Renaissance of contact radiotherapy with RT 50 Papillon machine: A revival of new treatment option for early low rectal cancer?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14149-e14149
Author(s):  
Arthur Sun Myint ◽  
Keyword(s):  
Rectal Cancer ◽  
Standard Treatment ◽  
Multimodality Treatment ◽  
Low Rectal Cancer ◽  
Major Surgery ◽  
Early Rectal Cancer ◽  
Permanent Stoma ◽  
The Past ◽  
Rectal Polyps ◽  
New Treatment

e14149 Background: Local contact radiotherapy for early rectal cancer is an accepted treatment in most centers but still controversial in some centres. However, the old Philips machine is obsolete and many centers are unable to continue treating patients using this technique. A new RT 50 Papillon machine is now commercially available and there is a new hope for elderly patients and others who whish to avoid major surgery or permanent stoma. Methods: Although contact radiotherapy has been in clinical use for the past 80 years it is still not regarded as standard treatment in many centers around the world. This is due to the fact that there were no large randomized trials to prove its efficacy against standard surgical treatment. ICONE group has launched CONTEM trials, which are observational trials that combine Contact RT with TEMS for various stages of malignant rectal polyps. Results: ICONE group meets annually and organized courses for contact radiotherapy. So far, 10 centers in Europe have now been trained. We hope to start the CONTEM trials later this year. The data from these trials will be collected centrally in Nice and updated annually. The results will be published later. Conclusions: At present approximately 30-50% of patients with early (T1N0) low rectal cancer (<6cm) are being over treated with APR. Revival of contact radiotherapy allows multimodality treatment for selected patients to avoid major surgery and permanent stoma. We hope the CONTEM trials will provide some evidence in this approach for suitable patients with early rectal cancer. [Table: see text]

scholarly journals Presence of the Human Cytomegalovirus in Glioblastomas—A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5051
Author(s):  
Inti Peredo-Harvey ◽  
Afsar Rahbar ◽  
Cecilia Söderberg-Nauclér
Keyword(s):  
Human Cytomegalovirus ◽  
Standard Treatment ◽  
Clinical Samples ◽  
Treatment Protocols ◽  
Blood Samples ◽  
The Past ◽  
Dismal Prognosis ◽  
High Prevalence ◽  
New Treatment ◽  
Immunohistochemical Techniques

Glioblastoma is a malignant brain tumor with a dismal prognosis. The standard treatment has not changed in the past 15 years as clinical trials of new treatment protocols have failed. A high prevalence of the human cytomegalovirus (HCMV) in glioblastomas was first reported in 2002. The virus was found only in the tumor and not in the surrounding healthy brain tissue. Many groups have confirmed the presence of the HCMV in glioblastomas, but others could not. To resolve this discrepancy, we systematically reviewed 645 articles identified in different databases. Of these, 81 studies included results from 247 analyses of 9444 clinical samples (7024 tumor samples and 2420 blood samples) by different techniques, and 81 articles included 191 studies that identified the HCMV in 2529 tumor samples (36% of all tumor samples). HCMV proteins were often detected, whereas HCMV nucleic acids were not reliably detected by PCR methods. Optimized immunohistochemical techniques identified the virus in 1391 (84,2%) of 1653 samples. These data suggest that the HCMV is highly prevalent in glioblastomas and that optimized immunohistochemistry techniques are required to detect it.

scholarly journals Intersphincteric Resection for Low Rectal Cancer – Case Report

2016 ◽  
Vol 62 (1) ◽  
pp. 142-145
Author(s):  
Cristian Russu ◽  
Călin Molnar ◽  
Sanda Maria Copotoiu ◽  
Claudiu Sărăcuț ◽  
Mircea Gherghinescu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Multimodality Treatment ◽  
Functional Results ◽  
Radical Resection ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Cancer Case ◽  
One Year

Abstract Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions) followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up. Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

scholarly journals Risk factor for permanent stoma and incontinence quality of life after sphincter-preserving surgery for low rectal cancer without a diverting stoma

2017 ◽  
Vol 2 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Takuya Miura ◽  
Yoshiyuki Sakamoto ◽  
Hajime Morohashi ◽  
Tatsuya Yoshida ◽  
Kentaro Sato ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Risk Factor ◽  
Low Rectal Cancer ◽  
Permanent Stoma ◽  
Diverting Stoma

Rectal Polyps and Early Rectal Cancer Assessment by Three-Dimensional Endorectal Ultrasonography

2009 ◽  
pp. 103-113
Author(s):  
Guilio Aniello Santoro ◽  
Sandro Magrini ◽  
Luciano Pellegrini ◽  
Guiseppe Gizzi ◽  
Guiseppe Di Falco
Keyword(s):  
Rectal Cancer ◽  
Three Dimensional ◽  
Early Rectal Cancer ◽  
Endorectal Ultrasonography ◽  
Rectal Polyps

Cumulative Incidence of Permanent Stoma After Sphincter Preserving Low Anterior Resection of Mid and Low Rectal Cancer

2013 ◽  
Vol 56 (10) ◽  
pp. 1134-1142 ◽  
Author(s):  
Adam Dinnewitzer ◽  
Tarkan Jäger ◽  
Clemens Nawara ◽  
Selina Buchner ◽  
Hitzl Wolfgang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Cumulative Incidence ◽  
Low Anterior Resection ◽  
Low Rectal Cancer ◽  
Permanent Stoma

scholarly journals Preservation and Restoration of Sphincter Function in Patients with Rectal Cancer

2000 ◽  
Vol 14 (5) ◽  
pp. 423-426 ◽  
Author(s):  
Rudolf Schiessel ◽  
Harald R Rosen
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Standard Treatment ◽  
Surgical Techniques ◽  
Radical Resection ◽  
Permanent Colostomy ◽  
Sphincter Function ◽  
The Past ◽  
Surgical Options ◽  
Upper Third

Radical resection of rectal cancer is the standard treatment for curing this disease. Half of these tumours are located in the rectosigmoid region or the upper third of the rectum and are, therefore, easily resectable with preservation of the sphincter muscles, thus guaranteeing acceptable continence in most patients. However, tumours that originate in the lower parts of the rectum have been accompanied with the need for an abdominoperineal resection and the threat of a permanent colostomy. In the past 20 years, sphincter-saving surgery has become increasingly common in the treatment of tumours of the middle and low rectum due to the knowledge of tumour growth, the use of stapling devices, and the knowledge of the physiology of the pelvic floor and the sphincter muscles, respectively. Recent surgical techniques of resection of the ’ultralow’ rectum (intersphincteric resection) and the reconstruction by coloanal anastomosis are reviewed. Functional problems following ultralow resections are emphasized, as well as the possibility of sphincter restoration after abdominoperineal resection by use of dynamic graciloplasty. Taking all surgical options into account, a permanent colostomy for rectal cancer can be avoided in most curatively and electively operated patients.

scholarly journals Completion surgery vs. primary TME for early rectal cancer: a national study

2021 ◽  
Author(s):  
William J. Lossius ◽  
Tore Stornes ◽  
Tor A. Myklebust ◽  
Birger H. Endreseth ◽  
Arne Wibe
Keyword(s):  
Rectal Cancer ◽  
Local Excision ◽  
Disease Free Survival ◽  
Distant Recurrence ◽  
Resected Specimen ◽  
Early Rectal Cancer ◽  
Free Survival ◽  
Permanent Stoma ◽  
Completion Surgery ◽  
Disease Free

Abstract Purpose While local excision by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) is an option for low-risk early rectal cancers, inaccuracies in preoperative staging may be revealed only upon histopathological evaluation of the resected specimen, demanding completion surgery (CS) by formal resection. The aim of this study was to evaluate the results of CS in a national cohort. Method This was a retrospective analysis of national registry data, identifying and comparing all Norwegian patients who, without prior radiochemotherapy, underwent local excision by TEM or TAMIS and subsequent CS, or a primary total mesorectal excision (pTME), for early rectal cancer during 2000–2017. Primary endpoints were 5-year overall and disease-free survival, 5-year local and distant recurrence, and the rate of R0 resection at completion surgery. The secondary endpoint was the rate of permanent stoma. Results Forty-nine patients received CS, and 1098 underwent pTME. There was no difference in overall survival (OR 0.73, 95% CI 0.27–2.01), disease-free survival (OR 0.72, 95% CI 0.32–1.63), local recurrence (OR 1.08, 95% CI 0.14–8.27) or distant recurrence (OR 0.67, 95% CI 0.21–2.18). In the CS group, 53% had a permanent stoma vs. 32% in the pTME group (P = 0.002); however, the difference was not significant when adjusted for age, sex, and tumor level (OR 2.17, 0.95–5.02). Conclusions Oncological results were similar in the two groups. However, there may be an increased risk for a permanent stoma in the CS group.

scholarly journals Nonoperative Management for T2 Low Rectal Cancer: A Western Approach

2020 ◽  
Vol 33 (06) ◽  
pp. 366-371
Author(s):  
Laura Melina Fernandez ◽  
Guilherme Pagin São Julião ◽  
Bruna Borba Vailati ◽  
Angelita Habr-Gama ◽  
Rodrigo Oliva Perez
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Organ Preservation ◽  
Complete Response ◽  
Tumor Stage ◽  
Neoadjuvant Chemoradiation ◽  
Major Surgery ◽  
Early Rectal Cancer ◽  
Mesorectal Excision ◽  
Early Tumor

AbstractThe possibility of organ preservation in early rectal cancer has gained popularity during recent years. Patients with early tumor stage and low risk for local recurrence do not usually require neoadjuvant chemoradiation for oncological reasons. However, these patients may be considered for chemoradiation exclusively for the purpose of achieving a complete clinical response and avoid total mesorectal excision. In addition, cT2 tumors may be more likely to develop complete response to neoadjuvant therapy and may constitute ideal candidates for organ-preserving strategies. In the setting where the use of chemoradiation is exclusively used to avoid major surgery, one should consider maximizing tumor response. In this article, we will focus on the rationale, indications, and outcomes of patients with early rectal cancer being treated by neoadjuvant chemoradiation to achieve organ preservation by avoiding total mesorectal excision.

scholarly journals Hybrid transanal and total mesorectal excision after transanal endoscopic microsurgery for unfavourable early rectal cancer: a report of two cases

2017 ◽  
Vol 24 (3) ◽  
pp. 188-192 ◽  
Author(s):  
Narimantas E. Samalavičius ◽  
Audrius Dulskas ◽  
Kęstutis Petrulis ◽  
Alfredas Kilius ◽  
Renatas Tikuišis ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Transanal Endoscopic Microsurgery ◽  
Low Rectal Cancer ◽  
Early Rectal Cancer ◽  
Mesorectal Excision ◽  
Final Histology ◽  
Complex Procedure ◽  
Endoscopic Microsurgery

Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology. Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient. We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.

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