Update on advances and controversy in rectal cancer treatment

Abstract Changes in the multidisciplinary treatment of rectal cancer have been recently proposed. We performed a comprehensive review of the current data on neoadjuvant and adjuvant treatment of rectal cancer, focussing on chemoradiotherapy treatment and timing of surgery. Six components were proposed as the framework for the treatment of rectal cancer: neoadjuvant therapy and changing patterns in patient selection, long- or short-course radiotherapy, adverse effects of radiotherapy, timing of surgery, non-operative management of rectal cancer and postoperative adjuvant therapy. Lack of a consistent difference in terms of local recurrence has been observed between short-course radiotherapy and long-course chemoradiotherapy. Indications for preoperative radiotherapy have been reconsidered in the last years. An interval of 10–11 weeks seemed to be the optimal timing, with no impact on patient safety. Since assessment criteria of clinical complete response are not well defined, and the basis for non-operative management of rectal cancer is still not clear, further investigations are required. There is controversy about standard treatments for patients with locally advanced rectal cancer that are being analyzed by ongoing studies. Tailored treatments could avoid over-treatment for a large number of patients without any impairment of the oncologic results.
Source: Techniques in Coloproctology - Category: Surgery Source Type: research

Related Links:

Condition:   Rectal Cancer Interventions:   Radiation: Chemoradiotherapy;   Drug: Ipilimumab;   Drug: Nivolumab Sponsors:   Medical University of Vienna;   Bristol-Myers Squibb Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
PMID: 31607418 [PubMed - as supplied by publisher]
Source: Asian Journal of Surgery - Category: Surgery Authors: Tags: Asian J Surg Source Type: research
We examined the association between pathological lateral pelvic lymph node (LPLN) metastasis and the LPLN diameter in patients with locally advanced rectal cancer (LARC) who received a neoadjuvant chemotherapy (NAC) regimen based on oxaliplatin as induction chemotherapy. We aimed to determine whether or not the LPLN size predicts LPLN metastasis in NAC cases.MethodsWe retrospectively examined data from 3 institutes for 60 patients with LARC who received mesorectal excision and LPLN dissection after NAC. We evaluated the LPLN size on magnetic resonance imaging (MRI) scans acquired before and after NAC. We performed multivar...
Source: Surgery Today - Category: Surgery Source Type: research
"Watch and Wait" for complete clinical response after neoadjuvant chemoradiotherapy for rectal cancer. Minerva Chir. 2019 Sep 30;: Authors: Peacock O, Chang GJ Abstract The management of rectal cancer has evolved substantially over recent decades, becoming increasingly complex. This was once a disease associated with high mortality and limited treatment options that typically necessitated a permanent colostomy, has now become a model for multidisciplinary evaluation, treatment and surgical advancement. Despite advances in the rates of total mesorectal excision, decreased local recurrence and ...
Source: Minerva Chirurgica - Category: Surgery Tags: Minerva Chir Source Type: research
AbstractBackgroundAlthough neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer (LARC), it remains difficult to predict the prognosis of LARC patients. We aimed to explore the impacts of local immune status on survival of LARC after noeadjuvant radiotherapy (nRT).MethodsA total of 76 consecutive LARC patients were enrolled in our institute from February 2012 to September 2015. CD3+ T-cell and CD8+ T-cell count were determined from surgical specimens. Factors associated with disease-free survival (DFS) and overall survival (OS) were identified by univariate and multivariate Cox regressi...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsThe results demonstrate that robotic-assisted TME for patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy) is effective and for patient with tumor invaded to bladder, prostate or uterus, neoadjuvant chemotherapy is a safe and effective way for organ-preserving instead of salvage surgery.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsPeritumoral abscesses and fistulas should not be considered as contraindication to neoadjuvant chemoradiotherapy. CRT is feasible and safe in patients with tumor-associated complications.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsOur analysis suggested a higher completeness of weekly irinotecan was associated with a higher CR rate. Comprehensive evaluation of the patient performance is necessary before starting the intensified treatment.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundGuidelines for rectal cancer treatment differ in Japan, Europe, and the United States. Neoadjuvant chemoradiotherapy (CRT) has been used to control lateral lymph nodes (LLNs) in the West. The usefulness of LLN dissection (LLND) has been discussed in Japan, and a randomized study stated the possible advantage of local control. However, it is still unclear whether adding LLND to CRT is beneficial.MethodsTo investigate the effectiveness of LLND on rectal cancer patients who underwent neoadjuvant CRT, we retrospectively collected magnetic resonance images (MRIs) in a cohort of 1500 patients with cStage II/III...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsPCRT may not be required for all stage II/III rectal cancer patients, especially for the MRI-based intermediate-risk group (cT1-2/N1, cT3N0) without CRM involvement and lateral lymph node metastasis. Further prospective studies are warranted.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
More News: Cancer | Cancer & Oncology | Neoadjuvant Chemotherapy Therapy | Neoadjuvant Therapy | Rectal Cancers | Study | Surgery