Effect of neoadjuvant pelvic perfusion on symptom control and resection of pelvic recurrent rectal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 723-723
Author(s):  
Harold J. Wanebo ◽  
Giovanni J. Begossi ◽  
Eric Gustafson ◽  
James Belliveau
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Symptom Control ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Recurrent Rectal Cancer ◽  
Borderline Resectable ◽  
Isolated Pelvic Perfusion ◽  
Pelvic Perfusion ◽  
Pelvic Resection

723 Background: Isolated pelvic perfusion (IPP) may improve disease control and facilitate pelvic resection in selected high-risk patients with advanced recurrent rectal cancer by reducing painful tumor burden and lessening chances of recurrence. Methods: IPP was done in 42 patients with locally advanced previously irradiated rectal cancer, 26 as preoperative therapy and 16 for palliation. A comparative larger non-perfused group included 63 patients with pelvic resection only via abdominal sacral resection (ABSR) for recurrent rectal cancer. Isolated pelvic perfusion (IPP) with a pump oxygenator, (temp > 41ºc), delivered sequential (q 10 minutes) chemotherapy:– 5FU (5fluorouracil) 1,500 mg/m2, cisplatin/oxaliplatin 100/150 mg/m2, mitomycin 10mg/m2, for 60 minutes in 42 patients. Results: Palliative IPP in 16 advanced rectal cancer patients resulted in significant relief (1–4 months) of narcotic resistant pain (in 70%). Pre-operative IPP in 26 locally advanced rectal cancer patients achieved a clinical path (CR) in 2 patients, and significant regression in 11 patients rendering them resectable. Seven had RO pelvic resections. Of 6 other patients, 4 refused surgery, 2 were medically excluded. Median survival was 30 months in 7 resected patients (all had RO resections) and 2 were 5-year survivors. This is compared to outcome in 63 patients having pelvic resection alone for recurrence: 57 % had RO resection (median OS = 36 months), 28% had R1 resection (median OS = 15 months) and 15% had R2 resection (marrow invasion) (median OS = 21 months). Conclusions: Neoadjuvant IPP may facilitate resection of advanced or (borderline resectable) recurrent rectal cancer by reducing tumor bulk and identifying therapeutic responders likely to benefit from major pelvic resection while excluding non-responders mostly likely to benefit from non-surgical therapy. The potential to induce regression and facilitate RO resection merits further exploration

Neoadjuvant pelvic perfusion may facilitate resection of pelvic recurrent rectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14599-e14599
Author(s):  
Harold J. Wanebo ◽  
Giovanni Begossi ◽  
James Belliveau ◽  
Eric Gustafson
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Palliative Therapy ◽  
Advanced Rectal Cancer ◽  
Recurrent Rectal Cancer ◽  
R0 Resection ◽  
Isolated Pelvic Perfusion ◽  
Pelvic Perfusion ◽  
Pelvic Resection

e14599 Background: Pelvic recurrence of rectal cancer is a persisting therapeutic challenge in spite of wide spread use of adjuvant/neoadjuvant chemo radiation and wide resection isolated pelvic perfusion (IPP) may facilitate pelvic resection in selected high-risk patients.IPP was done in 42 patients with locally advanced previously irradiated rectal cancer, 26 as a preoperative therapy and 16 for palliation. A comparative larger non-perfused group included 63 patients with pelvic resection only for recurrent rectal cancer. Methods: Isolated pelvic perfusion (60 min) utilized pump oxygenation (Temp>41°C)with chemo agents – 5 FU 1500mg/m2, Cisplatin/Oxaliplatin 100/ 150mg/m2, Mitomycin 10-20 mg/m2, which was done in 42 patients (26 as preoperative and 16 as palliative therapy). Results: Palliative IPP in 16 advanced rectal cancer patients (pts)resulted in significant relief (1-4 months) of narcotic resistant pain (in 70%). Preoperative IPP in 26 locally advanced rectal cancer pts achieved a clinical pathologic complete response (CR) in 2 patients, and significant regression in 11 patients rendering them resectable. Seven pts had R0 pelvic resections,(6 abdominal sacral resection (ABSR) and 1 extended APR).Of 8 other patients, 3 responders refused surgery, 5 were excluded.(medical or disease related ). Median survival was 22.5 months in 15 resectable and 32 mos in 7 resected pts (2 pts were 5 year survivors). This is compared to outcome in 63 patients amenable to having pelvic resection alone: 57% had R0 resection (median OS 36 mos), 28% had R1 resection (med OS = 15 mos) and 15% had R2 resection (med OS 21 mos). Conclusions: Neoadjuvant IPP may facilitate selection of recurrent rectal cancer by identifying therapeutic responders likely to benefit from major pelvic resection and excluding non-responders most likely to benefit from non-surgical therapy. The potential to induce regression and facilitate R0 resection merits further exploration.

scholarly journals 110: Improved Survival with The Use of Capecitabine in the Setting of Neoadjuvant Chemo-Radiation for Locally Advanced Rectal Cancer Patients

2020 ◽  
Vol 150 ◽  
pp. S48-S49
Author(s):  
Aswin George Abraham ◽  
Nawaid Usmani ◽  
Karen Mulder ◽  
JoAnn Thai ◽  
Sunita Ghosh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

scholarly journals Radiomics features on radiotherapy treatment planning CT can predict patient survival in locally advanced rectal cancer patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiazhou Wang ◽  
Lijun Shen ◽  
Haoyu Zhong ◽  
Zhen Zhou ◽  
Panpan Hu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Treatment Planning ◽  
Clinical Features ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Radiotherapy Treatment Planning ◽  
Radiotherapy Treatment

Abstract This retrospective study was to investigate whether radiomics feature come from radiotherapy treatment planning CT can predict prognosis in locally advanced rectal cancer patients treated with neoadjuvant chemoradiation followed by surgery. Four-hundred-eleven locally advanced rectal cancer patients which were treated with neoadjuvant chemoradiation enrolled in this study. All patients’ radiotherapy treatment planning CTs were collected. Tumor was delineated on these CTs by physicians. An in-house radiomics software was used to calculate 271 radiomics features. The results of test-retest and contour-recontour studies were used to filter stable radiomics (Spearman correlation coefficient > 0.7). Twenty-one radiomics features were final enrolled. The performance of prediction model with the radiomics or clinical features were calculated. The clinical outcomes include local control, distant control, disease-free survival (DFS) and overall survival (OS). Model performance C-index was evaluated by C-index. Patients are divided into two groups by cluster results. The results of chi-square test revealed that the radiomics feature cluster is independent of clinical features. Patients have significant differences in OS (p = 0.032, log rank test) for these two groups. By supervised modeling, radiomics features can improve the prediction power of OS from 0.672 [0.617 0.728] with clinical features only to 0.730 [0.658 0.801]. In conclusion, the radiomics features from radiotherapy CT can potentially predict OS for locally advanced rectal cancer patients with neoadjuvant chemoradiation treatment.

Postoperative versus preoperative chemoradiotherapy in locally advanced rectal cancer patients.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e14156-e14156
Author(s):  
H. F. EL-Shazly. ◽  
G. Schlimok ◽  
A. F. Barakat ◽  
L. A. Korashy ◽  
N. M. El Mashad
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer
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