Clinical Target Volume Definition in Preoperative Radiotherapy of Rectal Carcinoma: a Systematic Review
AbstractPurpose of ReviewPreoperative radiotherapy (RT) or chemoradiation represents a standard option in neoadjuvant treatment of rectal cancer (RC). The aim of this analysis is to present a systematic review of clinical target volume (CTV) definition in preoperative RT of RC.A systematic review of published literature was performed. Studies providing clear indications for CTV definition in preoperative RT of RC were eligible. Only studies published as full text were considered. The search was restricted to English, German, and French languages. The CTV delineation, based on the different guidelines, was drawn on selected...
Source: Current Colorectal Cancer Reports - June 21, 2017 Category: Cancer & Oncology Source Type: research
The Role of CT Colonography as a Screening Tool for Colorectal Cancer
AbstractMost colorectal cancers (CRC) are preventable through screening and polyp removal; however, CRC remains fixed as the second leading cause of cancer mortality in the USA. This is largely due to suboptimal screening participation. This review of current literature explores the use of CT colonography (CTC), also known as virtual colonoscopy, as another option for CRC screening. Relevant recent research topics include exploring the elimination of pre-procedure colon cleansing, the extension of recommended CTC screening intervals, the implications of extracolonic findings, and the significance of CTC radiation dose in a...
Source: Current Colorectal Cancer Reports - June 20, 2017 Category: Cancer & Oncology Source Type: research
Colonoscopy and Flexible Sigmoidoscopy in Colorectal Cancer Screening and Surveillance
AbstractSince the invention of endoscopy in the 1800s, colonoscopy and flexible sigmoidoscopy have evolved into important tools in the diagnosis and treatment of lower gastrointestinal luminal diseases. These two modalities along with biochemical markers and widespread implementation of colorectal cancer (CRC) screening are responsible for the overall downtrend of CRC. However, this downward trend is not as robustly reflected in the right-sided CRC. It is thought that flat lesions in the right colon (sessile serrated polyp (SSA/P)), suboptimal colon preparation, differences in gender, and endoscopic techniques are some of ...
Source: Current Colorectal Cancer Reports - June 20, 2017 Category: Cancer & Oncology Source Type: research
Inflammation and Colorectal Cancer
AbstractPurpose of ReviewColorectal cancer (CRC) is the fourth most common cancer in both men and women in the USA, resulting in over 55,000 deaths annually. Environmental and genetic factors influence the development of CRC, and inflammation is a critical hallmark of cancer that may arise from a variety of factors. While patients with inflammatory bowel disease (IBD) have a higher risk of developing CRC, sporadic CRCs may engender or be potentiated by inflammation as well. In this review, we focus on recent advances in basic and translational research utilizing murine models to understand the contribution of inflammatory ...
Source: Current Colorectal Cancer Reports - June 17, 2017 Category: Cancer & Oncology Source Type: research
Resistance Mechanisms to Colorectal Cancer Therapeutics and the Clinical Implications
AbstractPurpose of ReviewColorectal cancer (CRC) is a leading cause of cancer-related death and additional treatment options are urgently needed. Cytotoxic chemotherapy has been the mainstay of treatment options for patients for many years, including FOLFOX (leucovorin, 5-fluorouracil (5-FU), and oxaliplatin) or FOLFIRI (5-FU, leucovorin, and irinotecan) Here we review the current clinical use of systemic therapies for metastatic CRC and mechanisms of resistance to these agents.Recent FindingsBiologic therapies, including anti-angiogenic and anti-epidermal growth factor monoclonal antibodies, have shown increased efficacy ...
Source: Current Colorectal Cancer Reports - June 16, 2017 Category: Cancer & Oncology Source Type: research
Treatment of Refractory Colorectal Cancer: Regorafenib vs. TAS-102
AbstractPurpose of ReviewThis paper reviews the development, mechanism of action, clinical efficacy, and safety of regorafenib and TAS-102. Through this review, we aimed to help clinicians make an appropriate choice in patients who progressed after standard therapies.Recent FindingsRegorafenib and TAS-102 have shown superior survival results compared with placebo in refractory metastatic colorectal cancer (mCRC). In the phase III CORRECT study, regorafenib showed significant improvement in overall survival (OS) and progression-free survival (PFS). TAS-102 was associated with OS and PFS benefit as well in the phase III RECO...
Source: Current Colorectal Cancer Reports - June 14, 2017 Category: Cancer & Oncology Source Type: research
Quality Colorectal Cancer Screening: Endoscopic Performance Measures and Beyond
This article will evaluate recent data on this subject and summarize pertinent findings in the growing field of quality improvement research surrounding colonoscopy for CRC screening.Recent FindingsBoth pre- and intra-procedural metrics have been studied across a variety of practice models and patient populations. Contemporary metrics include adequate bowel preparation, cecal intubation rate, adenoma detection rate, polypectomy rate, proximal serrated polyp detection rate, withdrawal time, and patient satisfaction.SummaryMultiple quality metrics have been formally evaluated regarding colonoscopy, and others have recently b...
Source: Current Colorectal Cancer Reports - June 13, 2017 Category: Cancer & Oncology Source Type: research
Current Trends in the Use of Bowel Preparation for Colorectal Surgery
This article reviews recent findings in the use of bowel preparation for preventing infectious complications after colorectal surgery.Recent FindingsWhereas mechanical bowel preparation (MBP) was formerly used routinely in combination with prophylactic non-absorbable oral antibiotics (OAs) and prophylactic intravenous antibiotics, there was a trend toward omitting OAs in the 1990s and early 2000s. Since the mid-2000s, the use of MBP has declined given evidence of the limited role of MBP alone in preventing infectious complications. However, recent studies have demonstrated favorable outcomes after MBP when used in combinat...
Source: Current Colorectal Cancer Reports - May 31, 2017 Category: Cancer & Oncology Source Type: research
Chemoprevention of Colorectal Cancer in High-Risk Patients: from Molecular Targets to Clinical Trials
AbstractAn increased understanding of the molecular pathways involved in colorectal carcinogenesis has helped researchers to develop possible chemopreventive strategies. This has been of particular relevance for high-risk subjects, for whom chemopreventive strategies may be helpful in slowing cancer development. In order to obtain more definitive data on chemopreventive agents, there has been a great effort to develop preclinical models that resemble the clinical scenarios encountered in high-risk patients. Importantly, many compounds, in particular non-steroidal anti-inflammatory drugs, have shown significant effects in m...
Source: Current Colorectal Cancer Reports - May 20, 2017 Category: Cancer & Oncology Source Type: research
Current Views on the Interval Between Neoadjuvant Chemoradiation and Surgery for Rectal Cancer
AbstractNeoadjuvant chemoradiation (CRT) has been established as standard treatment for stage II and III rectal cancer, and delayed interval between CRT and rectal resection has emerged as appropriate treatment due to the marked benefits associated with this approach. Despite favorable findings on downstaging and pathological complete response without increasing in morbidity and mortality, no significant improvement in sphincter preservation rate and rectal cancer overall survival has been observed with the current recommended 6 –8-week interval. Trials are currently underway and may provide answers regarding the optimal...
Source: Current Colorectal Cancer Reports - May 4, 2017 Category: Cancer & Oncology Source Type: research
DNA Mismatch Repair and Lynch Syndrome
AbstractPurpose of ReviewThis review will discuss the genetic basis and epidemiology of Lynch syndrome, review Lynch Syndrome colorectal cancer screening guidelines, and summarize the screening guidelines pertaining to other cancers that are associated with Lynch syndrome.Recent FindingsAll colorectal tumors should be universally tested for microsatellite instability (MSI) changes regardless of the age of the patient. Genetic testing of family members of patients with Lynch syndrome has significant cost effectiveness implications. Polyethylene glycol bowel preparation and chromocolonoscopy improve screening exams. Aspirin ...
Source: Current Colorectal Cancer Reports - April 21, 2017 Category: Cancer & Oncology Source Type: research
Anti-EGFR and Anti-VEGF Agents in First-Line Therapy for Advanced Colorectal Cancer
AbstractOutcomes for metastatic colorectal cancer have improved progressively with the incorporation of new drugs into standard treatment regimens. Most recently, targeted therapies against VEGF and EGFR have improved upon the prior standard for first-line therapy with FOLFOX or FOLFIRI. As attempts to combine anti-VEGF and anti-EGFR drugs have been unsuccessful, it is necessary to choose between them when beginning first-line therapy. This review summarizes the existing literature to best inform this decision. To date, three head-to-head trials have compared anti-EGFR and anti-VEGF therapy in RAS wild-type patients: PEAK,...
Source: Current Colorectal Cancer Reports - April 21, 2017 Category: Cancer & Oncology Source Type: research
Using 3D Organoid Cultures to Model Intestinal Physiology and Colorectal Cancer
AbstractPurpose of ReviewThe three-dimensional (3D) structure of the intestine is a key determinant of differentiation and function; thus, preserving this architecture is an important consideration for studies of intestinal homeostasis and disease. Over the past decade, a number of systems for 3D intestinal organoid cultures have been developed and adapted to model a wide variety of biological phenomenon. We discuss the current state of intestinal and colorectal cancer (CRC) 3D modeling, the most common methods for generating organoid cultures, and how these have yielded insights into intestinal physiology and tumor biolog...
Source: Current Colorectal Cancer Reports - April 18, 2017 Category: Cancer & Oncology Source Type: research
Personalizing Maintenance Therapy in Metastatic Colorectal Cancer
AbstractPurpose of ReviewCurrent systemic management of MCRC should include periods of intensive and less intensive treatment or even complete stop. Different systemic post-induction strategies have been evaluated in many trials. The aim of this article is to review the available data on maintenance strategies in MCRC and potential options to personalize choice of the respective strategy.Recent FindingsDespite the large variability of clinical trials conducted in this setting, it can be concluded that intermittent chemotherapy does not seem to be inferior to continuous chemotherapy if at least 3 months of intensive induc...
Source: Current Colorectal Cancer Reports - April 18, 2017 Category: Cancer & Oncology Source Type: research
Personalizing Colon Cancer Screening: Role of Age and Comorbid Conditions
AbstractPurpose of ReviewThis review will discuss the impact of patient age and comorbidity on colorectal cancer (CRC) screening value.Recent FindingsSociety guidelines recommend CRC screening starting at age 50 in average-risk individuals, but there is less agreement about when screening should be discontinued. In clinical practice, CRC screening and follow-up recommendations among elderly patients appear to be driven more by chronological age than by comorbid illnesses. However, several studies have highlighted the interaction between age and comorbidity burden when selecting appropriate patients for CRC screening. Altho...
Source: Current Colorectal Cancer Reports - April 18, 2017 Category: Cancer & Oncology Source Type: research
