scholarly journals Radiation-Induced Pelvic Colorectal Obstruction After Neoadjuvant Chemoradiotherapy and Sphincter-Saving Surgery for Rectal Cancer: Is IMRT Better?

2020 ◽  
Author(s):  
Shenghui Huang ◽  
Minghong Chen ◽  
Xiaojie Wang ◽  
Yuangui Chen ◽  
Xingrong Lu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Severe Complication ◽  
Clinical Parameters ◽  
Colorectal Obstruction ◽  
Receiver Operating Characteristic Curves ◽  
Diverting Stoma ◽  
Sphincter Saving ◽  
Radiation Induced

Abstract PurposeRadiation-induced pelvic colorectal obstruction (RIPCO) is a severe complication after neoadjuvant chemoradiotherapy (NCRT) and sphincter-saving surgery (SPS) with for rectal cancer. The incidence and risk factors remain unclear. This study aimed to evaluate the influences of anatomical and clinical parameters including radiation modalities on this complication.MethodsFrom 2010 to 2018, data from patients who received NCRT and SPS with a diverting stoma for rectal cancer were collected. Patients with clinical parameters and complete pelvimetric parameters associated with RIPCO were included for univariate and multivariate analyses. Receiver operating characteristic curves were used to calculate the best cutoff value.ResultsA total of 726 patients with rectal carcinoma received NCRT and SPS with diverting stoma, and 157 patients had complete pelvimetric data. Eighteen of the 726 (2.5%) patients developed RIPCO. Eleven patients only received recreation of a diverting stoma, and four were cured by intersphincteric resection with reconstruction of anastomosis and diverting stoma. In multivariate analysis, BMI (P =0.001), sacral depth (P=0.046), and Intensity-modulated radiotherapy (IMRT) (P<0.001) were independent predictors. The cutoff values of BMI and sacral depth were 21.1 kg/m2 and 4.1 cm, respectively. IMRT was independently associated with a lower incidence of RIPCO (P<0.001). The four-factor scoring system showed that the sensitivity was 88.9%, and the specificity was 85.6%. The AUC was 0.921.ConclusionRIPCO is a rare but severe complication after SPS following NCRT. A BMI more than 21.1 kg/m2, a sacral depth less than 4.1 cm, and IMRT may decrease the risk of RIPCO.

Sarcomatoid Carcinoma Manifesting as Recurrent Rectal Cancer and Mimicking Radiation-Induced Extraskeletal Osteosarcoma: A Case Report

2017 ◽  
Vol 25 (8) ◽  
pp. 732-738 ◽  
Author(s):  
MiJo Lee ◽  
Hyun-Jin Son ◽  
Je-Ho Jang ◽  
Hyun-Young Han ◽  
Moon Hyang Park
Keyword(s):  
Rectal Cancer ◽  
Periodic Acid ◽  
Neoadjuvant Chemoradiotherapy ◽  
Sarcomatoid Carcinoma ◽  
Gluteus Maximus ◽  
Recurrent Rectal Cancer ◽  
Extraskeletal Osteosarcoma ◽  
Periodic Acid Schiff ◽  
Calcified Tissue ◽  
Radiation Induced

Here, we report an unusual case of sarcomatoid carcinoma mimicking extraskeletal osteosarcoma that manifested as recurrent rectal cancer. Five years earlier, a 76-year-old male patient had undergone neoadjuvant chemoradiotherapy followed by a laparoscopic low anterior resection due to adenocarcinoma of the rectum. He was admitted because of pain in the anus and left hip. He underwent abdominal computed tomography that revealed a newly developed left perirectal mass with gluteus maximus invasion measuring up to 8 cm, and therefore, an abdominoperineal resection was performed. Histologically, the tumor revealed sheets of spindled or epithelioid cells, an absence of gland formation, mucicarmine and periodic acid–Schiff stain negativity, and prominent intercellular deposits of osteoid-like calcified tissue. Tumor cells were diffusely immunoreactive for vimentin and cytokeratins. Ultrastructural examination demonstrated microvilli on the surface or within intercellular spaces. In this report, we also discuss the possible pathogenesis as well as the differential diagnosis.

scholarly journals Sphincter Saving Surgery in Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiotherapy

2018 ◽  
Vol 86 (March) ◽  
pp. 187-193
Author(s):  
ISMAIEL A. MOURAD, M.D. HISHAM A. EL-HOSSIENY, M.D. ◽  
ABDEL-HAMID H. EZZAT, M.D. IHAB S. HUSSEIN, M.D. ◽  
MOHAMMAD T. FOUAD, M.Sc. RASHA M. ALLAM, M.D.
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Low Rectal Cancer ◽  
Sphincter Saving

scholarly journals Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 607-612 ◽  
Author(s):  
Concetta Anna Dodaro ◽  
Armando Calogero ◽  
Vincenzo Tammaro ◽  
Tommaso Pellegrino ◽  
Ruggero Lionetti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
The Elderly ◽  
Integrated Treatment ◽  
Radical Excision ◽  
Free Survival ◽  
Diverting Stoma ◽  
Pathologic Complete Remission

AbstractBackgroundNeoadjuvant chemoradiotherapy has a significant role in downstaging cancer. It improves the local control of the disease and can make conservative resection of rectal cancer possible.MethodsWe enrolled 114 patients with subperitoneal rectal cancer who underwent neoadjuvant chemoradio-therapy and radical excision with total mesorectal excision (TME). The primary endpoint was oncological outcomes and the secondary endpoint was surgical outcomes.We evaluate the experience of a multidisciplinary team and the role of neoadjuvant chemoradiotherapy in integrated treatment of cancer of the subperitoneal rectum.ResultsSurgical procedures performed were abdominal perineal resection in 4 cases (3.5%), anterior resection in 89 cases (78%), Hartmann’s procedure in 5 cases (4.4%), and ultralow resection with coloanal anastomosis and diverting stoma in 16 patients (14%).Local recurrence occurred in 6 patients (5.2%), the overall survival was 71.9% at 5 years and disease-free survival was about 60%.ConclusionsThe effect of pathological downstaging amounted to 58.8%, including cPR. The pathologic complete remission occurred in 8.8% of cases.The outcomes of neoadjuvant therapy can be achieved when this treatment is associated with correct surgical technique with TME and the prognosis is defined by an anatomopathological examination performed according to Quirke’s protocol.

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