What Rectal Cancer Patients May Be Able to Safely Avoid Radiation?
Abstract   Purpose of ReviewRectal cancers are treated with chemotherapy, radiotherapy, and surgery. While trials have illustrated the benefits of radiotherapy for locoregional control, recent investigations have questioned the need in select cases. This review seeks to understand why, how, and when radiation can be omitted from rectal cancer management.Recent FindingsAbsolute contraindications of radiation include pregnancy, and relative contraindications include fertility concerns, sexual outcomes, autoimmune conditions, and prior radiation. Low-risk features of rectal cancer might warrant the omission of neoadjuvant ...
Source: Current Colorectal Cancer Reports - January 11, 2023 Category: Cancer & Oncology Source Type: research

Emerging Role of Brachytherapy in the Non-operative Management of Rectal Cancer
AbstractPurpose of reviewThe non-operative management of rectal cancer is an area of active research. Dose-escalated radiotherapy may improve sustained local control but toxicity is a concern. Brachytherapy is emerging as a promising boost technique that may confer dosimetric advantages over external beam radiotherapy (EBRT) –based boosts.Recent findingsPreliminary findings from two multicenter prospective randomized phase II/III trials suggest high rates of sustained 2-year local control with a combination of EBRT and either contact X-ray brachytherapy or high dose rate endorectal brachytherapy compared with an EBRT boo...
Source: Current Colorectal Cancer Reports - November 11, 2022 Category: Cancer & Oncology Source Type: research

Toxicity Management in the Era of Changing Treatment Paradigms for Locally Advanced Rectal Cancer
AbstractPurpose of ReviewTreatment paradigms for locally advanced rectal cancer have evolved over the last several decades. Patients now have several different “standard” options with different radiation courses, sequencing of treatment modality and in some scenarios potentially avoidance of surgery. In this context, an updated understanding of treatment toxicity is needed to help patients make informed decision regarding their treatment.Recent FindingsThe RAPIDO study showed no difference in cumulative rate or grade of toxicity between short and long course radiation. Based upon our experience, patients with short cou...
Source: Current Colorectal Cancer Reports - November 7, 2022 Category: Cancer & Oncology Source Type: research

Local Therapies for Colorectal Cancer Oligometastases to the Lung
AbstractPurpose of ReviewThere is a growing consensus that oligometastatic disease-directed treatment is associated with improved oncologic outcomes in patients with colorectal cancer; however,the optimal local management of pulmonary oligometastases remains controversial.Recent FindingsWhile surgery has traditionally been recognized as the gold standard local treatment for pulmonary metastases, there is no prospective data supporting a significant benefit of pulmonary metastasectomy (PME) compared to other local treatment modalities, such as stereotactic ablative radiotherapy (SABR) or radiofrequency ablation (RFA). There...
Source: Current Colorectal Cancer Reports - June 10, 2022 Category: Cancer & Oncology Source Type: research

Surgical Management of Metastatic Colorectal Cancer
AbstractPurpose of ReviewThe surgical management of metastatic colorectal cancer (CRC) has evolved over time. Most often, the management of asymptomatic primary CRC with simultaneous liver metastases (LM) proceeds with neoadjuvant chemotherapy followed by surgical resection. Although the timing of surgical resection has remained controversial, the ability to achieve R0 resection and the importance of patient selection remain widely accepted.Recent FindingsPreoperative novel modalities such as portal vein ligation (PVL) or portal vein embolization (PVE) have allowed for improved surgical outcomes and decreased post-surgical...
Source: Current Colorectal Cancer Reports - April 18, 2022 Category: Cancer & Oncology Source Type: research

Current Updates on HER2 –Directed Therapies in Metastatic Colorectal Cancer
AbstractPurpose of ReviewColorectal cancer is the third most common malignancy in the USA with 20% of patients presenting with metastatic disease. While first line agents include cytotoxic chemotherapy regimens, targeted therapies have an increasing role in the management of metastatic colorectal cancer (mCRC). Next Generation Sequencing (NGS) has expanded the ability to identify HER2 variations and is crucial to the next steps in personalized medicine.Recent FindingsAnti-HER2 therapies provide a promising treatment option for patients who have exhausted traditional  regimens including those who have failed prior anti-HER...
Source: Current Colorectal Cancer Reports - April 9, 2022 Category: Cancer & Oncology Source Type: research

Liver-Directed Therapy for Metastatic Colon Cancer: Update
AbstractPurpose of ReviewTo discuss the emerging technologies in the field of Interventional radiology (IR) for the management of metastatic colorectal cancer (mCRC). We review the field of selective internal radiation therapy (SIRT), and well-known IR treatments, with a more focused investigation of radioembolization with Yttrium-90 (Y-90).Recent FindingsState-of-the-art treatment modalities for unresectable hepatic malignancies are crucial to increased patient survival. There are many options for the treating physician to manage and potentially cure patient ’s disease, with Y-90 as the cornerstone of liver neoplasm tre...
Source: Current Colorectal Cancer Reports - March 23, 2022 Category: Cancer & Oncology Source Type: research

Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Colectomy: A Meta-Analysis and Systematic Review
AbstractPurpose of ReviewLaparoscopic hemicolectomy (LHC) is widely used to treat benign and malignant colorectal disease. However, the optimal method to restore intestinal continuity is still controversial; hence, this study aims to compare the safety and efficacy of intracorporeal anastomosis (IA) with extracorporeal anastomosis (EA).Recent FindingsCurrent literature comprises largely of retrospective cohort studies and three significant randomized controlled trials examining the differences between IA and EA in mostly right-sided colectomies. The evidence points to superior intraoperative and postoperative outcomes such...
Source: Current Colorectal Cancer Reports - March 23, 2022 Category: Cancer & Oncology Source Type: research

Imaging Advances on CT and MRI in Colorectal Cancer
AbstractPurpose of ReviewColorectal cancer (CRC) is the most common gastrointestinal neoplasm. Imaging plays a key role in the primary diagnosis, risk stratification and prognosis, therapy planning, treatment response assessment, follow-up, and, to some extent, also in prevention of CRC. The most used imaging modalities for the evaluation of these tumours are computed tomography (CT) and magnetic resonance imaging (MRI). We review the literature and, drawed on our own experience, evaluate recent innovations in hardware, software (including artificial intelligence), and analytic tools that are opening new possibilities to C...
Source: Current Colorectal Cancer Reports - December 11, 2021 Category: Cancer & Oncology Source Type: research

The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer
AbstractPurpose of ReviewThis review describes recent data supporting locoregional ablative radiation in the treatment of oligometastatic colorectal cancer liver metastases.Recent FindingsStereotactic body radiotherapy (SBRT) demonstrates high rates of local control in colorectal cancer liver metastases when a biologically equivalent dose of  >  100 Gy is delivered. Future innovations to improve the efficacy of SBRT include MRI-guided radiotherapy (MRgRT) to enhance target accuracy, systemic immune activation to treat extrahepatic disease, and genomic customization. Selective internal radiotherapy (SIRT) with y-90 ...
Source: Current Colorectal Cancer Reports - December 1, 2021 Category: Cancer & Oncology Source Type: research

Recent Advances in Functional MRI to Predict Treatment Response for Locally Advanced Rectal Cancer
AbstractPurpose of ReviewEarly response prediction for locally advanced rectal cancer (LARC) provides an opportunity for response-tailored treatment management. The goal of this review is to summarize recent advances in applying functional MRI, such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), to predict treatment response for LARC patients, as well as to discuss the associated limitations and future directions.Recent FindingsMany recent studies incorporated advanced data analysis methods, such as radiomics and deep learning, to enhance prediction performance. Multi-parametric imaging ha...
Source: Current Colorectal Cancer Reports - November 12, 2021 Category: Cancer & Oncology Source Type: research

Current Trends in the Treatment of Locally Advanced Rectal Cancer: Where We Are and How We Got Here
AbstractPurpose of ReviewThe trimodal treatment for LARC —surgery, radiotherapy, and chemotherapy—has been the standard of care for more than 30 years but is facing fresh challenges. Major contemporary developments include the delivery of full systemic chemotherapy in the preoperative period, with or without chemoradiation (total neoadjuvant therapy or “TNT”), and the withholding of surgery for patients who achieve a complete clinical response (cCR) to initial treatment (“watch-and-wait”). We review the historical development of these trends and propose an approach to LARC treatment that integrates newly emerg...
Source: Current Colorectal Cancer Reports - November 6, 2021 Category: Cancer & Oncology Source Type: research

Current Treatment Landscape for Third- or Later-Line Therapy in Metastatic Colorectal Cancer
AbstractPurpose of ReviewThe aim of this paper is to summarize the current treatment landscape in metastatic colorectal cancer, as well as those on the horizon in the third-line and beyond settings.Recent FindingsHerein, recent data regarding TAS-102, regorafenib, and novel anti-angiogenic agents are described. Data on chemotherapy re-challenge and EGFR re-challenge is reviewed. A summary of data on the use of BRAF-targeted therapies, HER-2-targeted therapies, rare fusions (NTRK, RET), MET amplification, and KRAS G12C is included, as well as a brief review on the current role of immune checkpoint inhibitors in metastatic c...
Source: Current Colorectal Cancer Reports - October 23, 2021 Category: Cancer & Oncology Source Type: research

Role of MR-guided Radiotherapy (MRgRT) in Colorectal Cancer
AbstractPurpose of ReviewThe current standard treatment for locally advanced or metastatic colorectal cancer often includes radiotherapy delivered under computed tomography (CT) –based image guidance. Magnetic resonance–guided radiotherapy (MRgRT) offers a substantial improvement in target and adjacent organ visualization and allows for real-time imaging throughout treatment to ensure target accuracy with each fraction. However, this technology is in its relative infanc y, with many open questions regarding how to maximize the potential of this new treatment modality. We review the literature and share our institutiona...
Source: Current Colorectal Cancer Reports - September 4, 2021 Category: Cancer & Oncology Source Type: research

Precision Medicine for the Treatment of Colorectal Cancer: the Evolution and Status of Molecular Profiling and Biomarkers
AbstractPurpose of ReviewThe application of advanced genomic testing to develop tumor-specific molecular profiles is essential to facilitating precision medicine pharmacotherapy. These approaches are highly relevant in colorectal cancer, where tumors frequently contain druggable molecular mutations, as well as the potential to respond to immunotherapy. Here we review the literature characterizing biomarker-driven pharmacotherapy for colorectal cancer, and highlight the pivotal ongoing trials that will help inform future treatment of this disease.Recent FindingsBoth prospective and retrospective studies have confirmed that ...
Source: Current Colorectal Cancer Reports - July 22, 2021 Category: Cancer & Oncology Source Type: research