scholarly journals A Non-Operative Approach to Rectal Cancer after Chemo-Radiotherapy:

2019 ◽  
Vol 12 (1) ◽  
pp. 17-19
Author(s):  
Abeer Arian
Keyword(s):  
Rectal Cancer ◽  
Watchful Waiting ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Operative Approach ◽  
Pathological Complete Remission ◽  
Care Approach ◽  
Rectal Cancers

Introduction. Chemotherapy administered concurrently withradiotherapy for locally-advanced rectal cancer prior to surgeryis a standard of care approach. A fraction of patients after chemoradiotherapyachieve pathological complete remission. Our aim wasto evaluate patients treated only with a non-operative approach ofonly chemo-radiotherapy followed by observation at a communitycancer center.Methods. Medical charts of the patients who were treated for locallyadvanced rectal cancer and treated with chemo-radiation therapyalone from January 1, 2000 through May 1, 2017 at a Midwesterncancer center were reviewed. The clinical course of the patients wasfollowed from the time of the cancer diagnosis through their last availableclinical record.Results. A series of three cases were reviewed with locally-advanceddistal rectal cancers treated with a non-operative approach.Conclusions. Watchful waiting for patients with locally advanceddistal rectal cancer who have complete clinical response with neoadjuvantchemotherapy and radiation might be an effective treatmentstrategy. Kans J Med 2019;12(1):17-19.

Locally Advanced Rectal Cancer: Time for Precision Therapeutics

2015 ◽  
pp. e192-e196 ◽  
Author(s):  
Martin R. Weiser ◽  
Zhen Zhang ◽  
Deborah Schrag
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Current Standard ◽  
Trimodality Therapy

The year 2015 marks the 30th anniversary of the publication of NSABP-R01, a landmark trial demonstrating the benefit of adding pelvic radiation to the treatment regimen for locally advanced rectal cancer with a resultant decrease in local recurrence from 25% to 16%. These results ushered in the era of multimodal therapy for rectal cancer, heralding modern treatment and changing the standard of care in the United States. We have seen many advances over the past 3 decades, including optimization of the administration and timing of radiation, widespread adoption of total mesorectal excision (TME), and the implementation of more effective systemic chemotherapy. The current standard is neoadjuvant chemoradiation with 5-fluorouracil (5-FU) and a radiosensitizer, TME, and adjuvant chemotherapy including 5-FU and oxaliplatin. The results of this regimen have been impressive, with a reported local recurrence rate of less than 10%. However, the rates of distant relapse remain 30% to 40%, indicating room for improvement. In addition, trimodality therapy is arduous and many patients are unable to complete the full course of treatment. In this article we discuss the current standard of care and alternative strategies that have evolved in an attempt to individualize therapy according to risk of recurrence.

Outcomes of younger patients diagnosed with locally advanced rectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 500-500 ◽  
Author(s):  
Rosemary Habib ◽  
Val Gebski ◽  
James Toh ◽  
Nimalan Pathma-Nathan ◽  
Toufic El Khoury ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Patient Group ◽  
Older Patients ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Survival Outcomes ◽  
Older Patient ◽  
Presenting Symptoms ◽  
Rectal Cancers

500 Background: The incidence of rectal cancer is higher in the older population. In developed nations there has been a rise in incidence in young onset rectal cancer (yRC). We evaluated and compared the presentation and survival outcomes of treatments for locally advanced rectal cancer in yRC patients to that of older patients. Methods: All cases of rectal cancers referred to a large tertiary referral cancer centre in Western Sydney between 2009-2016 were examined. Patient demographics, presenting symptoms, treatment, clinico-pathological characteristics, progression free survival (PFS) and overall survival (OS) were obtained. Under 50 years old was used as the cut-off age for defining yRC. Results: One hundred sixty-two patients were identified, 33 in the yRC and 129 in the older patient group. The median age at diagnosis was 62 (24 – 92). Median follow-up was 40 months. There was no difference in presenting symptoms between the two groups, with per rectal bleeding being the most common symptom at presentation. 17.5% of yRC presented with stage IV disease, compared with 22.1% of older patients. yRC were more likely to complete neoadjuvant therapy (97% vs 81%; P=0.02). yRC were more likely to proceed to surgery (91% vs 72%, P=0.02). There were no significant differences in surgical outcomes, including complications and postoperative TNM staging. yRC were more likely to have microsatellite high tumours (18% vs 4%; P=0.01). No statistical differences were seen in survival outcomes (PFS 57.1 vs 62.9 months, P=0.26; OS 85.1 Vs 92.8 months, P=0.57) between older and yRC patients. Eight progressions (eight deaths) were observed in the yRC group and 40 progressions (36 deaths) were observed in the older patient group. Conclusions: 20% of rectal cancers were considered yRC. These patients were more likely to complete neoadjuvant therapy and proceed to surgery. In this cohort, median PFS and OS were longer compared to the older patient group, although this was not statistically significant. yRC were more likely to have MMR deficiency. Patients under 50 years with alarm symptoms including per rectal bleeding require vigilance in investigations to allow for earlier detection and appropriate management of 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.

scholarly journals Radio (chemo) therapy in locally advanced rectal cancer

2002 ◽  
Vol 49 (2) ◽  
pp. 33-35
Author(s):  
Ljiljana Radosevic-Jelic
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Cancer Radiotherapy ◽  
Resectable Rectal Cancer ◽  
Rectal Cancers ◽  
Established Role

Radiotherapy has an role in combined treatment to lower local recurrence in resectable rectal cancer. Radiotherapy also has an established role in nonresectable rectal cancers to increase the operability, but radiochemotherapy is more efficient. Radiotherapy can be administered as a transcutaneous therapy on the megavoltage machines as well as brachytherapy and combined - transcutaneous and brachtherapy.

scholarly journals A Primer on the Current State-of-the-Science Neoadjuvant and Adjuvant Therapy for Patients with Locally Advanced Rectal Adenocarcinomas

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Jeffrey T. Yorio ◽  
Nishin A. Bhadkamkar ◽  
Bryan K. Kee ◽  
Christopher R. Garrett
Keyword(s):  
Adjuvant Therapy ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Current Standard ◽  
Colon Cancers ◽  
Standard Of Care Treatment ◽  
Rectal Cancers ◽  
State Of The Science

Patients with rectal cancers, due to the unique location of the tumor, have a recurrence pattern distinct from colon cancers. Advances in adjuvant therapy over the last three decades have played an important role in improving patient outcomes. This article serves to review the clinical studies that lay the basis for our current standard-of-care treatment of patients with locally advanced rectal cancer, as well as touch upon future ongoing experimental clinical trials of adjuvant chemoradiation therapy.

Current possibilities of predicting the therapeutic response to neoadjuvant chemoradiotherapy in rectal cancer

2020 ◽  
Vol 74 (5) ◽  
pp. 393-403
Author(s):  
Filip Pazdírek ◽  
Marek Minárik ◽  
Lucie Benešová ◽  
Jiří Hoch ◽  
Radka Lohynská
Keyword(s):  
Rectal Cancer ◽  
Therapeutic Response ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Therapy Response ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Dna And Rna ◽  
Post Radiation

Neoadjuvant chemotherapy in combination with radiation is currently the standard of care for patients with locally advanced rectal cancer. The main purpose of the treatment is to reduce the risk of recurrence, however at the same time it may be accompanied by severe adverse effects due to post-radiation pelvic damage. An effort towards finding markers allowing the prediction of the therapy response has been undertaken by many groups. In this review we have performed a literature search to identify the main studies directed at the use of clinical, radiological, immunological and molecular (protein, DNA and RNA) markers. We present a summary for each group with an overall conclusion that a certain level of ambiguity and disunity in interpretation of the results currently exists among the reported findings. Apparently, even in the most promising direction of circulating molecular bio­markers further work is needed before a clinical utility can be established.

Effect of short course radiation followed by four cycles of FOLFOX as preoperative therapy for rectal cancer on rate of PCR: A phase II trial.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 471-471
Author(s):  
Robert J. Myerson ◽  
Parag J. Parikh ◽  
Steven R. Hunt ◽  
Benjamin Tan
Keyword(s):  
Rectal Cancer ◽  
Residual Disease ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Cytotoxic Agents ◽  
Preoperative Treatment ◽  
Short Course ◽  
Grade 3

471 Background: Preoperative radiotherapy (RT) with 5FU chemotherapy (CT) is a standard of care for cT3-4 rectal cancer. Studies incorporating additional cytotoxic agents have resulted in increased morbidity with little benefit. We evaluate a template that seeks to (1) include the benefits of preoperative RT on local response/control, (2) provide preoperative multi-drug CT, (3) avoid the morbidity of concurrent RT and multi-drug CT. Methods: Patients with cT3-4, any N, any M rectal cancer were eligible. Patients were confirmed to be candidates for surgery, provided the response was sufficient. Preoperative treatment was 5 fractions RT (25 Gy to involved mesorectum, 20 Gy to elective nodes), followed by 4 cycles of mFOLFOX6. Postoperative CT was at the discretion of the medical oncologist. The principal objectives were to achieve T stage down staging (ypT < cT) and acute grade 3+ gastrointestinal (GI) morbidity equal or better than historic controls. Results: 80 patients were enrolled from 11/2009 through 4/2012. All have had sufficient time for principal endpoint analysis. Four are inevaluable for response: 1 patient withdrew consent after completing RT and never received CT and 3 did not undergo surgery (new comorbidity in 2 cases, progression of distant metastatic disease in 1 case). Grade 3 preoperative GI morbidity occurred in 7 cases (9%) (no grade 4 or 5). The 76 evaluable cases included 7 cT4 and 69 cT3; 59 (78%) cN+, 8 cM1. Sphincter preserving surgery was performed on 49 (64%) cases. At surgery 53 (70%) had ypT0-2 residual disease including 21 (28%) ypT0; 24 (32%) were ypN+. For M0 evaluable cases 2 year NED survival is 91+/-6% with no local failures. Cases were sub-analyzed by whether disease met requirements for the recently activated ACOSOG preoperative FOLFOX vs. 5FU-RT trial. Thirty eight cases met ACOSOG eligibility and achieved 16 ypT0 (42%) and 33 ypT0-2 (87%). Conclusions: This regimen achieved high response and low morbidity rates that compare favorably with conventionally fractionated RT and concurrent CT. The ongoing RAPIDO trial compares a similar regimen to conventional chemoradiation in poor risk locally advanced rectal cancer patients.

A phase II study of induction PD-1 blockade in subjects with locally advanced mismatch repair-deficient rectal adenocarcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS4123-TPS4123
Author(s):  
Andrea Cercek ◽  
Zsofia Kinga Stadler ◽  
Jenna L. Cohen ◽  
Jill A Weiss ◽  
Michelle F. Lamendola-Essel ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Mismatch Repair ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Rectal Adenocarcinoma ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Blood Draw ◽  
Rectal Cancers

TPS4123 Background: The treatment of patients with locally advanced rectal cancer includes total neoadjuvant therapy with chemotherapy, chemoradiation followed by surgery. While most rectal cancers respond to combination induction chemotherapy, patients with mismatch repair deficient (dMMR) or MSI-H tumors have a significantly higher chance of progression with this treatment regimen. dMMR or MSI-H tumors have shown remarkable responses to PD-1 blockade, but the effect of neoadjuvant checkpoint inhibition has not been well studied. In this trial we will determine the pathologic complete response rate (pCR) of neoadjuvant anti-PD-1 blockade followed by standard chemoradiation in dMMR or MSI-H locally advanced rectal cancer. We hypothesize that treatment naïve dMMR or MSI-H rectal cancers will achieve a robust clinical response to PD-1 blockade and that the total neodjuvant therapy with PD-1 blockade followed by chemoradiation will improve pCR rates. Methods: Eligible patients ≥18 years of age with Stage II (T3-4, N-) or Stage III (any T, N+) histologically confirmed dMMR or MSI-H (by NGS) rectal adenocarcinoma will be enrolled. Patients will receive TSR-042 (500mg IV) every 3 weeks for a maximum of 8 cycles (6 months of treatment). Imaging, internal endoscopic exam and ctDNA blood draw will be performed at 6 weeks and every 3 months during induction anti-PD-1 treatment. Adverse events and surgical complications will be graded according to the NCI CTCAE v5 and the Clavien-Dindo classification, respectively. Following neoadjuvant checkpoint blockade, patients will undergo conventional chemoradiotherapy followed by surgical resection. The primary endpoint is pathologic complete response compared with historical control in pMMR patients. Patients will be followed up every 6 months for assessment of disease-free survival for up to five years. Clinical trial information: NCT04165772 .

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