scholarly journals Effect of Carbogen to Chemoradiation in Volume of Rectal Cancer

2020 ◽  
Author(s):  
Christina Hari Nawangsih ◽  
Soehartati Gondhowiardjo ◽  
Sofia Mubarika Haryana ◽  
Soeharyo Hadisaputro ◽  
Catharina Suhart ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Treatment Group ◽  
Tumor Volume ◽  
Standard Treatment ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Post Test ◽  
Rectal Cancer Treatment

The outcome of inoperable rectal cancer treatment by chemotherapy, radiotherapy, and targeted therapy are still unfavorable. Carbogen is a combination of 98% oxygen and 2% carbon dioxide proven effective as chemoradiosensitizer. The aim of this study is to know the effect of concurrent carbogen and chemoradiotherapy in locally advanced rectal cancer by measuring the shrinkage of the tumor volume. The design of this study was randomized true experimental 2 groups pre and post-test-controlled design. Samples were patients with locally advanced rectal cancer. MRI of the pelvis before and 4-8 weeks after the chemoradiation were examined. A total of 28 subjects were randomized to 14 patients who received concurrent chemoradiation with carbogen (treatment group) and 14 patients chemoradiation (control) The tumor shrinkage in the treatment group (13.08 to 6.08 cm3 ) was significantly higher compared to the control group (18.00 to 12.83 cm3 ). Supplementation of carbogen to standard treatment chemoradiation for locally advanced rectal cancer significantly shrinkage the tumor volume.

scholarly journals Cost drivers of locally advanced rectal cancer treatment—An analysis of a leading healthcare insurer

2021 ◽  
Vol 123 (4) ◽  
pp. 1023-1029
Author(s):  
Fabian Grass ◽  
Amit Merchea ◽  
Kellie L. Mathis ◽  
Nitin Mishra ◽  
Herbert Heien ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Treatment ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Cost Drivers ◽  
Rectal Cancer Treatment

Locally Advanced Rectal Cancer: Treatment Approach in Elderly Patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca De Felice ◽  
Daniele Crocetti ◽  
Veronica Maiuri ◽  
Martina Parisi ◽  
Francesco Marampon ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Elderly Patients ◽  
Cancer Treatment ◽  
Treatment Approach ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Rectal Cancer Treatment

Intensification of neoadjuvant therapy in patients with locally advanced rectal cancer

2021 ◽  
Vol 11 (2) ◽  
pp. 19-28
Author(s):  
Z. Z. Mamedli ◽  
A. V. Polynovskiy ◽  
D. V. Kuzmichev ◽  
S. I. Tkachev ◽  
A. A. Aniskin
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Free Survival ◽  
Disease Free

The aim of the study: to increase the frequency of achieving pathologic complete response and increase disease-free survival in the investigational group of patients with locally advanced rectal cancer T3(MRF+)–4N0–2M0 by developing a new strategy for neoadjuvant therapy.Materials and methods. In total, 414 patients were assigned to treatment. Control group I included 89 patients who underwent radiotherapy (RT) 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week. Control group II included 160 patients who underwent RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and oxaliplatin once a week, during the course of RT. Study group III consisted of 165 patients. This group combined RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and additional consecutive CapOx cycles. This group was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating chemotherapy (after CRT); subgroup IIIb included 59 patients who underwent “sandwich” treatment. Therapy consisted of conducting from 1 to 2 cycles of induction CapOx (up to CRT) and from 1 to 2 cycles of consolidating CapOx with an interval of 7 days. In the interval between the courses of drug therapy, RT 52–56 Gy/26–28 fractions was performed. According to the results of the control examination, further treatment tactics were determined. The primary end points were 5-year disease-free survival and the achievement of a pathologic complete response.Results. Pathologic complete response was significantly more often recorded in patients in the investigational group III (17.48 %; p = 0.021) compared with control groups (7.95 % in the I group and 8.28 % in the II group). 5-year disease-free survival in patients in the study groups was: 71.5 % in the III group, 65.6 % in the II group and 56.9 % in the I group.Conclusion. The shift in emphasis on strengthening the neoadjuvant effect on the tumor and improving approaches to drug therapy regimens have significantly improved disease-free survival of patients with locally advanced rectal cancer.

A randomized phase III trial of capecitabine with or without irinotecan driven by UGT1A1 in neoadjuvant chemoradiation of locally advanced rectal cancer (CinClare).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS3632-TPS3632 ◽  
Author(s):  
Ji Zhu ◽  
Xinchen Sun ◽  
Tao Zhang ◽  
Anwen Liu ◽  
Yuan Zhu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Small Sample ◽  
Phase Iii ◽  
Control Group ◽  
Case Group ◽  
Phase Iii Trial

TPS3632 Background: Irinotecan is an effective drug for rectal cancer. Early small sample size trials have assessed the addition of irinotecan to standard CRT with fluoropyrimidines in neoadjuvant phase of locally advanced rectal cancer, in which pCR rates varied from 13.7 to 37%. ARISTOTLE trial, a multicentre UK-based phase III trial, will complete recruitment in autumn 2016. However, all patients in case group were prescribed with weekly irinotecan dose of 60mg/m2 guided by UGT1A1*28 6/6 and 6/7 genetypes in neoadjuvant chemoradiation. Therefore, this phase III trial was designed to confirm the potential improvement in outcomes seen with the addition of irinotecan to CRT. Methods: Eligible patients are randomly allocated to either radiotherapy 50 Gy with concurrent capecitabine, followed by a cycle of capecitabine and oxaliplatin two weeks after the end of CRT (Control arm) or radiotherapy 50 Gy with concurrent capecitabine and irinotecan, followed by a cycle of capecitabine and irinotecan (Case arm). Capecitabine is prescribed with 825mg/m2 The primary end point is ypCR. The hypothesis is to increase ypCR from 12% in the control group to 25% in the case group. To detect such a difference, with alpha = 0.05 (two-tailed) and belta = 0.15, 360 randomly assigned patients are required. Secondary end points are toxicities, surgical complications, local control, progression-free survival and overall survival. Clinical trial information: NCT02605265.

Rectal admission of chemotherapeutic drugs in neoadjuvant treatment schemes of locally advanced rectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15168-e15168
Author(s):  
Luiza Korytova
Keyword(s):  
Rectal Cancer ◽  
Sodium Alginate ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Treatment Results ◽  
Similar Treatment

e15168 Background: High incidence and steady rise of rectal cancer morbidity, unsatisfactory treatment results, amount of disabling surgery, high rate of local recurrents advocate for searching for new methods of combined treatment of locally advanced rectal cancer. Methods: We had suggested to rectally install sterile hydrogel material based on sodium alginate with incorporated 5-FU for radio modification purposes during neoadjuvant chemo radiotherapy. 39 patients with histologically confirmed diagnosis were included into our study. 19 patients received preoperative radiotherapy with summary dose of 50-56 Gy and systemic chemotherapy with fluorpirimidines and rectally admitted hydrogel material with incorporated 5-FU twice per day. Control group consisted of 20 patients who had similar treatment, excluding rectal hydrogel installations. Results: There was no increase in early radiotherapy complications noticed. Three study group patients had complete response, 16 had partial response (versus 1 CR, 15 PR, 3 stabilization and 1 progression in control group). This allowed reduction of surgical assistance volume in seven patients - sphincter-preserving operations were performed. Grade 3-4 pathomorphosis by Dworak’s scale was identified in 17 out of 19 patients (13 out of 20 in control group). Conclusions: Use of hydrogel material based on sodium alginate with incorporated 5-FU does not increase amount and intensity of radiation induced complications, allows to improve patients quality of life and treatment results.

scholarly journals Neoadjuvant Chemotherapy plus Bevacizumab Combined with Total Mesorectal Excision in Treating Locally Advanced Rectal Cancer Patients with BRAF Mutation: Clinical Benefit and Safety

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jintian Song ◽  
Yi Wang ◽  
Hui Yu ◽  
Liang Zheng ◽  
Xiongchao Cai ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Benefit ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Observation Group ◽  
Mesorectal Excision ◽  
Short Term

Objective. To investigate clinical benefit and safety of neoadjuvant chemotherapy (NAC) plus bevacizumab combined with total mesorectal excision (TME) in treating patients with BRAF-mutated locally advanced rectal cancer (LARC). Methods. This study included LARC patients with BRAF mutation admitted to the Oncology Department of Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, between June 2013 and December 2018. Patients in the control group received a standard treatment regimen of TME combined with NAC ( n = 45 ), and patients in the observation group received NAC plus bevacizumab combined with TME ( n = 55 ). The short-term clinical efficacy of the two groups after NAC treatment was observed and compared, including differences in the pathological downstaging rate. The incidence of perioperative complications and adverse reactions during neoadjuvant therapy was compared to evaluate the safety of the treatment. Besides, the relapse-free survival (RFS) and overall survival (OS) of patients were analyzed to evaluate the long-term clinical benefit of the treatment. Results. Compared with the control group, the ypT staging rate ( p = 0.014 ) in the observation group was markedly lower. In addition, patients in the observation group had a prominently lower overall incidence of complications ( p < 0.001 ) during the perioperative period and a remarkably lower incidence of leukopenia ( p = 0.037 ) during neoadjuvant therapy. In terms of long-term clinical benefit, the RFS of patients in the observation group was evidently longer ( p = 0.037 ) than that in the control group. Conclusion. Compared with TME plus NAC treatment, the short-term and long-term clinical benefits are higher and safety is more favorable of NAC plus bevacizumab combined with TME in treating LARC patients.

Three-year outcomes of sandwich therapy in patients with locally advanced cancer of the middle and lower rectum

2021 ◽  
Vol 11 (2) ◽  
pp. 29-35
Author(s):  
A. A. Aniskin ◽  
D. V. Kuzmichev ◽  
Z. Z. Mamedli ◽  
A. V. Polynovskiy
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Chemoradiation Therapy ◽  
Control Group ◽  
Study Group ◽  
Positive Trend

Background. The most important criteria for the effectiveness of the treatment of locally advanced rectal cancer are indicators of overall survival (OS) and disease-free survival (DSF). Conducting systemic chemotherapy in addition to chemoradiotherapy at the preoperative stage can increase these indicators.Objective: to study analyze the indicators of 3-year OS and DFS, as well as the frequency of local relapses and distant metastases.Materials and methods. From 2013 to 2020, 72 patients with T≥3(CRM+)N0–2M0 lower and middle ampullar rectal cancer were included in the study using sandwich therapy. At the first stage, 2 courses of induction polychemotherapy were carried out according to the CapOx scheme (capecitabine 2000 mg/m2  orally for 14 days and oxaliplatin 130 mg/m2 intravenously once every 3 weeks). Further, chemoradiation therapy was carried out with a total focal dose of 50–56 Gy while taking capecitabine 1650 mg/m2  per day orally on the days of irradiation. After the end of chemotherapy, the patients underwent 2 courses of consolidating polychemotherapy according to the CapOx scheme (capecitabine 2000 mg/m2  orally for 14 days and oxaliplatin 130 mg/m2  intravenously once every 3 weeks). The control group consisted of 72 patients who underwent neoadjuvant treatment in accordance with current clinical guidelines (chemotherapy course with a total focal dose of 50–56 Gy while taking capecitabine 1650 mg/m2  per day orally on the days of irradiation).Results. In 19 (26.4 %) patients from the study group and in 6 (8.3 %) patients from the control group, the achievement of pCR was recorded (p = 0.006). The overall complication rate was 48 (66.7 %) in the study group and 37 (51.4 %) in the control group (p = 0.072), the frequency of grade III–IV toxicity was 8 (11.1 %) and 7 (9.7 %), respectively (p = 0.072). Sphincter-sparing surgical interventions were performed in 52 (72.2 %) and 40 (55.6 %) patients in the sandwich-therapy group and the control group of chemoradiation therapy, respectively (p = 0.037). Resection in the R0 volume was achieved in 71 (98.6 %) and 72 (100 %) patients, respectively (p = 0.316).Conclusion. The use of sandwich therapy is a promising trend in the treatment of patients with locally advanced rectal cancer. There were no significant differences in the frequency of 3-year OS (96.1 % versus 91.5 %, p = 0.247), DFS (89.8 % versus 84.0 %, p = 0.117) and local relapses (0 % versus 4.2 %, p = 0.997). In our study, statistically significant differences were obtained in the incidence of distant metastases (6.9 % versus 18.1 %, p = 0.05), which may indicate a positive trend towards an increase in OS and DFS rates.

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