Rectal cancer in old age –is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service
This study sought to examine the use of radical rectal cancer treatments and associated outcomes in relation to age across the English NHS.MethodsPatient, tumour and treatment characteristics for all patients diagnosed with a first primary rectal cancer in England between 1st April 2009 and 31st December 2014 were obtained from the CORECT-R data repository. Descriptive analyses and adjusted logistic regression models were undertaken to examine any association between age and the use of major resection and post-surgical outcomes. Funnel plots were used to show variation in adjusted rates of major resection.ResultsThe proportion of patients who underwent a major surgical resection fell from 66.5% to 31.7%, amongst those aged
ConclusionsNetwork pharmacology analysis revealed that the compounds isoquercitrin, quercitrin, berberine, chlorogenic acid and caffeic acid showed strong synergistic interactions with the cancer-related targets and pathways. It could be concluded that N. domestica Thunb. constituents affect both apoptosis and Akt-signaling pathways during the stages of early and intermediate adenoma through interaction with the targets CASP3 and MAPK1 (ErC2) while during the stages of late adenoma and carcinoma, the compounds acts through the p53 and ErbB signaling pathways.Graphical abstract
Condition: Locally Advanced Rectal Cancer Intervention: Drug: mFOLFOXIRI Sponsor: First Affiliated Hospital of Zhejiang University Recruiting
Conclusion: Low IMA ligation with dissection of LNs around the IMA origin showed no differences in anastomotic leakage rate compared with high IMA ligation, without affecting oncologic outcomes. High IMA ligation did not seem to increase the number of total harvested LNs, whereas the ratio of metastatic apical LNs were similar between groups. PMID: 31742210 [PubMed]
ConclusionTreatment decisions must be individualized, and depend on the presence of systemic disease. Selected patients may benefit from resection of metastases, and PET scan may be useful to identify patients who will benefit from resection.
Conclusions: The percentage of ADC increase, as an optimized predictor unaffected by different b-values, may have a significant role in differentiating those patients with a good response to N-CRT from those with a poor response. PMID: 31737679 [PubMed - in process]
Conditions: Ileostomy - Stoma; Ileostomy; Complications; Leakage, Anastomotic Intervention: Procedure: elective diverting ileostomy Sponsor: Campus Bio-Medico University Completed
MR imaging plays a crucial role in the post-CRT assessment of rectal cancer; results are used for treatment planning. Radiologists should assess response or progression, possibility of a complete response, risk factors for incomplete resection, and nodal stage. T2-weighted MR imaging with diffusion-weighted imaging yields the best results to identify a complete response, but endoscopy is also very important. Overstaging of transmural and MRF invasion after CRT occur regularly, owing to residual stranding regarded as tumor to err on the safe side. Nodal restaging is a challenge. A structured report format or checklist is recommended.
AbstractPurposePreoperative short-course radiotherapy (PSRT) and preoperative long-course radiotherapy (PLRT) are standard treatment regimens for locally advanced rectal cancer. However, whether the efficacy and safety of PSRT with delayed surgery (more than 4 weeks) are superior to those of PLRT remains unresolved and was explored in this meta-analysis.MethodsStudies published in PubMed, Embase, the Cochrane Library, andClinicalTrials.gov databases were systematically searched. RevMan 5.3 was used to calculate pooled hazard ratios (HR) and relative risk (RR).ResultsSeven studies including 4973 patients were identifi...
Conditions: Rectal Adenocarcinoma; Clinical Stage: Stage II (T3-4, N-); Stage III (Any T, N+) Interventions: Drug: TSR-042; Drug: capecitabine; Radiation: Intensity Modulated Radiation Therapy (IMRT) Sponsors: Memorial Sloan Kettering Cancer Center; Tesaro, Inc. Not yet recruiting
ConclusionCRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.