Science Hospital of Torino, Torino (Italy); Morino, Mario [General Surgery I, Department of Surgical Sciences, University of Torino, Torino (Italy)

    2015-06-01

    Purpose: This study was undertaken to assess the short-term outcomes of neoadjuvant short-course radiation therapy (SCRT) followed by transanal endoscopic microsurgery (TEM) for T1-T2 N0 extraperitoneal rectal cancer. Recent studies suggest that neoadjuvant radiation therapy followed by TEM is safe and has results similar to those with abdominal rectal resection for the treatment of extraperitoneal early rectal cancer. Methods and Materials: We planned a prospective pilot study including 25 consecutive patients with extraperitoneal T1-T2 N0 M0 rectal adenocarcinoma undergoing SCRT followed by TEM 4 to 10 weeks later (SCRT-TEM). Safety, efficacy, and acceptability of this treatment modality were compared with historical groups of patients with similar rectal cancer stage and treated with long-course radiation therapy (LCRT) followed by TEM (LCRT-TEM), TEM alone, or laparoscopic rectal resection with total mesorectal excision (TME) at our institution. Results: The study was interrupted after 14 patients underwent SCRT of 25 Gy in 5 fractions followed by TEM. Median time between SCRT and TEM was 7 weeks (range: 4-10 weeks). Although no preoperative complications occurred, rectal suture dehiscence was observed in 7 patients (50%) at 4 weeks follow-up, associated with an enterocutaneous fistula in the sacral area in 2 cases. One patient required a colostomy. Quality of life at 1-month follow-up, according to European Organization for Research and Treatment of Cancer QLQ-C30 survey score, was significantly worse in SCRT-TEM patients than in LCRT-TEM patients (P=.0277) or TEM patients (P=.0004), whereas no differences were observed with TME patients (P=.604). At a median follow-up of 10 months (range: 6-26 months), we observed 1 (7%) local recurrence at 6 months that was treated with abdominoperineal resection. Conclusions: SCRT followed by TEM for T1-T2 N0 rectal cancer is burdened by a high rate of painful dehiscence of the suture line and enterocutaneous

  5. Serum 25-hydroxyvitamin D and risks of colon and rectal cancer in Finnish men.

    Science.gov (United States)

    Weinstein, Stephanie J; Yu, Kai; Horst, Ronald L; Ashby, Jason; Virtamo, Jarmo; Albanes, Demetrius

    2011-03-01

    Prospective investigations of circulating vitamin D concentrations suggest inverse associations with colorectal cancer risk, although inconsistencies remain and few studies have examined the impact of season. The authors conducted a prospective case-control study of 239 colon cancer cases and 192 rectal cancer cases (diagnosed in 1993-2005) and 428 controls matched on age and blood collection date within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of Finnish male smokers. Baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations were categorized using a priori defined cutpoints of colon cancer and 0.64, 0.58, 0.84, 1.00, and 0.76 for rectal cancer, respectively (all 95% confidence intervals included 1.00). Colon cancer risks were significantly elevated for the highest season-specific and season-standardized quartiles versus the lowest quartiles (OR = 2.11 (95% CI: 1.20, 3.69) and OR = 1.88 (95% CI: 1.07, 3.28), respectively), while rectal cancer risk estimates were null. These results provide no evidence to support an inverse association between vitamin D status and colon or rectal cancer risk; instead, they suggest a positive association for colon cancer.

  6. Neoadjuvant bevacizumab and chemoradiotherapy in locally advanced rectal cancer: early outcome and technical impact on toxicity

    OpenAIRE

    Wang, Chia-Chun; Liang, Jin-Tung; Tsai, Chiao-Ling; Chen, Yu-Hsuan; Lin, Yu-Lin; Shun, Chia-Tung; Cheng, Jason Chia-Hsien

    2014-01-01

    Background We aimed to evaluate early clinical and pathological results for treating locally advanced rectal cancer with bevacizumab and neoadjuvant concurrent chemoradiotherapy using the technique of prone-position volumetric modulated arc therapy and to compare the toxicity of volumetric modulated arc therapy with that of supine-position four-field box radiotherapy. Methods Twelve patients with stage IIA to IVA rectal adenocarcinoma, treated with neoadjuvant concurrent chemoradiotherapy (45...

  7. Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique.

    Directory of Open Access Journals (Sweden)

    Weiping Chen

    Full Text Available Laparoscopic sphincter-preserving low anterior resection for rectal cancer is a surgery demanding great skill. Immense efforts have been devoted to identifying factors that can predict operative difficulty, but the results are inconsistent.Our study was conducted to screen patients' factors to build models for predicting the operative difficulty using well controlled data.We retrospectively reviewed records of 199 consecutive patients who had rectal cancers 5-8 cm from the anal verge. All underwent laparoscopic sphincter-preserving low anterior resections with total mesorectal excision (TME and double stapling technique (DST. Data of 155 patients from one surgeon were utilized to build models to predict standardized endpoints (operative time, blood loss and postoperative morbidity. Data of 44 patients from other surgeons were used to test the predictability of the built models.Our results showed prior abdominal surgery, preoperative chemoradiotherapy, tumor distance to anal verge, interspinous distance, and BMI were predictors for the standardized operative times. Gender and tumor maximum diameter were related to the standardized blood loss. Temporary diversion and tumor diameter were predictors for postoperative morbidity. The model constructed for the operative time demonstrated excellent predictability for patients from different surgeons.With a well-controlled patient population, we have built a predictable model to estimate operative difficulty. The standardized operative time will make it possible to significantly increase sample size and build more reliable models to predict operative difficulty for clinical use.

  8. Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Price, Jeremy G. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stone, Nelson N. [Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States)

    2013-08-01

    Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ≥grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following

  9. Preoperative staging of lung cancer with combined PET-CT

    DEFF Research Database (Denmark)

    Fischer, Barbara; Lassen, Ulrik; Mortensen, Jann

    2009-01-01

    BACKGROUND: Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC...... one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause...

  10. Survival of patients with colon and rectal cancer in central and northern Denmark, 1998–2009

    Directory of Open Access Journals (Sweden)

    Ostenfeld EB

    2011-07-01

    Full Text Available Eva B Ostenfeld1, Rune Erichsen1, Lene H Iversen1,2, Per Gandrup3, Mette Nørgaard1, Jacob Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark; 3Department of Surgery A, Aarhus University Hospital, Aalborg, DenmarkObjective: The prognosis for colon and rectal cancer has improved in Denmark over the past decades but is still poor compared with that in our neighboring countries. We conducted this population-based study to monitor recent trends in colon and rectal cancer survival in the central and northern regions of Denmark.Material and methods: Using the Danish National Registry of Patients, we identified 9412 patients with an incident diagnosis of colon cancer and 5685 patients diagnosed with rectal cancer between 1998 and 2009. We determined survival, and used Cox proportional hazard regression analysis to compare mortality over time, adjusting for age and gender. Among surgically treated patients, we computed 30-day mortality and corresponding mortality rate ratios (MRRs.Results: The annual numbers of colon and rectal cancer increased from 1998 through 2009. For colon cancer, 1-year survival improved from 65% to 70%, and 5-year survival improved from 37% to 43%. For rectal cancer, 1-year survival improved from 73% to 78%, and 5-year survival improved from 39% to 47%. Men aged 80+ showed most pronounced improvements. The 1- and 5-year adjusted MRRs decreased: for colon cancer 0.83 (95% confidence interval CI: 0.76–0.92 and 0.84 (95% CI: 0.78–0.90 respectively; for rectal cancer 0.79 (95% CI: 0.68–0.91 and 0.81 (95% CI: 0.73–0.89 respectively. The 30-day postoperative mortality after resection also declined over the study period. Compared with 1998–2000 the 30-day MRRs in 2007–2009 were 0.68 (95% CI: 0.53–0.87 for colon cancer and 0.59 (95% CI: 0.37–0.96 for rectal cancer.Conclusion: The survival after colon and rectal

  11. N-acetyltransferase 1 in colon and rectal cancer cases from an industrialized area.

    Science.gov (United States)

    Roemer, Hermann C; Weistenhofer, Wobbeke; Lohlein, Dietrich; Geller, Frank; Blomeke, Brunhilde; Golka, Klaus

    2008-01-01

    Colon and rectal cancers are both associated with genetic as well as nutritional, occupational, and environmental factors. Aromatic amines and heterocyclic amines are established colorectal carcinogens. The polymorphic enzyme N-acetyltransferase 1 (NAT1) contributes to heterocyclic amine metabolism in the human colon. Thereby, NAT1 may influence the risk for development of colorectal cancer. The distribution of NAT1 genotypes was determined in 107 colon cancer cases, 77 rectal cancer cases, and 185 controls (suffering from nonmalignant diseases) by standard methods. In addition, possible occupational and nonoccupational risk factors were determined by a personal interview. Cancer cases and controls were derived from an area of former coal, iron, and steel industries, which is known for elevated colon cancer mortality. The proportions of NAT1*4/*4 genotype were 72% in controls, 75% in rectal cancer cases, and 72% in colon cancer cases. The proportions of the NAT1*4/*10 genotype were 17.8% in controls, 12.9% in rectal cancer cases, and 14% in colon cancer cases. Combinations of the determined NAT1 alleles *3/*3, *3/*10, *4/*3, *4/*11, *10/*10 and *11/*11 contributed to 10.2% of the genotypes in controls, 12.1% in rectal cancer cases, and 14% in colon cancer cases. In contrast to another study on healthy German volunteers, the NAT1*4/*4 genotype (wild type) is overrepresented. This might be due to the variation in the proportion of NAT1 alleles in the general population. The present study does not support a relevant impact of the NAT1 genotype on colorectal cancer risk development in the study area.

  12. Discrimination of rectal cancer through human serum using surface-enhanced Raman spectroscopy

    Science.gov (United States)

    Li, Xiaozhou; Yang, Tianyue; Li, Siqi; Zhang, Su; Jin, Lili

    2015-05-01

    In this paper, surface-enhanced Raman spectroscopy (SERS) was used to detect the changes in blood serum components that accompany rectal cancer. The differences in serum SERS data between rectal cancer patients and healthy controls were examined. Postoperative rectal cancer patients also participated in the comparison to monitor the effects of cancer treatments. The results show that there are significant variations at certain wavenumbers which indicates alteration of corresponding biological substances. Principal component analysis (PCA) and parameters of intensity ratios were used on the original SERS spectra for the extraction of featured variables. These featured variables then underwent linear discriminant analysis (LDA) and classification and regression tree (CART) for the discrimination analysis. Accuracies of 93.5 and 92.4 % were obtained for PCA-LDA and parameter-CART, respectively.

  13. QUALITY OF LIFE OF FEMALE PATIENTS, WHO UNDERWENT RECTAL CANCER SURGERY

    Directory of Open Access Journals (Sweden)

    S. V. Averyanova

    2013-01-01

    Full Text Available Quality of life is the second most important clinical outcome criteria for cancer patients after survival. Quality of life shows the completeness of social rehabilitations of patients, who underwent radical treatment. In present study quality of life of 41 rectal cancer patients, who underwent abdominoperineal resection (n = 22 or anterior resection (n = 19 was assessed using SF-36 questionnaire. All patients without permanent colostomy had better postoperative quality of life. The phycho-emotional state of patients with permanent colostomy progres-sively decreases. The present study is important for developing an individualized rehabilitation programme for female rectal cancer patients.

  14. Rectal cancer: future directions and priorities for treatment, research and policy in New Zealand.

    Science.gov (United States)

    Jackson, Christopher; Ehrenberg, Nieves; Frizelle, Frank; Sarfati, Diana; Balasingam, Adrian; Pearse, Maria; Parry, Susan; Print, Cristin; Findlay, Michael; Bissett, Ian

    2014-06-06

    New Zealand has one of the highest incidences of rectal cancer in the world, and its optimal management requires a multidisciplinary approach. A National Rectal Cancer Summit was convened in August 2013 to discuss management of rectal cancer in the New Zealand context, to highlight controversies and discuss domestic priorities for the future. This paper summarises the priorities for treatment, research and policy for rectal cancer services in New Zealand identified as part of the Summit in August. The following priorities were identified: - Access to high-quality information for service planning, review of outcomes, identification of inequities and gaps in provision, and quality improvement; - Engagement with the entire sector, including private providers; - Focus on equity; - Emerging technologies; - Harmonisation of best practice; - Importance of multidisciplinary team meetings. In conclusion, improvements in outcomes for patients with rectal cancer in New Zealand will require significant engagement between policy makers, providers, researchers, and patients in order to ensure equitable access to high quality treatment, and strategic incorporation of emerging technologies into clinical practice. A robust clinical information framework is required in order to facilitate monitoring of quality improvements and to ensure that equitable care is delivered.

  15. CLINICAL OUTCOME OF INTERSPHINCTERIC RESECTION FOR ULTRA-LOW RECTAL CANCER

    Directory of Open Access Journals (Sweden)

    Valentin L. Ignatov

    2012-03-01

    Full Text Available BACKGROUND: Laparoscopic surgery has been reported to be one of the approaches for total mesorectal excision (TME in rectal cancer surgery. Intersphincteric resection (ISR has been reported as a promising method for sphincter-preserving operation in selected patients with very low rectal cancer. METHODS: We try to underline the important surgical issues surrounding the management of patients with low rectal cancer indicated to laparoscopic intersphincteric resection (ISR. From January 2007 till now, 35 patients with very low rectal cancer underwent laparoscopic TME with ISR. We report and analyze the results from them RESULTS: Conversion to open surgery was necessary in one (3% patient. The median operation time was 293 min and median estimated blood loss was 40 ml. The pelvic plexus was completely preserved in 32 patients. There was no mortality. Postoperative complications occurred in three (9% patients. The median length of postoperative hospital stay was 11 days. Macroscopic complete mesorectal excision was achieved in all cases. Complete resection (R0 was achieved in 21 (91% patients.CONCLUSIONS: Laparoscopic TME with ISR is technically feasible and a safe alternative to laparotomy with favorable short-term postoperative outcomes. The literature research made by us found that the laparoscopic approach can be underwent in most patients with low rectal cancer in which laparoscopic ISR represents a feasible alternative to conventional open surgery.

  16. Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer.

    Science.gov (United States)

    Märkl, Bruno; Kerwel, Therese G; Wagner, Theodor; Anthuber, Matthias; Arnholdt, Hans M

    2007-07-01

    Adequate lymph node assessment in colorectal cancer is crucial for prognosis estimation and further therapy stratification. However, there is still an ongoing debate on required minimum lymph node numbers and the necessity of advanced techniques such as immunohistochemistry or PCR. It has been proven in several studies that lymph node harvest is often inadequate under routine analysis. Lymph nodes smaller than 5 mm are especially concerning as they can carry the majority of metastases. These small, but affected lymph nodes may escape detection in routine analysis. Therefore, fat-clearing protocols and sentinel techniques have been developed to improve accuracy of lymph node staging. We describe a novel and simple method of ex vivo methylene blue injection into the superior rectal artery of rectal cancer specimens, which highlights lymph nodes and makes them easy to detect during manual dissection. Initially, this method was developed for proving accuracy of total mesorectal excision. We performed a retrospective study comparing lymph node recovery of 12 methylene blue stained and an equal number of unstained cases. Lymph node recovery differed significantly with average lymph node numbers of 27+/-7 and 14+/-4 (Pmethylene blue and the unstained group, respectively. The largest difference was found in size groups between 1 and 4 mm causing a shift in size distribution toward smaller nodes. Metastases were confirmed in 21 and 19 lymph nodes occurring in five and four cases, respectively. Hence, we conclude that methylene blue injection technique improves accuracy of lymph node staging by heightening the lymph node harvest in rectal resections. In our experience, it is a very simple time and cost effective method that can be easily established under routine circumstances.

  17. PET-Based Treatment Response Evaluation in Rectal Cancer: Prediction and Validation

    Energy Technology Data Exchange (ETDEWEB)

    Janssen, Marco H.M., E-mail: marco.janssen@maastro.nl [Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht (Netherlands); Oellers, Michel C.; Stiphout, Ruud G.P.M. van [Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht (Netherlands); Riedl, Robert G. [Department of Pathology, University Medical Centre Maastricht, Maastricht (Netherlands); Bogaard, Jorgen van den; Buijsen, Jeroen; Lambin, Philippe; Lammering, Guido [Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht (Netherlands)

    2012-02-01

    Purpose: To develop a positron emission tomography (PET)-based response prediction model to differentiate pathological responders from nonresponders. The predictive strength of the model was validated in a second patient group, treated and imaged identical to the patients on which the predictive model was based. Methods and Materials: Fifty-one rectal cancer patients were prospectively included in this study. All patients underwent fluorodeoxyglucose (FDG) PET-computed tomography (CT) imaging both before the start of chemoradiotherapy (CRT) and after 2 weeks of treatment. Preoperative treatment with CRT was followed by a total mesorectal excision. From the resected specimen, the tumor regression grade (TRG) was scored according to the Mandard criteria. From one patient group (n = 30), the metabolic treatment response was correlated with the pathological treatment response, resulting in a receiver operating characteristic (ROC) curve based cutoff value for the reduction of maximum standardized uptake value (SUV{sub max}) within the tumor to differentiate pathological responders (TRG 1-2) from nonresponders (TRG 3-5). The applicability of the selected cutoff value for new patients was validated in a second patient group (n = 21). Results: When correlating the metabolic and pathological treatment response for the first patient group using ROC curve analysis (area under the curve = 0.98), a cutoff value of 48% SUV{sub max} reduction was selected to differentiate pathological responders from nonresponders (specificity of 100%, sensitivity of 64%). Applying this cutoff value to the second patient group resulted in a specificity and sensitivity of, respectively, 93% and 83%, with only one of the pathological nonresponders being false positively predicted as pathological responding. Conclusions: For rectal cancer, an accurate PET-based prediction of the pathological treatment response is feasible already after 2 weeks of CRT. The presented predictive model could be used to

  18. Ezrin expression in rectal cancer predicts time to development of local recurrence

    DEFF Research Database (Denmark)

    Jörgren, Fredrik; Nilbert, Mef; Rambech, Eva

    2012-01-01

    : Immunohistochemical expression of ezrin was analysed in 104 primary rectal cancers from patients who developed local recurrences despite being treated with R0 major abdominal surgery. Time to local recurrence and distant metastasis as well as 5-year overall and cancer-specific survival were used as end points...

  19. Study shows colon and rectal tumors constitute a single type of cancer

    Science.gov (United States)

    The pattern of genomic alterations in colon and rectal tissues is the same regardless of anatomic location or origin within the colon or the rectum, leading researchers to conclude that these two cancer types can be grouped as one, according to The Cancer

  20. Associations between birth weight and colon and rectal cancer risk in adulthood

    DEFF Research Database (Denmark)

    Smith, Natalie R; Jensen, Britt W; Zimmermann, Esther

    2016-01-01

    BACKGROUND: Birth weight has inconsistent associations with colorectal cancer, possibly due to different anatomic features of the colon versus the rectum. The aim of this study was to investigate the association between birth weight and colon and rectal cancers separately. METHODS: 193,306 childr...

  1. Capecitabine and Oxaliplatin Before, During, and After Radiotherapy for High-Risk Rectal Cancer

    DEFF Research Database (Denmark)

    Larsen, Finn Ole; Markussen, Alice; Jensen, Benny V

    2017-01-01

    PURPOSE: To evaluate the effect of capecitabine and oxaliplatin before, during, and after radiotherapy for high-risk rectal cancer. PATIENTS AND METHODS: Patients with rectum cancer T4 or T3 involving the mesorectal fascia was included in a prospective phase 2 trial. Liver or lung metastases were...

  2. Clinical outcomes of chemoradiotherapy for locally recurrent rectal cancer

    Directory of Open Access Journals (Sweden)

    Oh Jae Hwan

    2011-05-01

    Full Text Available Abstract Background To assess the clinical outcome of chemoradiotherapy with or without surgery for locally recurrent rectal cancer (LRRC and to find useful and significant prognostic factors for a clinical situation. Methods Between January 2001 and February 2009, 67 LRRC patients, who entered into concurrent chemoradiotherapy with or without surgery, were reviewed retrospectively. Of the 67 patients, 45 were treated with chemoradiotherapy plus surgery, and the remaining 22 were treated with chemoradiotherapy alone. The mean radiation doses (biologically equivalent dose in 2-Gy fractions were 54.6 Gy and 66.5 Gy for the chemoradiotherapy with and without surgery groups, respectively. Results The median survival duration of all patients was 59 months. Five-year overall (OS, relapse-free (RFS, locoregional relapse-free (LRFS, and distant metastasis-free survival (DMFS were 48.9%, 31.6%, 66.4%, and 40.6%, respectively. A multivariate analysis demonstrated that the presence of symptoms was an independent prognostic factor influencing OS, RFS, LRFS, and DMFS. No statistically significant difference was found in OS (p = 0.181, RFS (p = 0.113, LRFS (p = 0.379, or DMFS (p = 0.335 when comparing clinical outcomes between the chemoradiotherapy with and without surgery groups. Conclusions Chemoradiotherapy with or without surgery could be a potential option for an LRRC cure, and the symptoms related to LRRC were a significant prognostic factor predicting poor clinical outcome. The chemoradiotherapy scheme for LRRC patients should be adjusted to the possibility of resectability and risk of local failure to focus on local control.

  3. Neoadjuvant Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Radiation for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Dipetrillo, Tom; Pricolo, Victor; Lagares-Garcia, Jorge; Vrees, Matt; Klipfel, Adam; Cataldo, Tom; Sikov, William; McNulty, Brendan; Shipley, Joshua; Anderson, Elliot; Khurshid, Humera; Oconnor, Brigid; Oldenburg, Nicklas B.E.; Radie-Keane, Kathy; Husain, Syed [Brown University Oncology Group, Providence, RI (United States); Safran, Howard, E-mail: hsafran@lifespan.org [Brown University Oncology Group, Providence, RI (United States)

    2012-01-01

    Purpose: To evaluate the feasibility and pathologic complete response rate of induction bevacizumab + modified infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) 6 regimen followed by concurrent bevacizumab, oxaliplatin, continuous infusion 5-fluorouracil (5-FU), and radiation for patients with rectal cancer. Methods and Materials: Eligible patients received 1 month of induction bevacizumab and mFOLFOX6. Patients then received 50.4 Gy of radiation and concurrent bevacizumab (5 mg/kg on Days 1, 15, and 29), oxaliplatin (50 mg/m{sup 2}/week for 6 weeks), and continuous infusion 5-FU (200 mg/m{sup 2}/day). Because of gastrointestinal toxicity, the oxaliplatin dose was reduced to 40 mg/m{sup 2}/week. Resection was performed 4-8 weeks after the completion of chemoradiation. Results: The trial was terminated early because of toxicity after 26 eligible patients were treated. Only 1 patient had significant toxicity (arrhythmia) during induction treatment and was removed from the study. During chemoradiation, Grade 3/4 toxicity was experienced by 19 of 25 patients (76%). The most common Grade 3/4 toxicities were diarrhea, neutropenia, and pain. Five of 25 patients (20%) had a complete pathologic response. Nine of 25 patients (36%) developed postoperative complications including infection (n = 4), delayed healing (n = 3), leak/abscess (n = 2), sterile fluid collection (n = 2), ischemic colonic reservoir (n = 1), and fistula (n = 1). Conclusions: Concurrent oxaliplatin, bevacizumab, continuous infusion 5-FU, and radiation causes significant gastrointestinal toxicity. The pathologic complete response rate of this regimen was similar to other fluorouracil chemoradiation regimens. The high incidence of postoperative wound complications is concerning and consistent with other reports utilizing bevacizumab with chemoradiation before major surgical resections.

  4. Role of Genetic Polymorphisms in NFKB-Mediated Inflammatory Pathways in Response to Primary Chemoradiation Therapy for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Dzhugashvili, Maia [Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia (Spain); Department of Radiation Oncology, Madrid Oncology Institute (Group IMO), Murcia (Spain); Luengo-Gil, Ginés; García, Teresa; González-Conejero, Rocío [Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia (Spain); Conesa-Zamora, Pablo [Department of Pathology, University Hospital Santa Lucía, Cartagena (Spain); Escolar, Pedro Pablo [Department of Radiation Oncology, University Hospital Santa Lucía, Cartagena (Spain); Calvo, Felipe [Department of Radiation Oncology, University General Hospital Gregorio Marañón, Madrid (Spain); Vicente, Vicente [Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia (Spain); Ayala de la Peña, Francisco, E-mail: frayala@um.es [Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Murcia (Spain)

    2014-11-01

    Purpose: To investigate whether polymorphisms of genes related to inflammation are associated with pathologic response (primary endpoint) in patients with rectal cancer treated with primary chemoradiation therapy (PCRT). Methods and Materials: Genomic DNA of 159 patients with locally advanced rectal cancer treated with PCRT was genotyped for polymorphisms rs28362491 (NFKB1), rs1213266/rs5789 (PTGS1), rs5275 (PTGS2), and rs16944/rs1143627 (IL1B) using TaqMan single nucleotide polymorphism genotyping assays. The association between each genotype and pathologic response (poor response vs complete or partial response) was analyzed using logistic regression models. Results: The NFKB1 DEL/DEL genotype was associated with pathologic response (odds ratio [OR], 6.39; 95% confidence interval [CI], 0.78-52.65; P=.03) after PCRT. No statistically significant associations between other polymorphisms and response to PCRT were observed. Patients with the NFKB1 DEL/DEL genotype showed a trend for longer disease-free survival (log-rank test, P=.096) and overall survival (P=.049), which was not significant in a multivariate analysis that included pathologic response. Analysis for 6 polymorphisms showed that patients carrying the haplotype rs28362491-DEL/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G (13.7% of cases) had a higher response rate to PCRT (OR, 8.86; 95% CI, 1.21-64.98; P=.034) than the reference group (rs28362491-INS/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G). Clinically significant (grade ≥2) acute organ toxicity was also more frequent in patients with that same haplotype (OR, 4.12; 95% CI, 1.11-15.36; P=.037). Conclusions: Our results suggest that genetic variation in NFKB-related inflammatory pathways might influence sensitivity to primary chemoradiation for rectal cancer. If confirmed, an inflammation-related radiogenetic profile might be used to select patients with rectal cancer for preoperative combined-modality treatment.

  5. Diffusion-Weighted Magnetic Resonance Imaging in Monitoring Rectal Cancer Response to Neoadjuvant Chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Barbaro, Brunella, E-mail: bbarbaro@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, Rome (Italy); Vitale, Renata; Valentini, Vincenzo; Illuminati, Sonia [Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, Rome (Italy); Vecchio, Fabio M. [Department of Pathology, Catholic University School of Medicine, Rome (Italy); Rizzo, Gianluca [Department of Surgery, Catholic University School of Medicine, Rome (Italy); Gambacorta, Maria Antonietta [Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, Rome (Italy); Coco, Claudio; Crucitti, Antonio; Persiani, Roberto; Sofo, Luigi [Department of Surgery, Catholic University School of Medicine, Rome (Italy); Bonomo, Lorenzo [Department of Bioimaging and Radiological Sciences, Catholic University School of Medicine, Rome (Italy)

    2012-06-01