scholarly journals Staging of Locally Advanced Rectal Cancer Beyond TME

2020 ◽  
Vol 33 (05) ◽  
pp. 258-267
Author(s):  
Deborah S. Keller
Keyword(s):  
Rectal Cancer ◽  
Best Practice ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Advanced Rectal Cancer ◽  
Cancer Staging ◽  
Locally Advanced Rectal Cancer ◽  
Multidisciplinary Teams ◽  
Treatment Decision Making

AbstractThe management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI allows a noninvasive assessment of the tumor site, relationship to surrounding structures, and provides highly accurate rectal cancer staging, which is necessary for determining the appropriate treatment strategy. However, the applications of MRI extend far beyond pretreatment staging. MRI can be used to predict outcomes in locally advanced rectal cancer and guide the surgical or nonsurgical plan, serving as a predictive and prognostic biomarker. With continued MRI hardware improvement and new sequence development, MRI may offer new perspectives in the assessment of treatment response and new innovations that could provide better insight into the staging, restaging, and outcomes with rectal cancer.

scholarly journals Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

2020 ◽  
Vol 27 (11) ◽  
pp. 4319-4336 ◽  
Author(s):  
S. Hoendervangers ◽  
J. P. M. Burbach ◽  
M. M. Lacle ◽  
M. Koopman ◽  
W. M. U. van Grevenstein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Treatment Strategies ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Abstract Background Pathological complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) is associated with better survival, less local recurrence, and less distant failure. Furthermore, pCR indicates that the rectum may have been preserved. This meta-analysis gives an overview of available neoadjuvant treatment strategies for LARC and analyzes how these perform in achieving pCR as compared with the standard of care. Methods Pubmed, Embase, and Cochrane Central bibliographic databases were searched. Randomized controlled trials in which patients received neoadjuvant treatment for MRI-staged nonmetastatic resectable LARC were included. The primary outcome was pCR, defined as ypT0N0. A meta-analysis of studies comparing an intervention with standard fluoropyrimidine-based chemoradiation (CRT) was performed. Results Of the 17 articles included in the systematic review, 11 were used for the meta-analysis. Addition of oxaliplatin to fluoropyrimidine-based CRT resulted in significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ grade 3 toxicity. Other treatment strategies, including consolidation/induction chemotherapy and short-course radiotherapy (SCRT), did not improve pCR rates. None of the included trials reported a benefit in local control or OS. Five-year DFS was significantly worse after SCRT-delay compared with CRT (59% vs. 75.1%, HR 1.93). Conclusions All included trials fail to deliver high-level evidence to show an improvement in pCR compared with standard fluoropyrimidine-based CRT. The addition of oxaliplatin might result in more pCR but at the expense of more toxicity. Furthermore, this benefit does not translate into less local recurrence or improved survival.

Multimodal treatment strategies for locally advanced rectal cancer

2012 ◽  
Vol 12 (4) ◽  
pp. 481-494 ◽  
Author(s):  
Georg F Weber ◽  
Robert Rosenberg ◽  
Janet E Murphy ◽  
Christian Meyer zum Büschenfelde ◽  
Helmut Friess
Keyword(s):  
Rectal Cancer ◽  
Multimodal Treatment ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Emerging strategies in the initial management of locally advanced rectal cancer

2019 ◽  
Vol 15 (25) ◽  
pp. 2955-2965 ◽  
Author(s):  
Lucy Gately ◽  
Hui-Li Wong ◽  
Jeanne Tie ◽  
Rachel Wong ◽  
Margaret Lee ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Treatment Plan ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Current Standard ◽  
Initial Management

The initial management of locally advanced rectal cancer continues to evolve and formulating the ideal treatment plan remains challenging, with a multitude of emerging treatment strategies and either limited or inconsistent data to support these. The main objective of neoadjuvant treatment is to maximize disease control and minimize toxicity and impact on quality of life. Ultimately, the optimal approach needs to be personalized to the individual. In this Review, we discuss the various strategies currently used and being further investigated in the initial treatment of patients presenting with locally advanced rectal cancer. We describe the evidence behind the current standard of care recommendations and emerging new options, as well as potential biomarkers that may assist with further refining treatment selection.

2056 Locally advanced rectal cancer with neoadyuvant treatment strategies: Our experiences

2015 ◽  
Vol 51 ◽  
pp. S347
Author(s):  
M.L. Blanco Villar ◽  
A. Rodriguez Gutierrez ◽  
A. Nieto Palacio ◽  
A. Matias Perez ◽  
P Soria Carreras ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

scholarly journals Pre-clinical modelling of rectal cancer to develop novel radiotherapy-based treatment strategies

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael A. Gillespie ◽  
Colin W. Steele ◽  
Tamsin R.M. Lannagan ◽  
Owen J. Sansom ◽  
Campbell S.D. Roxburgh
Keyword(s):  
Rectal Cancer ◽  
Mouse Models ◽  
Adjuvant Treatment ◽  
Relevant Literature ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Recurrence Rates ◽  
Advantages And Disadvantages

Pre-operative chemoradiotherapy reduces local recurrence rates in locally advanced rectal cancer. 10-20% of patients undergo complete response to chemoradiotherapy, however, many patients show no response. The mechanisms underlying this are poorly understood; identifying molecular and immunological factors underpinning heterogeneous responses to chemoradiotherapy, will promote development of treatment strategies to improve responses and overcome resistance mechanisms. This review describes the advances made in pre-clinical modelling of colorectal cancer, including genetically engineered mouse models, transplantation models, patient derived organoids and radiotherapy platforms to study responses to chemoradiotherapy. Relevant literature was identified through the PubMed and MEDLINE databases, using the following keywords: rectal cancer; mouse models; organoids; neo-adjuvant treatment; radiotherapy; chemotherapy. By delineating the advantages and disadvantages of available models, we discuss how modelling techniques can be utilized to address current research priorities in locally advanced rectal cancer. We provide unique insight into the potential application of pre-clinical models in the development of novel neo-adjuvant treatment strategies, which will hopefully guide future clinical trials.

scholarly journals Computertomography-Based Prediction of Complete Response Following Neoadjuvant Chemoradiotherapy of Locally Advanced Rectal Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Marina Maslova ◽  
Heinz Herden ◽  
Karin Schork ◽  
Michael Turewicz ◽  
Martin Eisenacher ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Treatment Strategies ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Individual Treatment ◽  
Watch And Wait ◽  
Current Standard

Therapeutic strategies for patients with locally advanced rectal cancer (LARC) who are achieving a pathological complete response (pCR) after neoadjuvant radio-chemotherapy (neoCRT) are being increasingly investigated. Recent trials challenge the current standard therapy of total mesorectal excision (TME). For some patients, the treatment strategy of “watch-and-wait” seems a preferable procedure. The key factor in determining individual treatment strategies following neoCRT is the precise evaluation of the tumor response. Contrast-enhanced computer tomography (ceCT) has proven its ability to discriminate benign and malign lesions in multiple cancers. In this study, we retrospectively analyzed the ceCT based density of LARC in 30 patients, undergoing neoCRT followed by TME. We compared the tumors´ pre- and post-neoCRT density and correlated the results to the amount of residual vital tumor cells in the resected tissue. Overall, the density decreased after neoCRT, with the highest decrease in patients achieving pCR. Densitometry demonstrated a specificity of 88% and sensitivity of 68% in predicting pCR. Thus, we claim that ceCT based densitometry is a useful tool in identifying patients with LARC who may benefit from a “watch-and-wait” strategy and suggest further prospective studies.

scholarly journals Diffusion kurtosis imaging in patients with locally advanced rectal cancer: current status and future perspectives

2019 ◽  
Vol 47 (6) ◽  
pp. 2351-2360 ◽  
Author(s):  
Vincenza Granata ◽  
Roberta Fusco ◽  
Alfonso Reginelli ◽  
Paolo Delrio ◽  
Francesco Selvaggi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Treatment Decision ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Response To Therapy ◽  
Current Status ◽  
Diffusion Kurtosis Imaging ◽  
Diffusion Kurtosis

Morphological magnetic resonance imaging is currently the best imaging technique for local staging in patients with rectal cancer. However, morphological sequences have some limitations, especially after preoperative chemoradiotherapy (pCRT). Diffusion-weighted imaging has been applied to rectal cancer for detection of lesions, characterization of tissue, and evaluation of the response to therapy. In 2005, a non-Gaussian diffusion model called diffusion kurtosis imaging (DKI) was suggested.  Several electronic databases were evaluated in the present review. The search included articles published from January 2000 to May 2018. The references of all articles were also evaluated. All titles and abstracts were assessed, and only the studies of DKI in patients with rectal cancer were retained.  We identified 35 potentially relevant references through the electronic search. According to the inclusion and exclusion criteria, we retained five clinical studies that met the inclusion criteria.  DKI is a useful tool for assessment of tumor aggressiveness, the nodal status, and the risk of early metastases as well as prediction of the response to pCRT. The results of DKI should be considered in treatment decision-making during the work-up of patients with rectal cancer.

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