scholarly journals Three Perspectives: The Approach of Neoadjuvant Treatment of Rectum Cancer According to Medical Oncologists, Radiation Oncologists, and Surgeons

2022 ◽  
Author(s):  
İsmail Beypinar ◽  
Mustafa Tercan ◽  
Fuzuli Tugrul
Keyword(s):  
Radiation Therapy ◽  
Neoadjuvant Treatment ◽  
Real Life ◽  
Treatment Modalities ◽  
Optimal Time ◽  
Radiation Oncologists ◽  
Short Course ◽  
Medical Oncologists ◽  
Significant Difference ◽  
Short Course Radiotherapy

Abstract Purpose Two treatment modalities are considerable for radiation therapy: short-course radiotherapy and immediate surgery or chemoradiation with 5-Fluorouracil based chemotherapy with delayed surgery. In this study, we try to evaluate the real-life treatment approaches of medical, radiation, and surgical oncologists for neoadjuvant treatment of rectal cancers. Method The online survey form was established via Google Forms. The survey was taken voluntarily by medical oncologists, radiation oncologists, surgical oncologists, and general surgeons. Results One hundred eighty-three of the participants were medical oncologists while 36 were radiotherapists and 36 were surgeons. Most of the study population preferred long-course radiation therapy and chemotherapy which was consisting eighty-five percent. Two-thirds of the participants apply chemotherapies before operation. The most frequent chemotherapy cycles for the pre-operative setting were ‘three’ or ‘four-or-more’ with the percent of 27,8 and 25,1 respectively. Medical oncologists had a significantly higher tendency of offering chemotherapy between radiation therapy and surgery compared with the other groups. The optimal time of surgery was different between groups. There was no difference among groups between surgery and the ‘watch & wait’ strategy. A significant difference was observed between groups in offered neoadjuvant chemotherapy regimens. Conclusion In our study, we found the new pre-operative chemotherapy regimen with short-course radiotherapy was slowly adopted in current practice. Also, medical oncologists tend pre-operative chemotherapy compared with other groups. The optimal surgery time for patients receiving neoadjuvant treatment is still controversial.

scholarly journals Sequential short-course radiation therapy and chemotherapy in the neoadjuvant treatment of rectal adenocarcinoma

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Y. Jia ◽  
Amol Narang ◽  
Bashar Safar ◽  
Atif Zaheer ◽  
Adrian Murphy ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Neoadjuvant Treatment ◽  
Rectal Adenocarcinoma ◽  
Short Course

scholarly journals Future of Radiotherapy Delivery in Rectal Cancer— European and US Approaches

2014 ◽  
Vol 10 (02) ◽  
pp. 139
Author(s):  
Jordan A Torok ◽  
Brian G Czito ◽  
Christopher G Willett ◽  
Manisha Palta ◽  
◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Significant Difference ◽  
Long Course

Neoadjuvant radiation therapy is integral in the management of patients with localized rectal cancer. In parts of Europe, patients with operable rectal cancer are treated with short-course radiation therapy delivered in five daily, 5 Gy fractions to a total dose of 25 Gy, followed by surgery within 1 week. In the US, the standard for locally advanced rectal cancer is neoadjuvant chemoradiotherapy. This approach is principally based on the results of the German Rectal Cancer Study Group trial evaluating preoperative compared with postoperative chemoradiation. Surgery is typically performed at 4–8 weeks following completion of long-course chemoradiotherapy, facilitating tumor downstaging, and potential sphincter sparing surgery. No significant difference in clinical outcomes has been observed between these two approaches in two randomized clinical trials; however, further follow-up of these studies and new results from ongoing trials are anticipated to further clarify the optimal neoadjuvant treatment strategy.

Short-Course Radiotherapy in Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-analysis

2018 ◽  
Vol 17 (4) ◽  
pp. 320-330.e5 ◽  
Author(s):  
Bin Ma ◽  
Peng Gao ◽  
Yongxi Song ◽  
Xuanzhang Huang ◽  
Hongchi Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Short Course ◽  
Short Course Radiotherapy

Future of Radiotherapy Delivery in Rectal Cancer—European and US Approaches

2015 ◽  
Vol 11 (1) ◽  
pp. 45
Author(s):  
Jordan A Torok ◽  
Brian G Czito ◽  
Christopher G Willett ◽  
Manisha Palta ◽  
◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Significant Difference ◽  
Long Course

Neoadjuvant radiation therapy is integral in the management of patients with localized rectal cancer. In parts of Europe, patients with operable rectal cancer are treated with short-course radiation therapy delivered in five daily, 5 Gy fractions to a total dose of 25 Gy, followed by surgery within 1 week. In the US, the standard for locally advanced rectal cancer is neoadjuvant chemoradiotherapy. This approach is principally based on the results of the German Rectal Cancer Study Group trial evaluating preoperative compared with postoperative chemoradiation. Surgery is typically performed at 4–8 weeks following completion of long-course chemoradiotherapy, facilitating tumor downstaging, and potential sphincter sparing surgery. No significant difference in clinical outcomes has been observed between these two approaches in two randomized clinical trials; however, further follow-up of these studies and new results from ongoing trials are anticipated to further clarify the optimal neoadjuvant treatment strategy.

scholarly journals Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 796
Author(s):  
Jakob Liermann ◽  
Mustafa Syed ◽  
Edgar Ben-Josef ◽  
Kai Schubert ◽  
Ingmar Schlampp ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Target Volume ◽  
Radiation Oncologists ◽  
Pet Ct ◽  
Significant Difference ◽  
Target Definition ◽  
Recurrent Pancreatic Cancer ◽  
Locally Recurrent

(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer.

Comparison of multimodal surgical and radiation treatment methods for pediatric craniopharyngioma: long-term analysis of progression-free survival and morbidity

2021 ◽  
pp. 1-8
Author(s):  
Vijay M. Ravindra ◽  
M. Fatih Okcu ◽  
Lucia Ruggieri ◽  
Thomas S. Frank ◽  
Arnold C. Paulino ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Vision Loss ◽  
Progression Free Survival ◽  
Treatment Modalities ◽  
Secondary Malignancy ◽  
Free Survival ◽  
Treatment Methods ◽  
Significant Difference ◽  
Chi Square Analysis

OBJECTIVE The authors compared survival and multiple comorbidities in children diagnosed with craniopharyngioma who underwent gross-total resection (GTR) versus subtotal resection (STR) with radiation therapy (RT), either intensity-modulated radiation therapy (IMRT) or proton beam therapy (PBT). The authors hypothesized that there are differences between multimodal treatment methods with respect to morbidity and progression-free survival (PFS). METHODS The medical records of children diagnosed with craniopharyngioma and treated surgically between February 1997 and December 2018 at Texas Children’s Hospital were reviewed. Surgical treatment was stratified as GTR or STR + RT. RT was further stratified as PBT or IMRT; PBT was stratified as STR + PBT versus cyst decompression (CD) + PBT. The authors used Kaplan-Meier analysis to compare PFS and overall survival, and chi-square analysis to compare rates for hypopituitarism, vision loss, and hypothalamic obesity (HyOb). RESULTS Sixty-three children were included in the analysis; 49% were female. The mean age was 8.16 years (95% CI 7.08–9.27). Twelve of 14 children in the IMRT cohort underwent CD. The 5-year PFS rates were as follows: 73% for GTR (n = 31), 54% for IMRT (n = 14), 100% for STR + PBT (n = 7), and 77% for CD + PBT (n = 11; p = 0.202). The overall survival rates were similar in all groups. Rates of hypopituitarism (96% GTR vs 75% IMRT vs 100% STR + PBT, 50% CD + PBT; p = 0.023) and diabetes insipidus (DI) (90% GTR vs 61% IMRT vs 85% STR + PBT, 20% CD + PBT; p = 0.004) were significantly higher in the GTR group. There was no significant difference in the HyOb or vision loss at the end of study follow-up among the different groups. Within the PBT group, 2 patients presented a progressive vasculopathy with subsequent strokes. One patient experienced a PBT-induced tumor. CONCLUSIONS GTR and CD + PBT presented similar rates of 5-year PFS. Hypopituitarism and DI rates were higher with GTR, but the rate of HyOb was similar among different treatment modalities. PBT may reduce the burden of hypopituitarism and DI, although radiation carries a risk of potential serious complications, including progressive vasculopathy and secondary malignancy. Further prospective study comparing neurocognitive outcomes is necessary.

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