CT Staging to Triage Selection of Patients With Poor-Prognosis Rectal Cancer for Neoadjuvant Treatment

570 Background: 20% of rectal cancer patients have metastatic lymph nodes outside the mesorectum (EMRs). These EMR node positives are associated with poor prognosis. Accurate selection would help to tailor treatment and improve prognosis for these patients. Methods: Rectal cancer patients were included in a study in which treatment was based on (contrast-enhanced) MRI. EMR-status was predicted by an expert radiologist. Based on this prediction patients underwent chemoradiation (CRT) of the EMRs. 6-8 weeks after CRT EMRs were restaged. If still involved, the EMRs were resected. When the EMRs were sterilised by the CRT, they were not resected. Patients were followed 3 to 6-monthly after surgery by a combination of modalities. 3-year outcome was estimated with Kaplan-Meier curves. Results: 50 patients with suspected EMRs were included. Median follow-up was 26(0-50) months. In 13 patients EMRs were resected after CRT and in only 2/13 positive nodes were found. Of the remaining 37 patients 5 had a local recurrence (LR). In total 32+11=43 patients (86%) had no involved EMRs after CRT. Five patients had metastasis of whom 2 also had a LR. 3-year LR was 2.3%, 3-year DFS was 86% and 3-year OS was 90%. Conclusions: MRI-based selection of patients with EMRs for CRT provides adequate local control. Distant metastasis is the main cause of poor prognosis in these patients. When MRI is used for EMR identification and thus for identification of patients who need CRT also on the obturator regions, patients can be spared an extensive resection with associated morbidity.

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Bevacizumab in neoadjuvant treatment of patients with liver metastases from colorectal carcinoma

Archive of oncology ◽

10.2298/aoo1003075n ◽

2010 ◽

Vol 18 (3) ◽

pp. 75-78

Author(s):

Ivan Nikolic ◽

Svetlana Pavin ◽

Biljana Kukic ◽

Bogdan Bogdanovic ◽

Miroslav Ilic ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Neoadjuvant Treatment ◽

Hepatic Metastases ◽

Response Rates ◽

Control Group ◽

Significant Difference ◽

Experimental Group ◽

Selection Of Patients ◽

Selection Of

Background: Liver metastases are the leading cause of death in patients with colorectal cancer. Despite advances in chemotherapy, surgical resection of hepatic metastases is still considered the only curative options. However, the majority of patients have inoperable disease at presentation. Perioperative chemotherapy is the most successful way for improved selection of patients for resection. The aim of the study was to demonstrate if and to what extent does bevacizumab, introduced in chemotherapy, increase response rates, and development of liver metastases. Methods: Our study included 50 patients who were divided in two groups. The experimental group included patients who were treated with bevacizumab plus chemotherapy, and the control group included patients who were treated with chemotherapy only. Results: The comparison showed that the patients who were treated with bevacizumab became candidates for resection of liver metastases in higher percentage (85%:52%). In addition, distribution of patients regarding the development of metastases resulted in statistically significant difference. Ratio between the patients with good response from the experimental and the control group was 67%:39%. Ratio of patients with stable disease was 26%:48%, and of patients with progressive disease, it was 7%:3%. The estimate of margin after resection was statistically insignificant. Conclusion: Bevacizumab in combination with chemotherapy in therapy of liver metastases from primary colorectal cancer improves and increases response rates and development of liver metastases.

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Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

World Journal of Gastrointestinal Oncology ◽

10.4251/wjgo.v7.i7.55 ◽

2015 ◽

Vol 7 (7) ◽

pp. 55 ◽

Cited By ~ 13

Author(s):

Nikoletta Dimitriou

Keyword(s):

Rectal Cancer ◽

Low Rectal Cancer ◽

Selection Of Patients ◽

Selection Of

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Preoperative staging of rectal cancer allows selection of patients for preoperative radiotherapy

British Journal of Surgery ◽

10.1046/j.1365-2168.2000.01689-4.x ◽

2000 ◽

Vol 87 (12) ◽

pp. 1733-1733

Author(s):

I. M. Loftus

Keyword(s):

Rectal Cancer ◽

Preoperative Radiotherapy ◽

Preoperative Staging ◽

Selection Of Patients ◽

Selection Of

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Progress in Rectal Cancer Treatment

ISRN Gastroenterology ◽

10.5402/2012/648183 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 5

Author(s):

Wim P. Ceelen

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Imaging Techniques ◽

Dramatic Improvement ◽

Term Outcome ◽

Long Term Outcome ◽

Number Of Patients ◽

Systemic Relapse ◽

Selection Of Patients ◽

Selection Of

The dramatic improvement in local control of rectal cancer observed during the last decades is to be attributed to attention to surgical technique and to the introduction of neoadjuvant therapy regimens. Nevertheless, systemic relapse remains frequent and is currently insufficiently addressed. Intensification of neoadjuvant therapy by incorporating chemotherapy with or without targeted agents before the start of (chemo)radiation or during the waiting period to surgery may present an opportunity to improve overall survival. An increasing number of patients can nowadays undergo sphincter preserving surgery. In selected patients, local excision or even a “wait and see” approach may be feasible following active neoadjuvant therapy. Molecular and genetic biomarkers as well as innovative imaging techniques may in the future allow better selection of patients for this treatment option. Controversy persists concerning the selection of patients for adjuvant chemotherapy and/or targeted therapy after neoadjuvant regimens. The currently available evidence suggests that in complete pathological responders long-term outcome is excellent and adjuvant therapy may be omitted. The results of ongoing trials will help to establish the ideal tailored approach in resectable rectal cancer.

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