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  1. Article: Role of combined-modality therapy in the management of locally advanced rectal cancer.

    Hosein, Peter J / Rocha-Lima, Caio M

    Clinical colorectal cancer

    2008  Volume 7, Issue 6, Page(s) 369–375

    Abstract: ... combined-modality therapy because of higher rates of sphincter preservation, less toxicity, and lower local recurrence rates ... survival. Neoadjuvant combined chemotherapy and radiation therapy are superior to adjuvant ... the local recurrence rate, but not overall survival, in patients with resectable rectal cancer. The addition ...

    Abstract The majority of patients with nonmetastatic rectal cancer are candidates for an aggressive multimodality approach with curative intent. Preoperative staging is critical in determining which patients should be offered neoadjuvant therapy. Available staging tools include digital rectal examination, transrectal ultrasound, computed tomography, positron-emission tomography, and magnetic resonance imaging scans. Magnetic resonance imaging has emerged as the most accurate staging modality in experienced centers. Multidisciplinary preoperative patient evaluation, better staging techniques, neoadjuvant chemoradiation, acceptance of shorter distal rectal margins, and transanal excision of T1 N0 rectal tumors in close proximity to the anal sphincter have resulted in decreased rates of abdominoperineal resections. Total mesorectal excision has been adopted as the standard surgical approach because of a reduction in rates of pelvic relapse. Preoperative and postoperative radiation therapy was shown to decrease the local recurrence rate, but not overall survival, in patients with resectable rectal cancer. The addition of chemotherapy to radiation was consistently shown to improve local control, and in some trials, improved overall survival. Neoadjuvant combined chemotherapy and radiation therapy are superior to adjuvant combined-modality therapy because of higher rates of sphincter preservation, less toxicity, and lower local recurrence rates. For patients with stage II or III disease, neoadjuvant continuous-infusion 5-fluorouracil (5-FU), concurrently with pelvic radiation, followed by postoperative 5-FU-based chemotherapy, remains the standard multimodality approach. Ongoing trials are testing the integration of newer cytotoxic agents such as capecitabine, oxaliplatin, irinotecan, and biologic agents such as cetuximab and bevacizumab to chemoradiation.
    MeSH term(s) Clinical Trials as Topic ; Combined Modality Therapy ; Diagnostic Imaging ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Patient Care Team ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy ; Survival Analysis
    Language English
    Publishing date 2008-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2112638-0
    ISSN 1533-0028
    ISSN 1533-0028
    DOI 10.3816/CCC.2008.n.049
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  2. Article ; Online: The role of intraoperative radiotherapy in advanced rectal cancer: a meta-analysis.

    Fahy, Matthew R / Kelly, Michael E / Power Foley, Megan / Nugent, Timothy S / Shields, Conor J / Winter, Des C

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 8, Page(s) 1998–2006

    Abstract: Aim: Patients with locally advanced and locally recurrent rectal cancer (LARC/LRRC) experience ... of multimodal treatment for advanced rectal cancer from 2000 to 2020 and an analysis of IORT and surgery/external beam ... management of these challenging cases. However, clear evidence regarding the oncological benefit of IORT is ...

    Abstract Aim: Patients with locally advanced and locally recurrent rectal cancer (LARC/LRRC) experience higher rates of local recurrence (LR) and poorer overall survival than patients with primary rectal cancer restricted to the mesorectum despite improved neoadjuvant treatment regimens and radical surgical procedures. Intraoperative radiotherapy (IORT) has been suggested as an adjunctive tool in the surgical management of these challenging cases. However, clear evidence regarding the oncological benefit of IORT is sparse. The aim of this review was to update this evidence in the era of standardized neoadjuvant radiotherapy administration.
    Method: A systematic review of patients who received IORT as part of multimodal treatment for advanced rectal cancer from 2000 to 2020 and an analysis of IORT and surgery/external beam radiotherapy (EBRT) groups was performed. The primary endpoint was the rate of LR between the two groups.
    Results: Seven papers met the predefined criteria. LR was reduced by the addition of IORT when compared with the surgery/EBRT alone group (14.7% vs. 21.4%; OR 0.55, 95% CI 0.27-1.14; p = 0.11). There was no increase in reported genitourinary morbidity, wound issues, pelvic collections or anastomotic leak in those patients who received IORT. Notably, there was no survival difference between the two groups.
    Conclusion: The addition of IORT to current treatment strategies in the management of patients with LARC/LRRC is associated with a lower rate of locoregional recurrence without increased morbidity. However, this marks a highly selective group of patients, with heterogeneity regarding indications, prior neoadjuvant treatments and/or IORT dosing.
    MeSH term(s) Combined Modality Therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery
    Language English
    Publishing date 2021-05-17
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15698
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  3. Article ; Online: Role of Chemotherapy in the Neoadjuvant/Adjuvant Setting for Patients With Rectal Adenocarcinoma Undergoing Chemoradiotherapy and Surgery or Radiotherapy and Surgery.

    Ahmed, Shahab / Eng, Cathy

    Current oncology reports

    2018  Volume 20, Issue 1, Page(s) 3

    Abstract: ... In this article, we discuss the role of chemotherapy in both the neoadjuvant and the adjuvant settings for locally ... advanced rectal cancer. ... Rectal cancer has been successfully managed in the last couple of decades. In the USA ...

    Abstract Rectal cancer has been successfully managed in the last couple of decades. In the USA, as the initial approach, neoadjuvant concurrent chemoradiation has been associated not only with decrease in tumor size and recurrence but also with higher resection rate with minimal side effects. Data support that addition of chemotherapy to radiotherapy is superior to radiotherapy alone in the neoadjuvant setting. Recent debates have addressed the question of administration of adjuvant chemotherapy following surgery. In this article, we discuss the role of chemotherapy in both the neoadjuvant and the adjuvant settings for locally advanced rectal cancer.
    MeSH term(s) Adenocarcinoma/therapy ; Combined Modality Therapy/methods ; Humans ; Neoplasm Staging/methods ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy
    Language English
    Publishing date 2018-01-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057359-5
    ISSN 1534-6269 ; 1523-3790
    ISSN (online) 1534-6269
    ISSN 1523-3790
    DOI 10.1007/s11912-018-0652-7
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  4. Article: The role of ultrasound in primary workup of cervical cancer staging (ESGO, ESTRO, ESP cervical cancer guidelines).

    Fischerová, D / Cibula, D

    Ceska gynekologie

    2019  Volume 84, Issue 1, Page(s) 40–48

    Abstract: ... its role in the staging. Apart from the local extent of the disease, it is necessary to accurately evaluate ... on the diagnosis and management of cervical cancer. The European Society of Gynaecological Oncology (ESGO ... advanced cervical cancer (T1b2 and higher, except T2a1) or early stages with positive lymph nodes detected ...

    Title translation Role ultrazvuku ve stagingu zhoubného nádoru děložního hrdla (doporučení Evropské onkogynekologické, radiační a patologické společnosti).
    Abstract Objective: In 2018 three European societies have joined to create clinically relevant guidelines on the diagnosis and management of cervical cancer. The European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) agreed on diagnostic approaches in cervical cancer staging.
    Design: Review article.
    Setting: Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague.
    Methods: A literature review of published data on cervical cancer staging.
    Results: Physical examination with biopsy still has its place in histological confirmation of malignancy but doesnt offer much information on the extent of the disease. It is historically the first time when transvaginal/transrectal ultrasound (TVS/TRS) is recommended as an alternative to the magnetic resonance (MRI) in a primary workup. Both imaging modalities offer excellent soft tissue contrast resolution, which is crucial in tumour detection and evaluation of local extent of tumour, including the depth of tumour infiltration in the bladder and rectal wall. These new advances in imaging rendered the use of cystoscopy and rectoscopy redundant. Similarly, with the implementation of modern imaging in pretreatment staging, intravenous urography has lost its role in the staging. Apart from the local extent of the disease, it is necessary to accurately evaluate the lymph node status in order to plan optimal treatment. The detection rate of imaging reflects the prevalence of lymph node metastases depending on tumor stage and size of metastasis. In the early stage disease (T1a, T1b1, T2a1) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging of pelvic lymph nodes is a method of choice for detection of small volume metastases. Both imaging modalities might not detect small metastatic lesions within non-enlarged lymph nodes, but by identifying the characteristic changes of the infiltrated lymph nodes they have very low rate of false positives. In locally advanced cervical cancer (T1b2 and higher, except T2a1) or early stages with positive lymph nodes detected on ultrasound or MRI, computed tomography (CT) or CT in combination with positron emission tomography (PET-CT) are recommended to assess distant spread including paraaortic lymph nodes and chest. PET-CT is the preferred option in cases indicated for primary chemoradiation. Unfortunatelly no imaging method is accurate enough to exclude small volume metastasis in paraaortic nodes. In the cases with negative paraaortic lymph nodes on CT or PET-CT, surgicopathological staging with dissection of the paraaortic lymph nodes may be considered. In order to reduce false positive findings by imaging methods, it is recomended to obtain an ultrasound or CT-guided tru-cut biopsy from any equivocal extrauterine lesion to avoid inappropriate treatment.
    Conclusion: This review offers scientific evidence that led to the recent changes in the cervical cancer staging.
    MeSH term(s) Female ; Guidelines as Topic ; Humans ; Lymph Nodes/diagnostic imaging ; Lymphatic Metastasis/pathology ; Magnetic Resonance Imaging ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography ; Pregnancy ; Societies, Medical ; Ultrasonography/methods ; Uterine Cervical Neoplasms
    Language English
    Publishing date 2019-06-18
    Publishing country Czech Republic
    Document type Journal Article ; Review
    ZDB-ID 1187094-1
    ISSN 1805-4455 ; 1210-7832 ; 0374-6852
    ISSN (online) 1805-4455
    ISSN 1210-7832 ; 0374-6852
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  5. Article ; Online: Evolving role of neoadjuvant therapy in rectal cancer.

    Schrag, Deborah

    Current treatment options in oncology

    2013  Volume 14, Issue 3, Page(s) 350–364

    Abstract: ... from both radiation and systemic therapy. Currently, the standard approach to management of locally advanced (T3 or T2 ... Opinion statement: Management of locally advanced rectal cancer is complex because curative ... disease, preoperative systemic therapy followed by preoperative chemoradiation and then surgery may be ...

    Abstract Opinion statement: Management of locally advanced rectal cancer is complex because curative treatment routinely involves administration of surgery, chemotherapy, and radiation. Optimal treatment delivery sequencing and timing are challenging, and moreover, there is considerable heterogeneity in risk based on rectal tumor location, extent, and nodal involvement. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Currently, the standard approach to management of locally advanced (T3 or T2) rectal cancer involves careful staging with a pelvic MRI and proctoscopic evaluation by a surgeon experienced in total mesorectal excision. MRI can help to distinguish between patients in low-, intermediate-, and high-risk categories. Low-risk tumors have no evidence of either extramural spread or nodal involvement and proximal location in the rectum. For such patients, R0 resection is almost always possible and immediate surgery often is reasonable. In the minority of cases where unanticipated lymph node involvement is detected at surgical pathology, postoperative radiation can be administered. Patients who opt for up-front rectal surgery need to understand that although there is a chance that radiation can be avoided, if it is necessary, it is less well tolerated when administered postoperatively. Initial surgical treatment should be reserved for low-risk patients for whom imaging indicates and multidisciplinary team members feel is able to undergo an R0 resection with low chance for regional spread of disease. For patients with high-risk disease based on distal tumor location requiring an APR, threatened radial margins, or T4 tumors, preoperative chemoradiation is essential. Indeed, this approach increases the likelihood of complete surgical resection with negative margins. For some high-risk patients, for example those with T4 or bulky nodal disease, preoperative systemic therapy followed by preoperative chemoradiation and then surgery may be optimal. The feasibility of this approach is well established based on nonrandomized trials, but it has not been evaluated in a randomized study. Preoperative administration of systemic therapy can achieve clinical downstaging, optimize rates of sphincter preservation, and establish tumor responsiveness, which may be valuable for incorporation into future treatment decisions. For patients with intermediate-risk T3 rectal cancers, for example, a cT3N1 tumor 7 cm from the anal verge with two to three regional lymph nodes in the 7-mm range, we encourage participation in the PROSPECT randomized trial, which is now open and accruing at numerous centers in North America, and shortly in Europe and South America as well. This study will determine in the era of optimal imaging, surgical technique, and better systemic chemotherapy, whether pelvic radiation remains an essential component of curative treatment. The PROSPECT study uses chemoradiation selectively rather than automatically and customizes subsequent treatment based on response to neoadjuvant FOLFOX. Clinical trials with interventions that tailor treatment to more precisely defined clinical subgroups based on both initial features and tumor responsiveness are expected to become the norm. Although this trend is likely to make clinical trial design more complex, customized treatment strategies are likely to achieve the optimal balance between under- and overtreatment and will address the heterogeneity of both tumor biology and disease presentation. For now, treatment for a patient with clinical T3N1 tumor in the mid rectum consists of the following components: ·Neoadjvuant chemoradiation with either 5-fluorouracil or capecitabine as sensitizing therapy. ·Low anterior resection with total mesorectal excision. Typically a temporary diverting ostomy is required. ·Postoperative administration of adjuvant systemic therapy, 8 cycles of FOLFOX is appropriate, although oxaliplatin should be omitted for early signs of peripheral neuropathy or on the basis of age/comorbidity. Although this is the current care standard, there is concern that such extensive treatment is not necessary for all patients to prevent local recurrence and to optimize cure. To determine if therapy can be streamlined, participation in PROSPECT or other clinical trials asking compelling clinical questions is a priority.
    MeSH term(s) Adenocarcinoma ; Antineoplastic Combined Chemotherapy Protocols ; Capecitabine ; Chemoradiotherapy ; Combined Modality Therapy ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Fluorouracil/administration & dosage ; Fluorouracil/analogs & derivatives ; Humans ; Leucovorin/administration & dosage ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/radiotherapy ; Neoplasm Recurrence, Local/surgery ; Organoplatinum Compounds ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/pathology ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery
    Chemical Substances Organoplatinum Compounds ; Deoxycytidine (0W860991D6) ; Capecitabine (6804DJ8Z9U) ; Leucovorin (Q573I9DVLP) ; Fluorouracil (U3P01618RT)
    Language English
    Publishing date 2013-07-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2057351-0
    ISSN 1534-6277 ; 1527-2729
    ISSN (online) 1534-6277
    ISSN 1527-2729
    DOI 10.1007/s11864-013-0242-8
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  6. Article ; Online: Role of MRI for staging of rectal cancer.

    Jhaveri, Kartik S / Sadaf, Arifa

    Expert review of anticancer therapy

    2009  Volume 9, Issue 4, Page(s) 469–481

    Abstract: ... a challenge with routine MRI. In this review, we describe the role of MRI in staging rectal cancer as well ... at risk of local recurrence and those likely to benefit from neoadjuvant therapy. Compared with CT and ... Total mesorectal excision has been established as a standard surgical procedure for rectal cancer ...

    Abstract Total mesorectal excision has been established as a standard surgical procedure for rectal cancer. MRI is now routinely used for preoperative staging of rectal cancer and provides accurate assessment of the tumor relative to the circumferential margin, that is, the mesorectal fascia. This identifies patients at risk of local recurrence and those likely to benefit from neoadjuvant therapy. Compared with CT and ultrasound, MRI is more reliable for the evaluation of the extent of locoregional disease, planning radiation therapy, assessing postoperative changes and pelvic recurrence. The evaluation of nodal metastases remains a challenge with routine MRI. In this review, we describe the role of MRI in staging rectal cancer as well as highlight some limitations and recent advances to overcome these.
    MeSH term(s) Carcinoma/diagnostic imaging ; Carcinoma/pathology ; Carcinoma/radiotherapy ; Carcinoma/secondary ; Carcinoma/surgery ; Combined Modality Therapy ; Disease Management ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Neoadjuvant Therapy ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging/methods ; Pelvic Neoplasms/secondary ; Preoperative Care ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Sensitivity and Specificity ; Tomography, X-Ray Computed
    Language English
    Publishing date 2009-04
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2112544-2
    ISSN 1744-8328 ; 1473-7140
    ISSN (online) 1744-8328
    ISSN 1473-7140
    DOI 10.1586/era.09.13
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  7. Article ; Online: Modern rectal cancer multidisciplinary treatment: the role of radiation and surgery.

    Allaix, Marco E / Fichera, Alessandro

    Annals of surgical oncology

    2013  Volume 20, Issue 9, Page(s) 2921–2928

    Abstract: ... centered around the indication for neoadjuvant radiation therapy in locally advanced rectal cancer and ... the role of surgery in patients with complete clinical response after neoadjuvant combined modality therapy ... response.: Conclusions: The standard of care still requires that locally advanced rectal cancer ...

    Abstract Introduction: Treatment of rectal cancer has evolved during the last few decades due to more in-depth knowledge of rectal cancer biology and major advances in the field of preoperative staging, medical management and surgical techniques. Consequently, treatment strategies are shifting moving towards a more personalized approach based on the response to treatment. Currently topics of controversy are centered around the indication for neoadjuvant radiation therapy in locally advanced rectal cancer and the role of surgery in patients with complete clinical response after neoadjuvant combined modality therapy. This manuscript aims to critically evaluate the evolution of treatment of rectal cancer during the last three decades and future directions.
    Methods: A review of the literature has been performed in PubMed/Medline electronic databases.
    Results: Treatment modalities are moving towards a tailored approach to rectal cancer patients based on the response to chemoradiation. A "wait-and-see" approach and local excision by Transanal Endoscopic Microsurgery (TEM) are strategies recently proposed in case of complete clinical response.
    Conclusions: The standard of care still requires that locally advanced rectal cancer should be treated by neoadjuvant chemoradiation therapy followed by total mesorectal excision, including patients with a clinical complete response. Further evidence is needed to endorse a "wait-and-see" strategy and to define the role of TEM.
    MeSH term(s) Adenocarcinoma/therapy ; Combined Modality Therapy ; Humans ; Microsurgery ; Prognosis ; Radiotherapy, Adjuvant ; Rectal Neoplasms/therapy
    Language English
    Publishing date 2013-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-013-2966-x
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  8. Article ; Online: The role of capecitabine in locally advanced rectal cancer treatment: an update.

    Fernández-Martos, Carlos / Nogué, Miquel / Cejas, Paloma / Moreno-García, Víctor / Machancoses, Ana Hernández / Feliu, Jaime

    Drugs

    2012  Volume 72, Issue 8, Page(s) 1057–1073

    Abstract: ... by total mesorectal surgery is the current standard of care for locally advanced rectal cancer (LAR ... setting for rectal cancer management. The addition of other new antineoplastic agents ... in rectal cancer. The role of capecitabine in the postoperative adjuvant setting is the aim of the ongoing Dutch ...

    Abstract Preoperative infusional 5-fluorouracil (5-FU) and concurrent radiation therapy (RT) followed by total mesorectal surgery is the current standard of care for locally advanced rectal cancer (LAR). When compared with postoperative 5-FU-based chemoradiation, this strategy is associated with significantly lower rates of local relapse, lower toxicity and better compliance. Capecitabine is a rationally designed oral prodrug that is converted into 5-FU by intracellular thymidine phosphorylase. Substitution of infusional 5-FU with capecitabine is an attractive option that provides a more convenient administration schedule and, possibly, increased efficacy. Indeed, incorporation of capecitabine in combined modality neoadjuvant therapy for LAR has been under intense investigation during the last 10 years. Phase I and II clinical trials showed that a regimen consisting of capecitabine 825mg/m(2) twice daily for 7 days/week continuous oral administration in combination with RT is an active and well tolerated regimen, thereby being the preferred concurrent regimen. The definitive demonstration that efficacy of capecitabine/RT is similar to 5-FU/RT has been provided by the NSABP-R-04 and the German Margit trials. One approach to improve outcomes in rectal cancer is to deliver a second RT-sensitizing drug with effective systemic activity. Oxaliplatin and irinotecan are therefore good candidates. However, two phase III trials demonstrated that incorporation of oxaliplatin to capecitabine with RT did not improve early outcomes and, by contrast, increased toxicity. Capecitabine has also been combined with irinotecan. This regimen showed encouraging results in phase I and II clinical trials, which led to an ongoing phase III clinical trial. New strategies with induction chemotherapy with or without chemoradiation prior to surgery are currently under investigation. Whether or not capecitabine has a role in this setting is being investigated in ongoing trials. Incorporation of agents directed towards new targets, such as anti-epidermal growth factor receptor (EGFR) antibodies or antiangiogenic agents, in combination preoperative regimens, is being hampered by results of early trials in which efficacy outcomes with cetuximab were poor and an excessive rate of surgical complications with bevacizumab was observed. The lack of improvements in efficacy with the addition of cetuximab or bevacizumab in the adjuvant treatment of colon cancer led to concerns about further development of these agents in rectal cancer. The role of capecitabine in the postoperative adjuvant setting is the aim of the ongoing Dutch SCRIPT trial. The prediction of response associated with capecitabine has been based on expression of thymidylate synthase and dihydropyrimidine dehydrogenase, as well as on gene expression arrays. All these procedures require further validation and should be considered as investigational. In conclusion, capecitabine can safely and effectively replace intravenous continuous infusion of 5-FU in the preoperative chemoradiation setting for rectal cancer management. The addition of other new antineoplastic agents to a fluoropyrimidine-based regimen remains investigational.
    MeSH term(s) Antineoplastic Agents/therapeutic use ; Capecitabine ; Clinical Trials as Topic ; Deoxycytidine/analogs & derivatives ; Deoxycytidine/therapeutic use ; Fluorouracil/analogs & derivatives ; Fluorouracil/therapeutic use ; Humans ; Neoadjuvant Therapy/methods ; Randomized Controlled Trials as Topic ; Rectal Neoplasms/drug therapy
    Chemical Substances Antineoplastic Agents ; Deoxycytidine (0W860991D6) ; Capecitabine (6804DJ8Z9U) ; Fluorouracil (U3P01618RT)
    Language English
    Publishing date 2012-05-23
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 120316-2
    ISSN 1179-1950 ; 0012-6667
    ISSN (online) 1179-1950
    ISSN 0012-6667
    DOI 10.2165/11633870-000000000-00000
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  9. Article ; Online: Role of pelvic exenteration in the management of locally advanced primary and recurrent rectal cancer.

    Xin, Koh Ye / Ng, Deanna Wan Jie / Tan, Grace Hwei Ching / Teo, Melissa Ching Ching

    Journal of gastrointestinal cancer

    2014  Volume 45, Issue 3, Page(s) 291–297

    Abstract: ... for patients with locally advanced primary and recurrent rectal cancer. The perioperative outcomes, morbidity ... pelvic exenterations for recurrent and locally advanced rectal cancer between 1 January 2006 and 1 August 2012 were ... Patients with locally advanced primary rectal cancer were counselled for pre-operative chemoradiation ...

    Abstract Aim: A review of a single-centre experience of pelvic exenteration as a treatment modality for patients with locally advanced primary and recurrent rectal cancer. The perioperative outcomes, morbidity and long term oncological outcomes are reviewed.
    Materials & methods: Patients undergoing pelvic exenterations for recurrent and locally advanced rectal cancer between 1 January 2006 and 1 August 2012 were identified from a prospective database. All patients underwent pre-operative staging investigations with computed tomography (CT) scan of chest, abdomen and pelvis and pelvic magnetic resonance imaging (MRI). Patients with locally advanced primary rectal cancer were counselled for pre-operative chemoradiation. Structures such as the urinary bladder and female reproductive organs were resected en bloc where indicated with the lesion. Urological or plastic reconstructions were employed where indicated. The primary outcome measured was overall survival and secondary outcomes measured were time to local recurrence (LR) and systemic recurrence. Disease-free survival was examined by the Kaplan-Meier Method (Fig. 1).
    Results: Pelvic exenterations were performed in 13 patients with a median age of 59 (range 26-81). The rate of major post-operative complications was 8% (n = 1), where the patient had anastomotic leakage. There were no mortalities in the perioperative period. All patients were operated with curative intent and negative circumferential margins were shown in 9 out of 13 patients (70%). The DFS was 19.4 and the OS was 22.5 months.
    Conclusion: An aggressive approach with en bloc resection of organs involved provides survival benefit to patients with locally advanced primary and recurrent rectal cancer with an acceptable morbidity profile.
    MeSH term(s) Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak/epidemiology ; Blood Loss, Surgical ; Chemoradiotherapy ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Operative Time ; Pelvic Exenteration/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Recurrence ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2014-02-22
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ZDB-ID 2452514-5
    ISSN 1941-6636 ; 1559-0739 ; 1941-6628 ; 1537-3649
    ISSN (online) 1941-6636 ; 1559-0739
    ISSN 1941-6628 ; 1537-3649
    DOI 10.1007/s12029-014-9586-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: The role of radiation therapy in the management of lung, prostate and colorectal cancer in South Dakota.

    Swartz, Michael J / Petereit, Daniel G

    South Dakota medicine : the journal of the South Dakota State Medical Association

    2010  Volume Spec No, Page(s) 60–66

    Abstract: Radiation therapy has a pivotal role in the management of lung, breast, prostate and ... caused by locally advanced or metastatic disease. In this article, we review the role of radiation ... combined with chemotherapy and/or surgery. Radiotherapy also provides effective palliation of symptoms ...

    Abstract Radiation therapy has a pivotal role in the management of lung, breast, prostate and colorectal cancer. It is frequently used with curative intent as a single treatment modality or, more frequently, combined with chemotherapy and/or surgery. Radiotherapy also provides effective palliation of symptoms caused by locally advanced or metastatic disease. In this article, we review the role of radiation in the treatment of lung, colon and prostate cancer. We also discuss ongoing clinical trials and a unique cancer disparity program, "Walking Forward", that investigates methods of improving access to cancer care, with the ultimate goal of improving cancer cure rates.
    MeSH term(s) Clinical Trials as Topic ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/radiotherapy ; Female ; Humans ; Lung Neoplasms/epidemiology ; Lung Neoplasms/radiotherapy ; Male ; Prostatic Neoplasms/epidemiology ; Prostatic Neoplasms/radiotherapy ; South Dakota/epidemiology
    Language English
    Publishing date 2010
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2278073-7
    ISSN 0038-3317
    ISSN 0038-3317
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