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Charalampakis N, Tsakatikas S, Schizas D, Kykalos S, Tolia M, Fioretzaki R, Papageorgiou G, Katsaros I, Abdelhakeem AAF, Sewastjanow-Silva M, Rogers JE, Ajani JA. Trimodality treatment in gastric and gastroesophageal junction cancers: Current approach and future perspectives. World J Gastrointest Oncol 2022; 14:181-202. [PMID: 35116110 PMCID: PMC8790425 DOI: 10.4251/wjgo.v14.i1.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/28/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric and gastroesophageal junction (GEJ) cancers represent an aggressive group of malignancies with poor prognosis even when diagnosed in relatively early stage, with an increasing incidence both in Asia and in Western countries. These cancers are characterized by heterogeneity as a result of different pathogenetic mechanisms as shown in recent molecular analyses. Accordingly, the understanding of phenotypic and genotypic correlations/classifications has been improved. Current therapeutic strategies have also advanced and moved beyond surgical extirpation alone, with the incorporation of other treatment modalities, such as radiation and chemotherapy (including biologics). Chemoradiotherapy has been used as postoperative treatment after suboptimal gastrectomy to ensure local disease control but also improvement in survival. Preoperative chemoradiotherapy/chemotherapy has been employed to increase the chance of a successful R0 resection and pathologic complete response rate, which is associated with improved long-term outcomes. Several studies have defined various chemotherapy regimens to accompany radiation (before and after surgery). Recently, addition of immunotherapy after trimodality of gastroesophageal cancer has produced an advantage in disease-free interval. Targeted agents used in the metastatic setting are being investigated in the early setting with mixed results. The aim of this review is to summarize the existing data on trimodality approaches for gastric and GEJ cancers, highlight the remaining questions and present the current research effort addressing them.
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Affiliation(s)
- Nikolaos Charalampakis
- Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, Piraeus 18537, Greece
| | - Sergios Tsakatikas
- Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, Piraeus 18537, Greece
| | - Dimitrios Schizas
- TheFirst Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Stylianos Kykalos
- TheSecond Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Maria Tolia
- Department of Radiation Oncology, University Hospital of Crete, Heraklion 71110, Greece
| | - Rodanthi Fioretzaki
- Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, Piraeus 18537, Greece
| | - Georgios Papageorgiou
- Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, Piraeus 18537, Greece
| | - Ioannis Katsaros
- Department of General Surgery, Metaxa Cancer Hospital of Piraeus, Piraeus 18537, Greece
| | - Ahmed Adel Fouad Abdelhakeem
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Matheus Sewastjanow-Silva
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jane E Rogers
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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A nomogram for predicting good response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: a retrospective, double-center, cohort study. Int J Colorectal Dis 2022; 37:2157-2166. [PMID: 36048198 PMCID: PMC9560928 DOI: 10.1007/s00384-022-04247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to explore the clinical factors associated with achieving good response after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) and to develop and validate a nomogram. METHODS A total of 1724 consecutive LARC patients treated at Fujian Medical University Union Hospital from January 2010 to December 2021 were retrospectively evaluated as the training cohort; 267 consecutive LARC patients treated at Zhangzhou Affiliated Hospital of Fujian Medical University during the same period were evaluated as the external 2 cohorts. Based on the pathological results after radical surgery, treatment response was defined as follows: good response, stage ypT0∼2N0M0 and poor response, ypT3∼4N0M0 and/or N positive. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation. RESULTS In the training cohort, 46.6% of patients achieved good response after nCRT combined with radical surgery. The rate of the retained anus was higher in the good response group (93.5% vs. 90.7%, P < 0.001). Cox regression analysis showed that the risk of overall survival and disease-free survival was significantly lower among good response patients than poor response patients, HR = 0.204 (95%CI: 0.146-0.287). Multivariate logistic regression analysis showed an independent association with 9 clinical factors, including histopathology, and a nomogram with an excellent predictive response was developed accordingly. The C-index of the predictive accuracy of the nomogram was 0.764 (95%CI: 0.742-0.786), the internal validation of the 200 bootstrap replication mean C-index was 0.764, and the external validation cohort showed an accuracy C-index of 0.789 (95%CI: 0.734-0.844), with good accuracy of the model. CONCLUSION We identified factors associated with achieving good response in LARC after treatment with nCRT and developed a nomogram to contribute to clinical decision-making.
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Routine contrast-enhanced CT is insufficient for TNM-staging of duodenal adenocarcinoma. Abdom Radiol (NY) 2022; 47:3436-3445. [PMID: 35864264 PMCID: PMC9463261 DOI: 10.1007/s00261-022-03589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT (CECT) for staging of duodenal adenocarcinoma, literature about diagnostic tests is sparse. METHODS In this retrospective single-center cohort study, we analyzed the real life performance of routine CECT for TNM-staging and the assessment of resectability of duodenal adenocarcinoma. Intraoperative findings and pathological staging served as reference standard for resectability, T-, and N-staging. Biopsies, 18FDG-PET-CT, and follow-up were used as the reference standard for M-staging. RESULTS Fifty-two consecutive patients with duodenal adenocarcinoma were included, 26 patients underwent resection. Half of the tumors were isodense to normal duodenum on CECT. The tumor was initially missed in 7/52 patients (13%) on CECT. The correct T-stage was assigned with CECT in 14/26 patients (54%), N-stage in 11/26 (42%), and the M-stage in 42/52 (81%). T-stage was underestimated in (27%). The sensitivity for detecting lymph node metastases was only 24%, specificity was 78%. Seventeen percent of patients had indeterminate liver or lung lesions on CECT. Surgery with curative intent was started in 32 patients, but six patients (19%) could not be resected due to unexpected local invasion or metastases. CONCLUSION Radiologists and clinicians have to be aware that routine CECT is insufficient for staging and determining resectability in patients with duodenal adenocarcinoma. CECT underestimates T-stage and N-stage, and M-stage is often unclear, resulting in futile surgery in 19% of patients. Alternative strategies are required to improve staging of duodenal adenocarcinoma. We propose to combine multiphase hypotonic duodenography CT with MRI.
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Liang Z, Zhang Z, Wu D, Huang C, Chen X, Hu W, Wang J, Feng X, Yao X. Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis. Technol Cancer Res Treat 2022; 21:15330338221105156. [PMID: 35731647 PMCID: PMC9228631 DOI: 10.1177/15330338221105156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Anterior resection is a common surgical approach used in rectal cancer surgery; however, this procedure is known to cause bowel injury and dysfunction. Neoadjuvant therapy is widely used in patients with locally advanced rectal cancer. In this study, we determined the effect of preoperative radiotherapy on long-term bowel function in patients who underwent anterior resection for treatment of rectal cancer. Methods: We performed a comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases. A random-effects model was used in the meta-analysis by the Review Manager software, version 5.3. Results: This systematic review and meta-analysis included 12 studies, which used low anterior resection syndrome score with a total of 2349 patients. Based on them, we concluded that low anterior resection syndrome was significantly more common in the preoperative radiotherapy group (odds ratio 3.59, 95% confidence interval 2.68-4.81, P < .00001) and that major low anterior resection syndrome also occurred significantly more frequently in the preoperative radiotherapy group (odds ratio 3.28, 95% confidence interval 2.05-5.26, P < .00001). Subgroup analyses of long-course radiation, total mesorectal excision, and non-metastatic tumors were performed, and the results met the conclusions of the primary outcomes. Conclusions: Preoperative radiotherapy negatively affects long-term bowel function in patients who undergo anterior resection for rectal cancer.
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Affiliation(s)
- Zongyu Liang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, People’s Republic of China
- Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Zhaojun Zhang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China
| | - Deqing Wu
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Chengzhi Huang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China
| | - Xin Chen
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, People’s Republic of China
| | - Weixian Hu
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Junjiang Wang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xingyu Feng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xueqing Yao
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, People’s Republic of China
- Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, People’s Republic of China
- Xueqing Yao, Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510100, People's Republic of China; Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou 341000, People's Republic of China.
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Zhang S, Yu M, Chen D, Li P, Tang B, Li J. Role of MRI‑based radiomics in locally advanced rectal cancer (Review). Oncol Rep 2021; 47:34. [PMID: 34935061 PMCID: PMC8717123 DOI: 10.3892/or.2021.8245] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer is the third most common type of cancer, with high morbidity and mortality rates. In particular, locally advanced rectal cancer (LARC) is difficult to treat and has a high recurrence rate. Neoadjuvant chemoradiotherapy (NCRT) is one of the standard treatment programs of LARC. If the response to treatment and prognosis in patients with LARC can be predicted, it will guide clinical decision‑making. Radiomics is characterized by the extraction of high‑dimensional quantitative features from medical imaging data, followed by data analysis and model construction, which can be used for tumor diagnosis, staging, prediction of treatment response and prognosis. In recent years, a number of studies have assessed the role of radiomics in NCRT for LARC. MRI‑based radiomics provides valuable data and is expected to become an imaging biomarker for predicting treatment response and prognosis. The potential of radiomics to guide personalized medicine is widely recognized; however, current limitations and challenges prevent its application to clinical decision‑making. The present review summarizes the applications, limitations and prospects of MRI‑based radiomics in LARC.
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Affiliation(s)
- Siyu Zhang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Mingrong Yu
- College of Physical Education, Sichuan Agricultural University, Ya'an, Sichuan 625000, P.R. China
| | - Dan Chen
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Peidong Li
- Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Bin Tang
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, P.R. China
| | - Jie Li
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, P.R. China
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Li R, Wang Q, Zhang B, Yuan Y, Xie W, Huang X, Zhou C, Zhang S, Niu S, Chang H, Chen D, Miao H, Zeng ZF, Xiao W, Gao Y. Neoadjuvant chemotherapy and radiotherapy followed by resection/ablation in stage IV rectal cancer patients with potentially resectable metastases. BMC Cancer 2021; 21:1333. [PMID: 34906114 PMCID: PMC8672531 DOI: 10.1186/s12885-021-09089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background The optimal treatment of stage IV rectal cancer remains controversial. The purpose of this study was to assess the treatment outcomes and toxicity of neoadjuvant chemotherapy and radiotherapy followed by local treatment of all tumor sites and subsequent adjuvant chemotherapy in stage IV rectal cancer patients with potentially resectable metastases. Methods Adult patients diagnosed with locally advanced rectal adenocarcinoma with potentially resectable metastases, who received neoadjuvant chemotherapy and radiotherapy from July 2013 and September 2019 at Sun Yat-sen University cancer center, were included. Completion of the whole treatment schedule, pathological response, treatment-related toxicity and survival were evaluated. Results A total of 228 patients were analyzed with a median follow-up of 33 (range 3.3 to 93.4) months. Eventually, 112 (49.1%) patients finished the whole treatment schedule, of which complete response of all tumor sites and pathological downstaging of the rectal tumor were observed in three (2.7%) and 90 (80.4%) patients. The three-year overall survival (OS) and progression-free survival (PFS) of all patients were 56.6% (50.2 to 63.9%) and 38.6% (95% CI 32.5 to 45.8%), respectively. For patients who finished the treatment schedule, 3-year OS (74.4% vs 39.2%, P < 0.001) and 3-year PFS (45.5% vs 30.5%, P = 0.004) were significantly improved compared those who did not finish the treatment. Grade 3–4 chem-radiotherapy treatment toxicities were observed in 51 (22.4%) of all patients and surgical complications occurred in 22 (9.6%) of 142 patients who underwent surgery, respectively. Conclusions Neoadjuvant chemotherapy and radiotherapy followed by resection/ablation and subsequent adjuvant chemotherapy offered chances of long-term survival with tolerable toxicities for selected patients with potentially resectable stage IV rectal cancer, and could be considered as an option in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09089-5.
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Affiliation(s)
- Rongzhen Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Qiaoxuan Wang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Bin Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
| | - Yan Yuan
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Weihao Xie
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Xiaoxue Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Chengjing Zhou
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Shu Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Shaoqing Niu
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
| | - Hui Chang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Dongni Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.,Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Huikai Miao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.,Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Zhi Fan Zeng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Weiwei Xiao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.
| | - Yuanhong Gao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.
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Low-Rank Matrix Denoising Algorithm-Based MRI Image Feature for Therapeutic Effect Evaluation of NCRT on Rectal Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3080640. [PMID: 34880974 PMCID: PMC8648445 DOI: 10.1155/2021/3080640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to explore the therapeutic effects of neoadjuvant chemoradiotherapy (NCRT) on rectal cancer patients using the MRI based on low-rank matrix denoising algorithm, which was then compared with the postoperative pathological examination to evaluate its application value in tumor staging after NCRT treatment. 15 patients with rectal cancer who met the requirements of radiotherapy and chemotherapy after conventional MRI were selected as the research subjects. The conventional MRI images before and after NCRT treatment were divided in two groups. One group was not processed and set as the conventional group; the other group was processed with low-rank matrix denoising algorithm and set as the optimized group. The two groups of images were observed for the changes in the ADC value and length and thickness of the tumor before and after NCRT treatment. The two groups were compared with the pathological examination for the complete remission of pathology (pCR) after the NCRT treatment and the tumor stage results. The results showed that Root Mean Square Error (RMSE) and Peak Signal to Noise Ratio (PSNR) (18.9121 and 74.9911 dB) after introducing the low-rank matrix denoising algorithm were significantly better than those before (20.1234 and 70.1234 dB) (P < 0.05); there were notable differences in the tumor index data within the two groups before and after NCRT treatment (P < 0.05), indicating that the NCRT treatment was effective. The pathological examination results of pCR data of the two groups were not much different (P > 0.05); the examination results between the two groups were different, but no notable difference was noted (P < 0.05); in the optimized group, there was no notable difference between the MRI results and the pathological examination results (P < 0.05), while in the conventional group, there were notable differences in the MRI results and pathological examination results (P < 0.05). In conclusion, MRI images based on low-rank matrix denoising algorithm are clearer, which can improve the diagnosis rate of patients and better display the changes of the microenvironment after NCRT treatment. It also indicates that NCRT treatment has significant clinical effects in the treatment of rectal cancer patients, which is worth promoting.
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Li Y, Guo W, Li X, Zhang J, Sun M, Tang Z, Ran W, Yang K, Huang G, Li L. Expert consensus on the clinical application of recombinant adenovirus human p53 for head and neck cancers. Int J Oral Sci 2021; 13:38. [PMID: 34785635 PMCID: PMC8595718 DOI: 10.1038/s41368-021-00145-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023] Open
Abstract
The first gene therapy product, recombinant adenovirus human p53 (rAd-p53 ), has been approved by CFDA since 2013. During these years, most of the clinical trials and the relevant basic research were carried out by Chinese oncologists. Gendicine was proved to be a safe and promising gene therapy drug for patients who suffered from head and neck squamous cell carcinoma (HNSCC). The basic therapeutic theories of gene therapy were totally different from the traditional ones, such as surgeries or radio- and chemotherapy, and the evaluation of treatment outcomes should also be changed simultaneously. However, there still existed a lot of misunderstandings about gene therapy, which resulted in improper administration, insufficient dosage calculation, and treatment cycles, and the treatment outcomes were unsatisfactory, especially for inexperienced oncologists or hospitals. Therefore, we will provide some practical guidance here on the gene therapy of rAd-p53 based on our previous research and experience, which focused on the basic theories and clinical issues, to answer the questions arising during the clinical of gene therapy and to accelerate the development of gene therapy for the benefit of patients bearing malignant tumors.
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Affiliation(s)
- Yi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Guo
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuqin Li
- Department of Obstetrics and Gynecology, Shengjing Hospital China Medical University, Shenyang, China
| | - Jianguo Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Moyi Sun
- Department of Oral and Maxillofacial Surgery, The Third Affiliated Hospital, Air Force Medical University, Xi'an, China
| | - Zhangui Tang
- Department of Oral and Maxillofacial Surgery, Xiangya School of Stomatology, Central South University, Changsha, China
| | - Wei Ran
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Yang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guilin Huang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Zunyi Medical University, Zunyi, China
| | - Longjiang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Marin S, Pérez-Cordón L, Salvà F, Camps ML, Campins L, Lianes P. Cost-minimisation analysis of rectal cancer neoadjuvant chemoradiotherapy based on fluoropyrimidines (capecitabine versus 5-fluorouracil). Eur J Hosp Pharm 2021; 28:e13-e17. [PMID: 34728541 DOI: 10.1136/ejhpharm-2019-002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/08/2020] [Accepted: 03/03/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The current standard treatment for patients with rectal cancer stage II-III is neoadjuvant chemoradiotherapy followed by surgery. Neoadjuvant chemoradiotherapy can be performed with 5-fluorouracil (5-FU) or capecitabine (CPC) considered to be equivalent therapies. Medication cost is higher for CPC than for 5-FU, however, the administration of continuous 5-FU intravenous infusion is related to other costs such as those associated with outpatient facilities or central venous catheter insertion. METHODS This retrospective study analysed the direct sanitary costs associated with the treatments and their complications from a hospital perspective. Costs in patients treated with 5-FU or CPC were measured between January 2010 and July 2018 at Mataró Hospital. The aim of this study was to perform a cost-minimisation analysis between the two treatments. We aimed to assess the cost associated with the complications related to each drug and the economic impact of applying the most efficient option. RESULTS Ninety-eight patients were analysed: 32 were treated with CPC and 66 with 5-FU. Treatment cost was significantly higher for 5-FU than for CPC (2560.86±99.17 and 563.10±9.52 respectively, P=0.0001). No significant differences were found in the costs associated with treatment complications between groups (148.21±934.91 and 41.41±102.50 euros respectively, P=0.322). CONCLUSIONS Considering the clinical equivalence shown in the available trials and previous reviews, the most efficient treatment is neoadjuvant chemoradiotherapy with CPC. Complications associated with the treatments did not significantly modify these results. Other studies gave similar results both in the neoadjuvant and adjuvant context, reaffirmed in this study.
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Affiliation(s)
- Sergio Marin
- Pharmacy Department, Hospital de Mataró, Mataró, Spain .,Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Marcel la Camps
- Pharmacy Department, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Lluís Campins
- Pharmacy Department, Hospital de Mataró, Mataró, Spain
| | - Pilar Lianes
- Oncology Department, Hospital de Mataró, Mataró, Spain
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Chiloiro G, Cusumano D, de Franco P, Lenkowicz J, Boldrini L, Carano D, Barbaro B, Corvari B, Dinapoli N, Giraffa M, Meldolesi E, Manfredi R, Valentini V, Gambacorta MA. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development. Radiol Med 2021; 127:11-20. [PMID: 34725772 DOI: 10.1007/s11547-021-01421-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Our study investigated the contribution that the application of radiomics analysis on post-treatment magnetic resonance imaging can add to the assessments performed by an experienced disease-specific multidisciplinary tumor board (MTB) for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS This analysis included consecutively retrospective LARC patients who obtained a complete or near-complete response after nCRT and/or a pCR after surgery between January 2010 and September 2019. A three-step radiomics features selection was performed and three models were generated: a radiomics model (rRM), a multidisciplinary tumor board model (yMTB) and a combined model (CM). The predictive performance of models was quantified using the receiver operating characteristic (ROC) curve, evaluating the area under curve (AUC). RESULTS The analysis involved 144 LARC patients; a total of 232 radiomics features were extracted from the MR images acquired post-nCRT. The yMTB, rRM and CM predicted pCR with an AUC of 0.82, 0.73 and 0.84, respectively. ROC comparison was not significant (p = 0.6) between yMTB and CM. CONCLUSION Radiomics analysis showed good performance in identifying complete responders, which increased when combined with standard clinical evaluation; this increase was not statistically significant but did improve the prediction of clinical response.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Paola de Franco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy.
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Carano
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Martina Giraffa
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
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Duzova M, Basaran H, Inan G, Gul OV, Eren OO, Korez MK. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Outcomes of survival, toxicity, sphincter preserving and prognostic factors. Transpl Immunol 2021; 69:101489. [PMID: 34687908 DOI: 10.1016/j.trim.2021.101489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to compare preoperative chemoradiotherapy (CRT) with postoperative CRT regarding survival, local control, disease control, sphincter preservation, toxicity and also prognostic factors for the treatment of locally advanced rectal cancer. METHODS Records of 140 patients with locally advanced rectal cancer who received preoperative or postoperative CRT were analyzed retrospectively. We compared the treatment groups (preoperative vs postoperative) according to baseline characteristics (demographic and rectal cancer disease characteristics), and also carried out the survival analyses. RESULTS From January 2010 to December 2019, 140 patients were included in the analysis, 65 received preoperative treatment and 75 postoperative treatment. There was no difference in survival, recurrence or distant metastasis rate in both treatment groups. The ratios of the failure to complete adjuvant chemotherapy (32% vs 4.6%) and acute grade 3-4 toxicity (32% vs 6.2%) were higher in the postoperative group (p < 0.001). In lower located tumors (≤5 cm from anal verge) the ratio of the sphincter preserving in the preoperative group was 60.7% (n = 17/28), and was 16.6% (n = 3/18) in the postoperative group (Yates χ2 = 5.829, p = 0.005). CONCLUSION This study showed no difference in recurrence and survival rate. Preoperative CRT is the preferred treatment for patients with locally advanced rectal cancer, given that it is associated with a superior overall treatment compliance rate, reduced toxicity, and an increased rate of sphincter preservation in low-lying tumors, but not for overall survival.
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Affiliation(s)
- Mursel Duzova
- Selcuk University, Faculty of Medicine, Department of Radiation Oncology, Konya, Turkey.
| | - Hamit Basaran
- Selcuk University, Faculty of Medicine, Department of Radiation Oncology, Konya, Turkey.
| | - Gokcen Inan
- Selcuk University, Faculty of Medicine, Department of Radiation Oncology, Konya, Turkey.
| | - Osman Vefa Gul
- Selcuk University, Faculty of Medicine, Department of Radiation Oncology, Konya, Turkey.
| | - Orhan Onder Eren
- Selcuk University, Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Muslu Kazım Korez
- Selcuk University, Faculty of Medicine, Biostatistics Department, Konya, Turkey.
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Yang K, Zhu J, Luo HH, Yu SW, Wang L. Pro-protein convertase subtilisin/kexin type 9 promotes intestinal tumor development by activating Janus kinase 2/signal transducer and activator of transcription 3/SOCS3 signaling in Apc Min/+ mice. Int J Immunopathol Pharmacol 2021; 35:20587384211038345. [PMID: 34586888 PMCID: PMC8485261 DOI: 10.1177/20587384211038345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction Pro-protein convertase subtilisin/kexin type 9 (PCSK9) regulates lipoprotein homeostasis in humans. Evolocumab is a selective PCSK9 inhibitor that can reduce low-density lipoprotein cholesterol (LDLC) level and decrease hypercholesterolemia. The current study aimed to explore whether PCSK9 increases the risk of colorectal cancer. Methods First, we utilized the classic intestinal tumor ApcMin/+ mouse model and PCSK9 knock-in (KI) mice to establish ApcMin/+PCSK9(KI) mice. Then, we investigated the effect of PCSK9 overexpression in ApcMin/+PCSK9(KI) mice and PCSK9 inhibition using evolocumab on the progression of intestinal tumors in vivo by hematoxylin and eosin (HE) staining, Western blot, and immunohistochemistry (IHC) assay. Results ApcMin/+PCSK9(KI) mice had higher numbers and larger sizes of adenomas, with 83.3% of these mice developing adenocarcinoma (vs. 16.7% of ApcMin/+ mice). However, treatment with evolocumab reduced the number and size of adenomas and prevented the development of adenocarcinomas in ApcMin/+ mice. PCSK9 overexpression reduced tumor cell apoptosis, the Bax/bcl-2 ratio, and the levels of cytokine signaling 3 protein (SOCS3) suppressors, but activated Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling in intestinal tumors. In contrast, evolocumab treatment had the opposite effect on ApcMin/+mice. Conclusion PCSK9 might act as an oncogene or have an oncogenic role in the development and progression of colorectal cancer in vivo via activation of JAK2/STAT3/SOCS3 signaling.
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Affiliation(s)
- Kai Yang
- Department of Pharmacy, Cheeloo College of Medicine, 66555Shandong University, Jinan, China.,Department of Pharmacy, Qilu Hospital, Cheeloo College of Medicine, 66555Shandong University, Jinan, China
| | - Jie Zhu
- Department of Pharmacy, Jinan Central Hospital, Cheeloo College of Medicine, 66555Shandong University, Jinan, China
| | - Huan-Hua Luo
- Department of Pharmacy, Jinan Central Hospital, Cheeloo College of Medicine, 66555Shandong University, Jinan, China
| | - Shu-Wen Yu
- Department of Pharmacy, Cheeloo College of Medicine, 66555Shandong University, Jinan, China.,Phase I Clinical Trial Center, Qilu Hospital of Shandong University; NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, Shandong University, Jinan, China
| | - Lu Wang
- Department of Pharmacy, Cheeloo College of Medicine, 66555Shandong University, Jinan, China.,Department of Pharmacy, Jinan Central Hospital, Cheeloo College of Medicine, 66555Shandong University, Jinan, China
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Li X, Wang Q, Yu S, Zhang M, Liu X, Deng G, Liu Y, Wu S. Multifunctional MnO 2-based nanoplatform-induced ferroptosis and apoptosis for synergetic chemoradiotherapy. Nanomedicine (Lond) 2021; 16:2343-2361. [PMID: 34523352 DOI: 10.2217/nnm-2021-0286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Radiosensitizers that can effectively consume glutathione provide broad prospects for enhancing the efficacy and reducing the side effects of radiotherapy. Aim: To explore the potential role of CuS@mSiO2@MnO2 nanocomposites in synergetic chemoradiotherapy. Methods: Nanocomposites were characterized by transmission electron microscopy, UV-Vis spectrometry and dynamic light scattering and were loaded with doxorubicin (DOX). The uptake and biodistribution of nanocomposites were observed by CCK8 assay, MRI and confocal laser scanning microscopy. The radiosensitization effect of nanocomposites and nanocomposites/DOX was assessed both in vitro and in vivo. Results: In vitro application of nanocomposites, with an average diameter of 30 nm and ζ-potential of 13.2 ± 0.4 mV, in combination with radiotherapy, depleted glutathione and induced ferroptosis and apoptosis. Nanocomposites/DOX exhibited tumor cell damage in vivo. Conclusion: We propose that this glutathione-depleting nanosystem could be a radiosensitizer as well as a drug transporter.
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Affiliation(s)
- Xi Li
- Department of Obstetrics & Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
| | - Qi Wang
- Department of Orthopedics, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200333, China.,Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
| | - Sihui Yu
- Department of Obstetrics & Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
| | - Minyi Zhang
- College of Chemistry & Chemical Engineering, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Xijian Liu
- College of Chemistry & Chemical Engineering, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Guoying Deng
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
| | - Yuan Liu
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
| | - Sufang Wu
- Department of Obstetrics & Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, 201620, China
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Zeiderman MR, Nuño M, Sahar DE, Farkas LM. Trends in flap reconstruction of pelvic oncologic defects: Analysis of the national inpatient sample. J Plast Reconstr Aesthet Surg 2021; 74:2085-2094. [PMID: 33455867 DOI: 10.1016/j.bjps.2020.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Flap reconstruction of radiated pelvic oncologic defects decreases perineal wound-healing complications. How widely and how often reconstructions are performed, and how technical mastery and improved perioperative care has affected outcomes, is unknown. Our objective is to 1) provide a comprehensive evaluation of national trends in flap reconstruction of pelvic oncologic defects and 2) compare complications and length of stay (LOS) in patients with/without reconstruction. METHODS The National Inpatient Sample (NIS) database was queried (1998-2014) for patients diagnosed with cancer, primarily of the rectum and anus, who underwent abdominoperineal resection (APR) or pelvic exenteration (PE). Differences in complications and LOS were compared between patients with flap reconstruction versus primary closure. Regional and hospital outcomes were also analyzed. RESULTS The cohort included 117,923 adult patients; 3,673 (3.1%) underwent flap reconstruction. Flap reconstruction rates increased from 0.8% in 1998 to 9.8% in 2014. Extirpative procedures decreased 37.4% from 1998 to 2014. Flap reconstruction decreased risk of wound breakdown (OR 0.87; p = 0.0029) and need for secondary closure of dehiscence (OR 0.82; p = 0.0023) between periods 1998-2009 and 2010-2014. Median LOS was higher for flap patients (median [IQR] of 9.8 [7.2,14.8] vs. 7.9 [6.1-11.0; p < 0.0001) and decreased over time. CONCLUSIONS The use of flap reconstruction for pelvic oncologic defects increased from 1998 to 2014, with a reduction in LOS. Following flap reconstruction, overall complications are higher, but wound breakdown and dehiscence requiring reclosure are decreasing, suggesting technique maturation. We anticipate flap reconstruction rates will increase with further improvement in patient outcomes.
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Affiliation(s)
- Matthew R Zeiderman
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA.
| | - Miriam Nuño
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA; Department of Public Health Sciences, Division of Biostatistics, University of California, Davis USA
| | - David E Sahar
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA
| | - Linda M Farkas
- Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA; Department of Surgery, Division of Colon and Rectal Surgery, University of Texas Southwestern Medical Center USA.
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Bong JW, Lee JA, Ju Y, Seo J, Kang SH, Lee SI, Min BW. Treatment outcomes of patients with involved resection margin after rectal cancer surgery: A nationwide population-based cohort study in South Korea. Asia Pac J Clin Oncol 2021; 18:378-387. [PMID: 34310853 DOI: 10.1111/ajco.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The involvement of resection margins after rectal cancer surgery by malignant tumors is a negative prognostic factor. Therefore, it is important to analyze treatment outcomes and establish adjuvant therapy. METHODS The Health Insurance Review and Assessment Service collects data from medical institutions in South Korea. We reviewed the database of this prospectively collected cohort for patients who underwent curative resection for rectal cancer. RESULTS Of the 5,620 patients, 113 (2.0%) were diagnosed with resection margin involvement after surgery. The resection margins of patients with mid-rectal cancer, pathologic stage III, mucinous/signet ring cell carcinoma, and undergoing emergency surgery were more frequently involved. Neoadjuvant chemoradiotherapy was a significant preventive factor for resection margin involvement (odds ratio = 0.53; 95% confidence interval [CI], 0.32-0.87; p = 0.012). The OS of patients with adjuvant treatment was better than that of patients without adjuvant treatment (5-year overall survival [OS]: 62.8% vs. 46.3%, p = 0.02). The administration of chemoradiotherapy was also significantly associated with better OS (hazard ratio = 0.36; 95% CI, 0.17-0.77; p = 0.009). CONCLUSION Efforts to acquire wider resection margins are necessary for patients with mid-rectal cancer, pathologic stage III, mucinous/signet ring cell carcinoma, and emergency surgery. Neoadjuvant chemoradiotherapy was a significant preventive factor for involved resection margin. Patients with resection margin involvement showed better OS after adjuvant treatment than those without adjuvant treatment. The adjuvant chemoradiotherapy was helpful to prevent the worse prognosis of these patients.
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Affiliation(s)
- Jun Woo Bong
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Ae Lee
- Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeonuk Ju
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Seo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hee Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Il Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Wook Min
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Turgeon MK, Gamboa AC, Keilson JM, Maniko J, Maguire L, Hrebinko K, Holder-Murray J, Wiseman JT, Abdel-Misih S, Hamdan S, Hawkins AT, Bauer P, Silviera M, Maithel SK, Balch GC. Radiological assessment of persistent retroperitoneal and lateral pelvic lymph nodes after neoadjuvant therapy for rectal cancer: An analysis of the United States Rectal Cancer Consortium. J Surg Oncol 2021; 124:818-828. [PMID: 34270097 DOI: 10.1002/jso.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. MATERIALS AND METHODS Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). RESULTS Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1-2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81-12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). CONCLUSIONS Radiographic persistence of RLPN was not associated with worse survival in well-selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.
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Affiliation(s)
- Michael K Turgeon
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Adriana C Gamboa
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jessica M Keilson
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffrey Maniko
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillias Maguire
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine Hrebinko
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer Holder-Murray
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jason T Wiseman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Sherif Abdel-Misih
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Saif Hamdan
- Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander T Hawkins
- Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Philip Bauer
- Department of Surgery, Section of Colon & Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Silviera
- Department of Surgery, Section of Colon & Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Glen C Balch
- Department of Surgery, Division of Colon & Rectal Surgery, Emory University, Atlanta, Georgia, USA
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Liu X, Zhang D, Liu Z, Li Z, Xie P, Sun K, Wei W, Dai W, Tang Z, Ding Y, Cai G, Tong T, Meng X, Tian J. Deep learning radiomics-based prediction of distant metastasis in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A multicentre study. EBioMedicine 2021; 69:103442. [PMID: 34157487 PMCID: PMC8237293 DOI: 10.1016/j.ebiom.2021.103442] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/17/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Accurate predictions of distant metastasis (DM) in locally advanced rectal cancer (LARC) patients receiving neoadjuvant chemoradiotherapy (nCRT) are helpful in developing appropriate treatment plans. This study aimed to perform DM prediction through deep learning radiomics. METHODS We retrospectively sampled 235 patients receiving nCRT with the minimum 36 months' postoperative follow-up from three hospitals. Through transfer learning, a deep learning radiomic signature (DLRS) based on multiparametric magnetic resonance imaging (MRI) was constructed. A nomogram was established integrating deep MRI information and clinicopathologic factors for better prediction. Harrell's concordance index (C-index) and time-dependent receiver operating characteristic (ROC) were used as performance metrics. Furthermore, the risk of DM in patients with different response to nCRT was evaluated with the nomogram. FINDINGS DLRS performed well in DM prediction, with a C-index of 0·747 and an area under curve (AUC) at three years of 0·894 in the validation cohort. The performance of nomogram was better, with a C-index of 0·775. In addition, the nomogram could stratify patients with different responses to nCRT into high- and low-risk groups of DM (P < 0·05). INTERPRETATION MRI-based deep learning radiomics had potential in predicting the DM of LARC patients receiving nCRT and could help evaluate the risk of DM in patients who have different responses to nCRT. FUNDING The funding bodies that contributed to this study are listed in the Acknowledgements section.
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Affiliation(s)
- Xiangyu Liu
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Dafu Zhang
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100080, China
| | - Zhenhui Li
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China
| | - Peiyi Xie
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Kai Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Wei Wei
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Zhenchao Tang
- Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing 100191, China
| | - Yingying Ding
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - Xiaochun Meng
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.
| | - Jie Tian
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing 100191, China; Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology, Beijing 100191, China.
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Lee SW, Jeong SY, Kim K, Kim SJ. Direct comparison of F-18 FDG PET/CT and MRI to predict pathologic response to neoadjuvant treatment in locally advanced rectal cancer: a meta-analysis. Ann Nucl Med 2021; 35:1038-1047. [PMID: 34109555 DOI: 10.1007/s12149-021-01639-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of the current study was to compare the diagnostic accuracies of F-18 FDG PET/CT and MRI for prediction of pathologic responses to neoadjuvant treatment (NAT) in locally advanced rectal cancer (LARC) patients based on a systematic review and meta-analyses. METHODS The PubMed, Cochrane, and Embase databases were searched to identify studies that conducted direct comparisons of the diagnostic performance of F-18 FDG PET/CT and MRI for the prediction of pathologic response to NAT in patients with LARC from the earliest available date of indexing up to July 31, 2020. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR + and LR -), and we constructed summary receiver operating characteristic curves. RESULTS In nine studies (427 patients), the pooled sensitivity of F-18 FDG PET/CT was 0.79 (95% CI 0.71-0.86) and the pooled specificity was 0.74 (95% CI 0.60-0.84). LR syntheses yielded an overall LR + of 3.1 (95% CI 1.9-5.0) and an LR - of 0.28 (95% CI 0.18-0.43). The pooled diagnostic odds ratio (DOR) was 11 (95% CI 5-26). The pooled sensitivity of MRI was 0.89 (95% CI 0.77-0.95) and the pooled specificity was 0.66 (95% CI 0.55-0.76). LR syntheses yielded an overall LR + of 2.6 (95% CI 1.9-3.6) and an LR - of 0.17 (95% CI 0.08-0.37). The pooled DOR was 15 (95% CI 6-42). In meta-regression analysis, no variable was identified as the source of the study heterogeneity. CONCLUSION F-18 FDG PET/CT and MRI showed similar diagnostic performances for the prediction of pathologic responses to NAT in patients with LARC. However, each modality can be a complement to other rather than being used singly.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital and School of Medicine, Daegu, 41404, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital and School of Medicine, Daegu, 41404, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea. .,BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
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Caruso R, Vicente E, Quijano Y, Duran H, Fabra I, Diaz E, Malave L, Agresott R, Cañamaque LG, Ielpo B, Ferri V. Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer. Discov Oncol 2021; 12:16. [PMID: 35201442 PMCID: PMC8777577 DOI: 10.1007/s12672-021-00405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. DATA DESCRIPTION We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.
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Affiliation(s)
- Riccardo Caruso
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Hipolito Duran
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Luis Malave
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Ruben Agresott
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
| | - Lina García Cañamaque
- Division of Nuclear Medicine, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Benedetto Ielpo
- HPB Unit, University Parc Salut Mar Hospital, Barcelona, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña No. 10, 28050 Madrid, Spain
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Bong JW, Ju Y, Seo J, Lee JA, Kang SH, Lee SI, Min BW. Clinical characteristics of rectal cancer patients with neoadjuvant chemoradiotherapy: a nationwide population-based cohort study in South Korea. Ann Surg Treat Res 2021; 100:282-290. [PMID: 34012946 PMCID: PMC8103159 DOI: 10.4174/astr.2021.100.5.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Neoadjuvant chemoradiotherapy has been accepted as a standard treatment for stage II–III rectal cancer. This study aimed to evaluate the clinical characteristics of patients who underwent neoadjuvant chemoradiotherapy for rectal cancer and effects on overall survival (OS) of neoadjuvant chemoradiotherapy in South Korea. Methods Patients who underwent curative resection for rectal cancer from 2014 to 2016 were retrospectively reviewed from the database of the National Quality Assessment program in South Korea. Patients were categorized into the upfront surgery group and neoadjuvant chemoradiotherapy group. We evaluated factors associated with the administration of neoadjuvant chemoradiotherapy and its effects on OS. Inverse probability of treatment weighting was performed to account for baseline differences between subgroups. Results A total of 6,141 patients were categorized into the upfront surgery group (n = 4,237) and neoadjuvant chemoradiotherapy group (n = 1,904). The neoadjuvant chemoradiotherapy was more frequently administered to male, midrectal cancer, and younger patients. In the neoadjuvant chemoradiotherapy group, old age, underweight, and pathologic stage were significant risk factors of OS, and male sex, the level of tumor and clinical stages were not associated with OS. After adjustment, the OS of the neoadjuvant chemoradiotherapy group followed the OS of the upfront surgery group of the same pathologic stage. Conclusion Male sex and the level of tumor were not related to the OS of rectal cancer patients with neoadjuvant chemoradiotherapy. The OS of patients who underwent neoadjuvant chemoradiotherapy was decided by their pathologic stages regardless of clinical stages.
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Affiliation(s)
- Jun Woo Bong
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeonuk Ju
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jihyun Seo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Ae Lee
- Department of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Hee Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sun Il Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung Wook Min
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Liu Y, Zhang FJ, Zhao XX, Yang Y, Liang CY, Feng LL, Wan XB, Ding Y, Zhang YW. Development of a Joint Prediction Model Based on Both the Radiomics and Clinical Factors for Predicting the Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer. Cancer Manag Res 2021; 13:3235-3246. [PMID: 33880066 PMCID: PMC8053518 DOI: 10.2147/cmar.s295317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Neoadjuvant chemoradiotherapy (nCRT) has become the standard treatment for locally advanced rectal cancer (LARC). However, the accuracy of traditional clinical indicators in predicting tumor response is poor. Recently, radiomics based on magnetic resonance imaging (MRI) has been regarded as a promising noninvasive assessment method. The present study was conducted to develop a model to predict the pathological response by analyzing the quantitative features of MRI and clinical risk factors, which might predict the therapeutic effects in patients with LARC as accurately as possible before treatment. Patients and Methods A total of 82 patients with LARC were enrolled as the training cohort and internal validation cohort. The pre-CRT MRI after pretreatment was acquired to extract texture features, which was finally selected through the minimum redundancy maximum relevance (mRMR) algorithm. A support vector machine (SVM) was used as a classifier to classify different tumor responses. A joint radiomics model combined with clinical risk factors was then developed and evaluated by receiver operating characteristic (ROC) curves. External validation was performed with 107 patients from another center to evaluate the applicability of the model. Results Twenty top image texture features were extracted from 6192 extracted-radiomic features. The radiomics model based on high-spatial-resolution T2-weighted imaging (HR-T2WI) and contrast-enhanced T1-weighted imaging (T1+C) demonstrated an area under the curve (AUC) of 0.8910 (0.8114–0.9706) and 0.8938 (0.8084–0.9792), respectively. The AUC value rose to 0.9371 (0.8751–0.9997) and 0.9113 (0.8449–0.9776), respectively, when the circumferential resection margin (CRM) and carbohydrate antigen 19-9 (CA19-9) levels were incorporated. Clinical usefulness was confirmed in an external validation cohort as well (AUC, 0.6413 and 0.6818). Conclusion Our study indicated that the joint radiomics prediction model combined with clinical risk factors showed good predictive ability regarding the treatment response of tumors as accurately as possible before treatment.
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Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Feng-Jiao Zhang
- Shanghai Concord Medical Cancer Center, Shanghai, 200001, People's Republic of China
| | - Xi-Xi Zhao
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Yuan Yang
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Chun-Yi Liang
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Li-Li Feng
- Department of Radiation Oncology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Xiang-Bo Wan
- Department of Radiation Oncology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Yi Ding
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Yao-Wei Zhang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
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Carannante F, Bianco G, Lauricella S, Mascianà G, Caricato M, Capolupo GT. TaTME approach as a rescue during a laparoscopic TME for high rectal cancer. A case report. Int J Surg Case Rep 2021; 82:105870. [PMID: 33857768 PMCID: PMC8065283 DOI: 10.1016/j.ijscr.2021.105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 12/01/2022] Open
Abstract
There are several surgical approaches for patient with rectal cancer, depending on tumor stage and tumor distance from anal verge. Total mesorectal excision (TME) is the gold standard surgical technique for rectal tumors, reducing rectal cancer local recurrence. Transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients with narrow pelvis, improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice. In conclusion, we believe that, if performed by experienced surgeons, TaTME is safe and useful and could be used not in his conventional use.
Introduction and importance In the last years, transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients, difficulties in pelvic exposure and limitations of instrumentation improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. Here we report a case report of anterior laparoscopic rectal resection for adenocarcinoma of the high-mid rectum converted to transanal approach. Case presentation A 69-year-old male presented hepatic nodules during radiological follow-up for prostate cancer treated with radical prostatectomy and adjuvant radiotherapy (70 Gy). The biopsy of the lesion demonstrated the presence of a metastatic lesion of an adenocarcinoma, with suspected intestinal origin. Then, we perform an endoscopic examination, which showed the presence of a rectal lesion, which cause a bowel stenosis extended from the middle part to the upper part of the rectum. After chemoradiotherapy, an anterior rectal resection was performed. During surgery we could not perform the resection of the rectum due the thickness and fibrosis of the tissue, despite we used different branded mechanical stapler. So, we decided to complete the surgical treatment starting a TaTME procedure with resolution of the problem. Clinical discussion TaTME is a relatively new technique that had already become a valid option in the treatment of low rectal cancer, and, nowadays, also in the treatment of inflammatory bowel disease. As reported in literature, this technique has a number of advantages, especially in narrow pelvis and it is very useful in low rectal surgery. Conclusion This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice.
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Affiliation(s)
- F Carannante
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - G Bianco
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - S Lauricella
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Mascianà
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Caricato
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G T Capolupo
- Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Jang S, Lee JM, Yoon JH, Bae JS. Reduced field-of-view versus full field-of-view diffusion-weighted imaging for the evaluation of complete response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Abdom Radiol (NY) 2021; 46:1468-1477. [PMID: 32986174 DOI: 10.1007/s00261-020-02763-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine whether reduced field-of-view (rFOV) DWI sequences can improve image quality and diagnostic performance compared with conventional full FOV (fFOV) DWI in the prediction of complete response (CR) to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancers. METHODS Between September 2015 and December 2017, seventy-three patients with locally advanced rectal cancers (≥ T3 or lymph node positive) who underwent CRT and subsequent surgery were included in this retrospective study. All patients had tumor located no more than 10 cm from the anal verge, and underwent rectal MRI including fFOV b-1000 DWI and rFOV b-1000 DWI at 3 T before and after CRT. Image quality and diagnostic performance in predicting CR were compared between rFOV DWI and fFOV DWI sets by two reviewers. RESULTS Based on a 12-point scale, rFOV DWI provided better image quality scores than fFOV DWI (9.1 ± 1.7 vs. 8.4 ± 1.0, respectively, P < 0.001). Diagnostic accuracy (Az) in evaluating CR was better with the rFOV DWI set than with the fFOV DWI set for both reviewers: reviewer 1, 0.78 vs. 0.57 (P = .004); reviewer 2, 0.72 vs. 0.61 (P = .031). CONCLUSION rFOV DWI of rectal cancer can provide better overall image quality, and its addition to conventional rectal MRI may provide better diagnostic accuracy than fFOV DWI in the evaluation of CR to neoadjuvant CRT in patients with locally advanced rectal cancer.
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Affiliation(s)
- Siwon Jang
- Department of Radiology, SMG - SNU Boramae Medical Center, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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Sakin A, Sahin S, Karyagar SS, Karyagar S, Atci M, Akboru MH, Cihan S. The Predictive Value of Baseline Volumetric PET/CT Parameters on Treatment Response and Prognosis in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy. J Gastrointest Cancer 2021; 53:341-347. [PMID: 33651265 DOI: 10.1007/s12029-021-00608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the prognostic effects of baseline volumetric PET/CT parameters including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) on treatment response and prognosis in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (NACRT). METHODS Between 2015 and 2018, 51 patients with LARC treated with NACRT followed by surgery were included in this retrospective study. Patients were divided into 2 groups by tumor regression grade (TRG) as follows: group I = TRG 1 (no detectable cancer cells) + TRG 2 (single cells and/or small groups of cancer cells) and group II = TRG3 (residual tumor outgrown by fibrosis) + TRG 4 (remarkable fibrosis outgrown by tumor cells) + TRG 5 (no fibrosis with extensive residual cancer). RESULTS Of the 51 patients, 34 (66.7%) were male. The median age was 55 (range, 37-78) years. According to TRG status, 14 (27.4%) patients were in group I and 37 (72.6%) patients were in group II. The area under the curve (95% CI) was 0.749 (0.593-0.905) in the ROC curve plotted for MTV. The cut-off value for MTV was 12, with 70% sensitivity and 65% specificity. MTV was ≥ 12 in 32 (62.8%) patients. MTV and TLG values were significantly different between groups I and II, whereas there was no significant difference between the groups in terms of SUVmax values (p = 0.006, p = 0.033, and p = 0.673, respectively). The disease-free survival was not reached in patients with MTV < 12 vs. 20 months in those with MTV ≥ 12 (p = 0.323). In multivariate analysis, MTV (OR, 95% Cl, 5.00 [1.17-21.383]) was found to be the factor that affected pathological complete response. CONCLUSION In LARC treated with NACRT, MTV prior to treatment can help predict the response to treatment.
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Affiliation(s)
- Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey.
| | - Suleyman Sahin
- Department of Medical Oncology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Sevda Saglampınar Karyagar
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr Cemil, Tascıoglu City Hospital, İstanbul, Turkey
| | - Savas Karyagar
- Department of Nuclear Medicine, University of Health Sciences, Prof. Dr Cemil, Tascıoglu City Hospital, İstanbul, Turkey
| | - Mustafa Atci
- Department of Medical Oncology, University of Health Sciences, Prof. Dr Cemil, Tascıoglu City Hospital, 34384, Istanbul, Turkey
| | - Mustafa Halil Akboru
- Department of Radiation Oncology, University of Health Sciences, Prof. Dr Cemil, Tascıoglu City Hospital, 34384, Istanbul, Turkey
| | - Sener Cihan
- Department of Medical Oncology, University of Health Sciences, Prof. Dr Cemil, Tascıoglu City Hospital, 34384, Istanbul, Turkey
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Two Zn(II) coordination polymers: Selective detection Fe3+ ion and inhibitory activity on the liver cancer viability by regulating the prolyl hydroxylase-3. ARAB J CHEM 2021. [DOI: 10.1016/j.arabjc.2021.102998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Chen T, Yang P, Jia Y. Molecular mechanisms of astragaloside‑IV in cancer therapy (Review). Int J Mol Med 2021; 47:13. [PMID: 33448320 PMCID: PMC7834967 DOI: 10.3892/ijmm.2021.4846] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022] Open
Abstract
Radix Astragali (RA) is widely used in traditional Chinese medicine (TCM), and astragaloside IV (AS-IV) is the most critical component of RA. Previous studies have demonstrated that AS-IV exerts effects on the myocardium, nervous system and endocrine system, among others. In the present review article, data from studies conducted over the past 20 years were collated, which have evaluated the effects of AS-IV on tumors. The mechanisms of action of AS-IV on malignant cells both in vivo and in vitro were summarized and it was demonstrated that AS-IV plays a vital role, particularly in inhibiting tumor growth and metastasis, promoting the apoptosis of tumor cells, enhancing immune function and preventing drug resistance. Moreover, AS-IV controls several epithelial-mesenchymal transformation (EMT)-related and autophagy-related pathways, such as the phosphoinositide-3-kinase (PI3K)/protein kinase B (AKT), Wnt/β-catenin, mitogen-activated protein kinase (MAPK)/extracellular regulated protein kinase (ERK) and transforming growth factor-β (TGF-β)/SMAD signaling pathways, which are commonly affected in the majority of tumors. The present review provides new perspectives on the functions of AS-IV and its role as an adjuvant treatment in cancer chemotherapy.
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Affiliation(s)
- Tianqi Chen
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, P.R. China
| | - Peiying Yang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, P.R. China
| | - Yingjie Jia
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, P.R. China
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Transanal total mesorectal excision for stage II or III rectal cancer: pattern of local recurrence in a tertiary referral center. Surg Endosc 2021; 35:7191-7199. [PMID: 33398553 DOI: 10.1007/s00464-020-08200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND For mid and low rectal cancer, transanal total mesorectal excision (TaTME) has been established as an alternative approach to laparoscopic surgery. However, there are concerns about an unexpected pattern of local recurrence. This study aimed to analyze the pattern of local recurrence for patients treated with TaTME in a tertiary referral center. METHODS A retrospective single-center analysis was performed. Since 2011, all patients with rectal cancer undergoing TaTME with curative intent were prospectively included in a standardized database. Patients with tumors within 12 cm, clinical stage II or III were included. The primary endpoint of the study was the overall local recurrence rate, together with a critical analysis of the patterns of local failures. RESULTS Two hundred and five patients were included in this analysis. At the time of surgery, patients had a mean age of 67.1 years (SD 12.3), and 66.8% were male. Neoadjuvant therapy was administered in 73.7%. Mesorectal specimen quality was complete or near-complete in 98.5%, while circumferential resection margin was ≤ 1 mm (including T4 tumors) in 11.8%. After a median follow-up of 34.3 months (95% CI 30.1-38.5), 3.4% (n = 7) presented with local recurrent disease. Six out of the seven patients were also diagnosed with hematogenous metastases. Of the seven patients, three presented with at least one of the following risk factors: T4 tumor, N2 disease, incomplete mesorectal specimen, or positive CRM. Local failure was noted posteriorly (n = 3), laterally (n = 2), anteriorly (n = 1), and in the axial compartment (n = 1). Median time to relapse was 31.5 months (10.3-40.9). The median follow-up after local recurrence was 7.9 (95% CI 6.7-9.1) months, with an overall survival of 85.7%. CONCLUSIONS TaTME provided satisfactory local recurrence outcomes, and the most common patterns of failure were in the central pelvis.
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Differences in and Prognostic Value of Quality of Life Data in Rectal Cancer Patients with and without Distant Metastases. Healthcare (Basel) 2020; 9:healthcare9010001. [PMID: 33374955 PMCID: PMC7821945 DOI: 10.3390/healthcare9010001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Individualization of treatment is a major challenge in oncology and requires a variety of predictive and prognostic parameters. In addition to tumor biology analyses, baseline health-related quality of life might be a valid tool to predict overall survival. This study was conducted to evaluate the prognostic relevance of baseline quality of life data in patients with rectal cancer. In this context, differences between patients with and without distant metastases were of particular interest. (2) Methods: Our cohort included 258 patients with rectal cancer treated in the radiotherapy department of the University Hospital Erlangen. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (QLQ C30) and colorectal cancer questionnaire (CR38). Clinical and survival data were provided by the Gießener Tumor Documentation System (GTDS) of the Comprehensive Cancer Center Erlangen-EMN (CCC, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany). Statistical analyses were performed using Kaplan–Meier analyses and univariate and multivariate Cox regression. (3) Results: A cohort of 258 patients with rectal adenocarcinoma was analyzed including 50 patients (19.4%) with metastatic disease. No differences were observed between patients with and without distant metastases in most areas of quality of life studied, with the exception of physical function, loss of appetite, chemotherapy side effects and weight loss. Gender, baseline physical function, sexual function, diarrhea, and weight loss over time had a prognostic value in the entire cohort. Appetite loss was an additional prognostic parameter in patients with distant metastases. (4) Conclusions: The quality of life of patients with metastatic disease differed only slightly from non-metastatic patients. Health-related quality of life data provide prognostic information for patients with rectal cancer.
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Clifford RE, Govindarajah N, Bowden D, Sutton P, Glenn M, Darvish-Damavandi M, Buczacki S, McDermott U, Szulc Z, Ogretmen B, Parsons JL, Vimalachandran D. Targeting Acid Ceramidase to Improve the Radiosensitivity of Rectal Cancer. Cells 2020; 9:E2693. [PMID: 33334013 PMCID: PMC7765421 DOI: 10.3390/cells9122693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
Previous work utilizing proteomic and immunohistochemical analyses has identified that high levels of acid ceramidase (AC) expression confers a poorer response to neoadjuvant treatment in locally advanced rectal cancer. We aimed to assess the radiosensitising effect of biological and pharmacological manipulation of AC and elucidate the underlying mechanism. AC manipulation in three colorectal cancer cell lines (HT29, HCT116 and LIM1215) was achieved using siRNA and plasmid overexpression. Carmofur and a novel small molecular inhibitor (LCL521) were used as pharmacological AC inhibitors. Using clonogenic assays, we demonstrate that an siRNA knockdown of AC enhanced X-ray radiosensitivity across all colorectal cancer cell lines compared to a non-targeting control siRNA, and conversely, AC protein overexpression increased radioresistance. Using CRISPR gene editing, we also generated AC knockout HCT116 cells that were significantly more radiosensitive compared to AC-expressing cells. Similarly, two patient-derived organoid models containing relatively low AC expression were found to be comparatively more radiosensitive than three other models containing higher levels of AC. Additionally, AC inhibition using carmofur and LCL521 in three colorectal cancer cell lines increased cellular radiosensitivity. Decreased AC protein led to significant poly-ADP ribose polymerase-1 (PARP-1) cleavage and apoptosis post-irradiation, which was shown to be executed through a p53-dependent process. Our study demonstrates that expression of AC within colorectal cancer cell lines modulates the cellular response to radiation, and particularly that AC inhibition leads to significantly enhanced radiosensitivity through an elevation in apoptosis. This work further solidifies AC as a target for improving radiotherapy treatment of locally advanced rectal cancer.
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Affiliation(s)
- Rachael E. Clifford
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
| | - Naren Govindarajah
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
| | - David Bowden
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
| | - Paul Sutton
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
| | - Mark Glenn
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
| | - Mahnaz Darvish-Damavandi
- Nuffield Department of Surgical Science, University of Oxford, Oxford OX3 7DQ, UK; (M.D.-D.); (S.B.)
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Simon Buczacki
- Nuffield Department of Surgical Science, University of Oxford, Oxford OX3 7DQ, UK; (M.D.-D.); (S.B.)
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | | | - Zdzislaw Szulc
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA; (Z.S.); (B.O.)
| | - Besim Ogretmen
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA; (Z.S.); (B.O.)
| | - Jason L. Parsons
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
- Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington CH63 4JY, UK
| | - Dale Vimalachandran
- Cancer Research Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; (N.G.); (D.B.); (P.S.); (M.G.); (J.L.P.)
- The Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK
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Dai J, Cheng Y, Wu J, Wang Q, Wang W, Yang J, Zhao Z, Lou X, Xia F, Wang S, Tang BZ. Modular Peptide Probe for Pre/Intra/Postoperative Therapeutic to Reduce Recurrence in Ovarian Cancer. ACS NANO 2020; 14:14698-14714. [PMID: 33174739 DOI: 10.1021/acsnano.9b09818] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Even with optimal surgery, 80% of patients with ovarian cancer will have recurrence. Adjuvant therapy can reduce the recurrence of tumors; however, the therapeutic effect is still not prominent. Herein, we designed a modular peptide probe (TCDTMP), which can be self-assembled into nanoparticles (NPs) by loading in miR-145-5p or VEGF-siRNA. In vivo, (1) preoperative administration of TCDTMP/miR-145-5p ensured that NPs were adequately accumulated in tumors through active targeting and increased the expression of miR-145-5p in tumors, thereby inducing tumor cell apoptosis. (2) Intraoperatively, most of the tumors were removed, while the microscopic residual tumors were largely eliminated by TCDTMP/miR-145-5p-mediated photodynamic therapy (PDT). (3) Postoperatively, TCDTMP/VEGF-siRNA were given for antiangiogenesis therapy, thus delaying the recurrence of tumors. This treatment was named a preoperative (TCDTMP/miR-145-5p)||intraoperative (surgery and PDT)||postoperative (TCDTMP/VEGF-siRNA) therapeutic system and abbreviated as the PIP therapeutic system, which reduced the recurrence of ovarian cancer in subcutaneous tumor models, intraperitoneal metastasis models, and patient-derived tumor xenograft models. Our findings provide a therapeutic system based on modular peptide probes to reduce the recurrence of ovarian cancer after surgery, which provides a perspective for the surgical management of ovarian cancer.
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Affiliation(s)
- Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Yong Cheng
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Jun Wu
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Quan Wang
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Juliang Yang
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Zujin Zhao
- State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
| | - Xiaoding Lou
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Fan Xia
- Engineering Research Center of Nano-Geomaterials of Ministry of Education, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430032, China
| | - Ben Zhong Tang
- State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
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Panic J, Defeudis A, Mazzetti S, Rosati S, Giannetto G, Vassallo L, Regge D, Balestra G, Giannini V. A Convolutional Neural Network based system for Colorectal cancer segmentation on MRI images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1675-1678. [PMID: 33018318 DOI: 10.1109/embc44109.2020.9175804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the study is to present a new Convolutional Neural Network (CNN) based system for the automatic segmentation of the colorectal cancer. The algorithm implemented consists of several steps: a pre-processing to normalize and highlights the tumoral area, the classification based on CNNs, and a post-processing aimed at reducing false positive elements. The classification is performed using three CNNs: each of them classifies the same regions of interest acquired from three different MR sequences. The final segmentation mask is obtained by a majority voting. Performances were evaluated using a semi-automatic segmentation revised by an experienced radiologist as reference standard. The system obtained Dice Similarity Coefficient (DSC) of 0.60, Precision (Pr) of 0.76 and Recall (Re) of 0.55 on the testing set. After applying the leave-one-out validation, we obtained a median DSC=0.58, Pr=0.74, Re=0.54. The promising results obtained by this system, if validated on a larger dataset, could strongly improve personalized medicine.
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Cho H, Kim JE, Kim SY, Kim KP, Kim TW, Park JH, Kim JH, Lim SB, Yu CS, Kim JC, Hong YS. Patterns of recurrence in patients with curative resected rectal cancer according to different chemoradiotherapy strategies: Does preoperative chemoradiotherapy lower the risk of peritoneal recurrence? Oncol Lett 2020; 20:242. [PMID: 32973956 DOI: 10.3892/ol.2020.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023] Open
Abstract
The present study aimed to compare the pattern of distant recurrence between patients with non-metastatic rectal cancer treated with pre-operative (OP) and those treated with post-operative (post-OP) chemoradiotherapy (CRT). A total of 631 patients with newly diagnosed non-metastatic rectal cancer who had received pre-OP or post-OP CRT with curative intent surgery between August 2008 and April 2015 were identified. Inverse probability of treatment weighting (IPTW) was performed to account for baseline differences between the two arms. Overall, 449 and 182 patients were treated with pre-OP and post-OP CRT, respectively. Sex, tumor location, clinical tumor stage, CRT regimen and adjuvant chemotherapy regimen were significantly different between the two arms. The median follow-up duration was 55.4 months (range, 53.7-57.1). The 5-year distant recurrence-free survival (RFS) rates and 5-year overall survival (OS) rates were not significantly different between the pre-OP and post-OP CRT arms (RFS, 67.5 vs. 71.6%, P=0.595 and OS, 81.9 vs. 77.0%, P=0.449), and no difference was observed in the distant recurrence patterns. Following IPTW, there was still no difference in distant RFS (pre-OP vs. post-OP CRT; hazard ratio (HR)=0.62; P=0.911), but pre-OP CRT was significantly associated with lower peritoneal recurrence (pre-OP vs. post-OP CRT; HR, 0.13; P=0.032). In addition, there was no significant difference in OS between the two arms (pre-OP vs. post-OP CRT; HR, 0.85; P=0.665). In conclusion, although distant RFS was not significantly different between the two arms, pre-OP CRT was significantly associated with a lower risk of peritoneal recurrence than post-OP CRT in patients non-metastatic rectal cancer.
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Affiliation(s)
- Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Kyu-Pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Seok-Byung Lim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Chang Sik Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Farshi Radvar F, Mohammad-Zadeh M, Mahdavi R, Andersen V, Nasirimotlagh B, Faramarzi E, Lotfi Yagin N. Effect of synbiotic supplementation on matrix metalloproteinase enzymes, quality of life and dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND: Probiotic/synbiotic has the important role of in altering intestinal bacteria, reducing inflammation and improvement of intestinal diseases. OBJECTIVE: We aimed to investigate the effect of synbiotic supplementation on matrix metalloproteinase (MMP) enzymes, hs-CRP, quality of life, dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (CRT). METHODS: In this study, 46 rectal cancer patients were recruited. Patients were allocated to the synbiotic (n = 23) group or placebo groups (n = 23) receiving 2 synbiotic or placebo capsules for six weeks. Anthropometric measurements, quality of life, dietary intakes, and serum levels of MMP-2, MMP-9, and hs-CRP were compared before and after intervention with the use of statistical tests. RESULTS: The mean energy, carbohydrate, and protein intake of patients increased in the synbiotic group, while in the placebo group, post intervention, significant reduction was noticed in these parameters (P < 0.05). Synbiotic supplementation caused improvement in global health status, symptom scale scores and scores of functional scale. At the end of intervention, the elevation in hs-CRP, MMP-2, and MMP-9 levels in the placebo group was approximately two and four times higher than the synbiotic group respectively. CONCLUSION: According to our results, synbiotic supplementation may be helpful in cancer patients undergoing CRT. However, further studies must consider synbiotic as a new complementary treatment.
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Affiliation(s)
| | - Mohammad Mohammad-Zadeh
- Radiotherapy Department Shahid Madani University hospital Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mahdavi
- Nutrition Research Centre of Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vibeke Andersen
- Organ Center, Hospital of Southern Jutland, 6200 Aabenraa, Denmark
| | - Behnam Nasirimotlagh
- Radiotherapy Department Shahid Madani University Hospital Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver & Gastrointestinal Diseases Research Centre of Tabriz University of Medical Sciences. Tabriz, Iran
| | - Neda Lotfi Yagin
- Nutrition Research Centre of Tabriz University of Medical Sciences. Tabriz, Iran
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Value of volumetric and textural analysis in predicting the treatment response in patients with locally advanced rectal cancer. Ann Nucl Med 2020; 34:960-967. [PMID: 32951129 DOI: 10.1007/s12149-020-01527-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the value of baseline 18F-FDG PET/CT in predicting the response to neoadjuvant chemo-radiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC) via the volumetric and texture data obtained from 18F-FDG PET/CT images. METHODS In total, 110 patients who had undergone NCRT after initial PET/CT and followed by surgical resection were included in this study. Patients were divided into two groups randomly as a train set (n: 88) and test set (n: 22). Pathological response using three-point tumor regression grade (TRG) and metastatic lymph nodes in PET/CT images were determined. TRG1 were accepted as responders and TRG2-3 as non-responders. Region of interest for the primary tumors was drawn and volumetric features (metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) and texture features were calculated. In train set, the relationship between these features and TRG was investigated with Mann-Whitney U test. Receiver operating curve analysis was performed for features with p < 0.05. Correlation between features were evaluated with Spearman correlation test, features with correlation coefficient < 0.8 were evaluated with the logistic regression analysis for creating a model. The model obtained was tested with a test set that has not been used in modeling before. RESULTS In train set 32 (36.4%) patients were responders. The rate of visually detected metastatic lymph node at baseline PET/CT was higher in non-responders than responders (71.4% and 46.9%, respectively, p = 0.022). There was a statistically significant difference between TLG, MTV, SHAPE_compacity, NGLDMcoarseness, GLRLM_GLNU, GLRLM_RLNU, GLZLM_LZHGE and GLZLM_GLNU between responders and non-responders. MTV and NGLDMcoarseness demonstrated the most significance (p = 0.011). A multivariate logistic regression analysis that included MTV, coarseness, GLZLM_LZHGE and lymph node metastasis was performed. Multivariate analysis demonstrated MTV and lymph node metastasis were the most meaningful parameters. The model's AUC was calculated as 0.714 (p = 0.001,0.606-0.822, 95% CI). In test set, AUC was determined 0.838 (p = 0.008,0.671-1.000, 95% CI) in discriminating non-responders. CONCLUSIONS Although there were points where textural features were found to be significant, multivariate analysis revealed no diagnostic superiority over MTV in predicting treatment response. In this study, it was thought higher MTV value and metastatic lymph nodes in PET/CT images could be a predictor of low treatment response in patients with LARC.
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85
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Sauter AP, Kössinger A, Beck S, Deniffel D, Dapper H, Combs SE, Rummeny EJ, Pfeiffer D. Dual-energy CT parameters in correlation to MRI-based apparent diffusion coefficient: evaluation in rectal cancer after radiochemotherapy. Acta Radiol Open 2020; 9:2058460120945316. [PMID: 32995044 PMCID: PMC7503032 DOI: 10.1177/2058460120945316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background Rectal cancer (RC) is a frequent malignancy for which magnetic resonance imaging (MRI) is the most common and accurate imaging. Iodine concentration (IC) can be quantified with spectral dual-layer computed tomography CT (DL-CT), which could improve imaging of RC, especially for evaluation of response to radiochemotherapy (RCT). Purpose To compare a DL-CT system to MRI as the non-invasive imaging gold standard for imaging of RC to evaluate the possibility of a response evaluation with DL-CT. Material and Methods Eleven patients who received DL-CT as well as MRI before and after RCT of RC were retrospectively included into this study. For each examination, a region of interest (ROI) was placed within the tumor. For MRI, the mean apparent diffusion coefficient (ADC) was assessed. For DL-CT, IC, z-effective, and Hounsfield Units (HU) were measured. IC, z-effective, and HU were normalized to the aorta. ADC was correlated to absolute and relative normalized IC, z-effective, and HU with Spearman’s ρ. Differences before and after treatment were tested with Wilcoxon signed-rank test. Results HU, IC, and Z-effective values in DL-CT images decreased significantly after RCT (P<0.01 for each comparison). The mean ADC increased significantly after RCT. Spearman’s ρ of the absolute IC difference and the absolute ADC (both before and after RCT) is high and significant (ρ = 0.73; P = 0.01), whereas the ρ-value for z-effective (ρ = 0.56) or HU (ρ = 0.45) to ADC was lower and non-significant. Conclusion Response evaluation of RC after RCT could be possible with DL-CT via the measurement of IC.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Antonia Kössinger
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Stefanie Beck
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Dominik Deniffel
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Munich, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (dktk), Partner Site Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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Zhang X, Deng X, Li J, Ding Y, Liu S, Wang Z. Laparoscopic total mesorectal excision combined with en-bloc seminal vesicle and prostate resection for rectal cancer after chemoradiotherapy. ANZ J Surg 2020; 90:E168-E171. [PMID: 32856381 DOI: 10.1111/ans.16239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to explore the surgical outcomes of laparoscopic total mesorectal excision (TME) combined with en-bloc seminal vesicle resection (SVR) and partial prostate resection (PPR) for locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT). METHODS Patients receiving TME combined with en-bloc SVR and PPR for LARC after CRT from 2014 to 2019 were enrolled retrospectively. Patients' characteristics and surgical outcomes were collected and analysed. RESULTS A total of six male patients were enrolled in this study. Among them, four patients proved to be T4b stage including three Denonvilliers fascia invasion and one seminal vesicle invasion. R0 resection was achieved in all patients. With a median follow-up time of 24 months, no local recurrence was observed. CONCLUSION It is safe and feasible to perform laparoscopic TME combined with en-bloc SVR and PPR in selected LARC patients after neoadjuvant CRT. It can provide a safe circumferential resection margin and R0 resection. More studies are warranted to improve the diagnostic accuracy for T4b stage after CRT and avoid unnecessary extended resection.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Li
- Department of operating Room, West China Hospital, Sichuan University, Chengdu, China
| | - Yanling Ding
- Department of Cardiology, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China
| | - Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Shao L, Liu Z, Feng L, Lou X, Li Z, Zhang XY, Wan X, Zhou X, Sun K, Zhang DF, Wu L, Yang G, Sun YS, Xu R, Fan X, Tian J. Multiparametric MRI and Whole Slide Image-Based Pretreatment Prediction of Pathological Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer: A Multicenter Radiopathomic Study. Ann Surg Oncol 2020; 27:4296-4306. [PMID: 32729045 PMCID: PMC7497677 DOI: 10.1245/s10434-020-08659-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 01/01/2023]
Abstract
Background The aim of this work is to combine radiological and pathological information of tumor to develop a signature for pretreatment prediction of discrepancies of pathological response at several centers and restage patients with locally advanced rectal cancer (LARC) for individualized treatment planning. Patients and Methods A total of 981 consecutive patients with evaluation of response according to tumor regression grade (TRG) who received nCRT were retrospectively recruited from four hospitals (primary cohort and external validation cohort 1–3); both pretreatment multiparametric MRI (mp-MRI) and whole slide image (WSI) of biopsy specimens were available for each patient. Quantitative image features were extracted from mp-MRI and WSI and used to construct a radiopathomics signature (RPS) powered by an artificial-intelligence model. Models based on mp-MRI or WSI alone were also constructed for comparison. Results The RPS showed overall accuracy of 79.66–87.66% in validation cohorts. The areas under the curve of RPS at specific response grades were 0.98 (TRG0), 0.93 (≤ TRG1), and 0.84 (≤ TRG2). RPS at each grade of pathological response revealed significant improvement compared with both signatures constructed without combining multiscale tumor information (P < 0.01). Moreover, RPS showed relevance to distinct probabilities of overall survival and disease-free survival in patients with LARC who underwent nCRT (P < 0.05). Conclusions The results of this study suggest that radiopathomics, combining both radiological information of the whole tumor and pathological information of local lesions from biopsy, could potentially predict discrepancies of pathological response prior to nCRT for better treatment planning. Electronic supplementary material The online version of this article (10.1245/s10434-020-08659-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lizhi Shao
- School of Computer Science and Engineering, Southeast University, Nanjing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Lili Feng
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoying Lou
- Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenhui Li
- Department of Radiology, Yunnan Cancer Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangbo Wan
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuezhi Zhou
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Kai Sun
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China.,Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Da-Fu Zhang
- Department of Radiology, Yunnan Cancer Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lin Wu
- Department of Pathology, Yunnan Cancer Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guanyu Yang
- School of Computer Science and Engineering, Southeast University, Nanjing, China.,LIST, Key Laboratory of Computer Network and Information Integration, Southeast University, Ministry of Education, Nanjing, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ruihua Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Xinjuan Fan
- Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, China. .,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China. .,Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.
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88
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Malekzadeh Moghani M, Alahyari S, Moradi A, Nasiri M. Pathological Predictors of Response to Neoadjuvant Treatment in Rectal Carcinoma. J Gastrointest Cancer 2020; 52:690-695. [PMID: 32643115 DOI: 10.1007/s12029-020-00450-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Neoadjuvant chemoradiotherapy has now become a standard treatment for rectal cancer. Recently, attempts have been made to predict the response rate to this treatment to decide whether or not it must be performed. However, tissue factors for predicting the response rate is not cohesively reviewed. METHODS Eighty-three patients with rectal cancer, all under neoadjuvant chemoradiotherapy and subsequent surgery, were examined for tissue factors in the biopsy sample. The tissue factors examined include tumor differentiation grade, lymphovascular invasion, perineural invasion, pathological stage, and lymphocytic infiltration. Lymphocytic infiltration was investigated by immunohistochemistry for CD8 T lymphocyte in biopsy samples. RESULTS In this study, tissue factors were found to play a decisive role in predicting response to neoadjuvant treatment. The most important factor was the pathological stage, which has the highest correlation with response to treatment. There is a significant relationship between CD8 lymphocyte infiltration and response to treatment (P value = 0.018). Primary perineural invasion and lymphovascular invasion also have a significant meaningful relationship with response to treatment (P value = 0.021 and P value = 0.036). CONCLUSION In this study, it was determined that the investigated factors have a significant relationship with response to treatment and could be used to predict the response to treatment, and if a low possibility of positive response exists, prevention of the complications of neoadjuvant chemoradiotherapy for the patients could occur.
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Affiliation(s)
- Mona Malekzadeh Moghani
- Department of Radiation Oncology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Afshin Moradi
- Department of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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89
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Hsu YC, Luo CW, Huang WL, Wu CC, Chou CL, Chen CI, Chang SJ, Chai CY, Wang HC, Chen TY, Li CF, Pan MR. BMI1-KLF4 axis deficiency improves responses to neoadjuvant concurrent chemoradiotherapy in patients with rectal cancer. Radiother Oncol 2020; 149:249-258. [PMID: 32592893 DOI: 10.1016/j.radonc.2020.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Neoadjuvant concurrent chemoradiotherapy (CCRT) is a gold standard treatment for patients with stage II/III rectal cancer. B-cell-specific Moloney murine leukemia virus insertion site 1 (BMI1) is a member of the polycomb group of proteins that are involved in regulating gene expression. High levels of BMI1 have been demonstrated to contribute to the malignant phenotypes of several cancers; however, its relevance in rectal cancer treated with CCRT is largely unknown. METHODS AND MATERIALS We used two patient cohorts to address the clinical relevance of BMI1 in human cancers. In addition, HT-29 and HCT-116 cells were chosen as our in vitro models to verify the role of BMI1 in cell response to ionizing radiation. Stemness-related proteins were analyzed by western blotting and cell survival was determined using clonogenic assays. RESULTS BMI1 overexpression was found to significantly correlate with advanced pre-treatment nodal status (N1-N2; p < 0.001), post-treatment tumor stage (T1-T2; p = 0.015), inferior tumor regression grade (p = 0.001), and also an independent prognosis factor in 172 rectal cancer patients receiving CCRT. Serial cell-based functional examination indicated that BMI1 deficiency sensitized cells to radiation treatment by modulating the gene expression of Kruppel-like factor 4 (KLF4) and enhanced radiosensitivity in microsatellite stable (MSS) colorectal cancers. Overexpression of KLF4 partially overcame BMI1-deficiency-mediated γ-H2AX expression after ionizing radiation exposure. Consistent with in vitro data, an analysis of an additional 30 rectal cancer tissue specimens revealed a positive correlation between BMI1 and KLF4 (p = 0.02). CONCLUSION Higher levels of BMI1 are associated with poor therapeutic response and adverse outcomes in rectal cancer patients receiving CCRT.
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Affiliation(s)
- Yin-Chou Hsu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wen Luo
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Lun Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Lin Chou
- Division of Colon & Rectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chih-I Chen
- Division of Colon & Rectal Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Jyuan Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Ching Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yi Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Mei-Ren Pan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
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90
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Geijsen AJ, van Roekel EH, van Duijnhoven FJ, Achaintre D, Bachleitner‐Hofmann T, Baierl A, Bergmann MM, Boehm J, Bours MJ, Brenner H, Breukink SO, Brezina S, Chang‐Claude J, Herpel E, de Wilt JH, Gicquiau A, Gigic B, Gumpenberger T, Hansson BM, Hoffmeister M, Holowatyj AN, Karner‐Hanusch J, Keski‐Rahkonen P, Keulen ET, Koole JL, Leeb G, Ose J, Schirmacher P, Schneider MA, Schrotz‐King P, Stift A, Ulvik A, Vogelaar FJ, Wesselink E, van Zutphen M, Gsur A, Habermann N, Kampman E, Scalbert A, Ueland PM, Ulrich AB, Ulrich CM, Weijenberg MP, Kok DE. Plasma metabolites associated with colorectal cancer stage: Findings from an international consortium. Int J Cancer 2020; 146:3256-3266. [PMID: 31495913 PMCID: PMC7216900 DOI: 10.1002/ijc.32666] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/06/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is the second most common cause of cancer-related death globally, with marked differences in prognosis by disease stage at diagnosis. We studied circulating metabolites in relation to disease stage to improve the understanding of metabolic pathways related to colorectal cancer progression. We investigated plasma concentrations of 130 metabolites among 744 Stages I-IV colorectal cancer patients from ongoing cohort studies. Plasma samples, collected at diagnosis, were analyzed with liquid chromatography-mass spectrometry using the Biocrates AbsoluteIDQ™ p180 kit. We assessed associations between metabolite concentrations and stage using multinomial and multivariable logistic regression models. Analyses were adjusted for potential confounders as well as multiple testing using false discovery rate (FDR) correction. Patients presented with 23, 28, 39 and 10% of Stages I-IV disease, respectively. Concentrations of sphingomyelin C26:0 were lower in Stage III patients compared to Stage I patients (pFDR < 0.05). Concentrations of sphingomyelin C18:0 and phosphatidylcholine (diacyl) C32:0 were statistically significantly higher, while citrulline, histidine, phosphatidylcholine (diacyl) C34:4, phosphatidylcholine (acyl-alkyl) C40:1 and lysophosphatidylcholines (acyl) C16:0 and C17:0 concentrations were lower in Stage IV compared to Stage I patients (pFDR < 0.05). Our results suggest that metabolic pathways involving among others citrulline and histidine, implicated previously in colorectal cancer development, may also be linked to colorectal cancer progression.
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Affiliation(s)
- Anne J.M.R. Geijsen
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Eline H. van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | | | - David Achaintre
- Biomarkers GroupInternational Agency for Research on CancerLyonFrance
| | | | - Andreas Baierl
- Department of Statistics and Operations ResearchUniversity of ViennaViennaAustria
| | | | - Jürgen Boehm
- Huntsman Cancer InstituteSalt Lake CityUT
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUT
| | - Martijn J.L. Bours
- Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Hermann Brenner
- Division of Preventive OncologyNational Center for Tumor Diseases and German Cancer Research CenterHeidelbergGermany
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Stéphanie O. Breukink
- Department of Surgery, GROW School for Oncology and Development BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine IMedical University of ViennaViennaAustria
| | - Jenny Chang‐Claude
- Division of Cancer EpidemiologyGerman Cancer Research CenterHeidelbergGermany
| | - Esther Herpel
- Institute of PathologyUniversity of HeidelbergHeidelbergGermany
| | - Johannes H.W. de Wilt
- Department of Surgery, Division of Surgical Oncology and Gastrointestinal SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Audrey Gicquiau
- Biomarkers GroupInternational Agency for Research on CancerLyonFrance
| | - Biljana Gigic
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Tanja Gumpenberger
- Institute of Cancer Research, Department of Medicine IMedical University of ViennaViennaAustria
| | - Bibi M.E. Hansson
- Department of SurgeryCanisius‐Wilhelmina HospitalNijmegenThe Netherlands
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Andreana N. Holowatyj
- Huntsman Cancer InstituteSalt Lake CityUT
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUT
| | | | | | - Eric T.P. Keulen
- Department of Internal Medicine and GastroenterologyZuyderland Medical CenterSittardThe Netherlands
| | - Janna L. Koole
- Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | | | - Jennifer Ose
- Huntsman Cancer InstituteSalt Lake CityUT
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUT
| | | | - Martin A. Schneider
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Petra Schrotz‐King
- Division of Preventive OncologyNational Center for Tumor Diseases and German Cancer Research CenterHeidelbergGermany
| | - Anton Stift
- Department of SurgeryMedical University ViennaViennaAustria
| | | | | | - Evertine Wesselink
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine IMedical University of ViennaViennaAustria
| | - Nina Habermann
- Division of Preventive OncologyNational Center for Tumor Diseases and German Cancer Research CenterHeidelbergGermany
- Genome BiologyEuropean Molecular Biology Laboratory (EMBL)HeidelbergGermany
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Augustin Scalbert
- Biomarkers GroupInternational Agency for Research on CancerLyonFrance
| | | | - Alexis B. Ulrich
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
| | - Cornelia M. Ulrich
- Huntsman Cancer InstituteSalt Lake CityUT
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUT
| | - Matty P. Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Dieuwertje E. Kok
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
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Maeda K, Shibutani M, Tachimori A, Nishii T, Aomatsu N, Fukuoka T, Nagahara H, Otani H, Inoue T, Ohira M. Prognostic Significance of Neoadjuvant Rectal Score and Indication for Postoperative Adjuvant Therapy in Rectal Cancer Patients After Neoadjuvant Chemoradiotherapy. In Vivo 2020; 34:283-289. [PMID: 31882490 DOI: 10.21873/invivo.11772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM Neoadjuvant chemoradiotherapy (CRT) is a standard treatment for patients with clinical Stage II/III rectal cancer. However, the benefit of postoperative adjuvant chemotherapy for patients after neoadjuvant CRT is uncertain. Recently, neoadjuvant rectal (NAR) score was suggested as an independent prognostic factor for patients with rectal cancer after neoadjuvant CRT. The aim of this study was to examine the prognostic significance of NAR score in rectal cancer patients who underwent neoadjuvant CRT followed by surgery, and to investigate which patients may benefit from postoperative adjuvant therapy. PATIENTS AND METHODS A total of 72 patients who underwent neoadjuvant CRT followed by R0 resection for clinical stage II /III rectal cancer were evaluated. The correlation between NAR score, various clinicopathological factors and disease recurrence were evaluated. RESULTS Disease recurrence was significantly more often observed in patients with incomplete neoadjuvant CRT, tumor regression grade (TRG) 3-4, and high NAR score. Multivariate analysis revealed that NAR score was an independent predictor of disease recurrence. CONCLUSION NAR score may be one of the predictive markers for disease recurrence in patients who underwent neoadjuvant CRT followed by surgery for rectal cancer. Patients with a low NAR score may benefit form postoperative adjuvant chemotherapy.
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Affiliation(s)
- Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan .,Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akiko Tachimori
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nishii
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Naoki Aomatsu
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Nagahara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Otani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toru Inoue
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
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92
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van Harten MJ, Greenwood EB, Bedrikovetski S, Dudi-Venkata NN, Hunter RA, Kroon HM, Sammour T. Minimally invasive surgery in elderly patients with rectal cancer: An analysis of the Bi-National Colorectal Cancer Audit (BCCA). Eur J Surg Oncol 2020; 46:1649-1655. [PMID: 32312590 DOI: 10.1016/j.ejso.2020.03.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advanced age is associated with worse outcomes after open rectal cancer surgery. However, not much is known about outcomes of minimally invasive surgery (MIS) in the elderly. The aim of this study was to evaluate safety and efficacy of MIS in elderly rectal cancer patients using the Bi-national Colorectal Cancer Audit (BCCA) data from Australia and New Zealand (ANZ). METHODS 3451 patients were included, divided into three groups: <50 years (n = 364), 50-74 years (n = 2157) and ≥75 years (n = 930). Propensity-score matching was performed for the elderly group analysis to correct for differences in baseline characteristics. RESULTS MIS was performed in 52.9% of elderly patients, slightly lower than rates in <50 year and 50-74 year old groups (61% and 55.5%, respectively, p = 0.022). Elderly patients had more postoperative complications (p < 0.0001) and had a longer length of hospital stay (LOS; median 11 vs. 8 days for both other groups; p < 0.0001). Elderly patients had higher (y)pT-stages compared to both other groups (p < 0.0001) and were less likely to receive adjuvant therapy (p < 0.0001). Propensity-score matched analysis of the elderly group showed a higher rate of superficial wound dehiscence and a longer LOS after open surgery compared to MIS (10.3% vs. 2.6%, p = 0.030; 12 days vs. 9.5 days, p = 0.001, respectively), with comparable short-term oncological outcomes. CONCLUSIONS MIS is performed in just over half of elderly rectal cancer patients who are selected for elective rectal resection surgery in ANZ. When performed in the elderly, MIS appears safe and is associated with fewer wound complications and a shorter LOS.
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Affiliation(s)
- Meike J van Harten
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emma B Greenwood
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sergei Bedrikovetski
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nagendra N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ronald A Hunter
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hidde M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Cai Z, Xie X, Chen Y, Chen Z, Cao W, Saad KSS, Zou Y, Lan P, Wu X. Risk factor analysis for inaccurate pre-operative MRI staging in rectal cancer. BMC Cancer 2020; 20:253. [PMID: 32216771 PMCID: PMC7099769 DOI: 10.1186/s12885-020-06761-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Various tumor characteristics might lead to inaccurate local MRI-defined stage of rectal cancer and the purpose of this study was to explore the clinicopathological factors that impact on the precision pre-treatment MRI-defined stage of rectal cancer. METHODS A retrospectively analysis was conducted in non-metastatic rectal cancer patients who received radical tumor resection without neoadjuvant treatment during 2007-2015 in the Sixth Affiliated Hospital of Sun Yat-sen University. Clinical T stage and N stage defined by pelvic enhanced MRI and pathological stage were compared and patients were subdivided into accurate-staging, over-staging and under-staging subgroups. Logistic regressions were used to explore risk factors for over-staging or under-staging. RESULTS Five hundred fifty-one cases of patients were collected. Among them, 109 cases (19.4%) of patients were over-T-staged and 50 cases (8.9%) were under-T-staged, while 78 cases (13.9%) were over-N-staged and 75 cases (13.3%) were under-N-staged. Logistic regression suggested that pre-operative bowel obstruction was risk factor for over-T-staging (OR = 3.120, 95%CI: 1.662-5.857, P < 0.001) as well as over-N-staging (OR = 3.494, 95%CI: 1.797-6.794, P < 0.001), while mucinous adenocarcinoma was a risk factor for under-N-staging (OR = 4.049, 95%CI: 1.876-8.772, P < 0.001). Patients with larger tumor size were at lower risk for over-T-staging (OR = 0.837, 95%CI: 0.717-0.976, P = 0.024) and higher risk for over-N-staging (OR = 1.434, 95%CI: 1.223-1.680, P < 0.001). CONCLUSION Bowel obstruction, mucinous adenocarcinoma and tumor size might have impact on the pre-operative MRI T staging or N staging of rectal cancer. Our results reminded clinicians to assess clinical stage individually in such rectal cancer patients.
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Affiliation(s)
- Zerong Cai
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Xiaoyu Xie
- Department of Oncology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yufeng Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Zexian Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Khamis Salem Saeed Saad
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Yifeng Zou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Xiaojian Wu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China.
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Deressa BT, Cihoric N, Tefesse E, Assefa M, Zemenfes D. Multidisciplinary Cancer Management of Colorectal Cancer in Tikur Anbessa Specialized Hospital, Ethiopia. J Glob Oncol 2020; 5:1-7. [PMID: 31589543 PMCID: PMC6825246 DOI: 10.1200/jgo.19.00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Multidisciplinary cancer care is currently considered worldwide as standard for the management of patients with cancer. It improves patient diagnostic and staging accuracy and provides patients the benefit of having physicians of various specialties participating in their treatment plan. The purpose of this study was to describe the profile of patients discussed in the Tikur Anbessa Multidisciplinary Tumor Board (MTB) and the potential benefits brought by multidisciplinary care. METHODS The study involved the retrospective assessment of all patient cases presented to the Tikur Anbessa Hospital colorectal cancers MTB between March 2016 and November 2017. The data were collected from the MTB medical summary documents and were analyzed using SPSS version 20 (SPSS, Chicago, IL). RESULTS Of 147 patients with colorectal cancer, 96 (65%) were men. The median age at presentation was 46 years (range, 17-78 years). The predominant cancer was rectal (n = 101; 69%), followed by colon (n = 24; 16%). Of these, 68 (45%) and 22 (15%) had stage III and IV disease, respectively, on presentation to the MTB. The oncology department presented the majority of the patients for discussion. Most patients had undergone surgery before the MTB discussion but had no proper preoperative clinical staging information. The majority of patients with rectal cancer treated before the MTB discussion had undergone surgery upfront; however, most of the patients who were treatment naive before MTB received neoadjuvant chemoradiotherapy before surgery. CONCLUSION Decisions made by tumor boards are more likely to conform to evidence-based guidelines than are those made by individual clinicians. Therefore, early referral of patients to MTB before any treatment should be encouraged. Finally, other hospitals in Ethiopia should take a lesson from the Tikur Anbessa Hospital colorectal cancers MTB and adopt multidisciplinary cancer management.
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Affiliation(s)
- Biniyam Tefera Deressa
- Addis Ababa University, Addis Ababa, Ethiopia.,Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Cihoric
- Bern University Hospital, University of Bern, Bern, Switzerland
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95
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Zhao F, Wang J, Yu H, Cheng X, Li X, Zhu X, Xu X, Lin J, Chen X, Yan S. Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients. Radiat Oncol 2020; 15:49. [PMID: 32103755 PMCID: PMC7045410 DOI: 10.1186/s13014-020-01497-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Neoadjuvant radiotherapy (RT) has been shown to improve local control; however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Methods Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. Results For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival, 88.96 M). For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p < 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 54.87 M). Older age (> 60 years), black race, unmarried status, high tumour grade, and tumour size > 5 cm were all associated with a poor prognosis (all p < 0.05). Conclusions Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.
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Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China.
| | - Jili Wang
- Graduate School, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Hao Yu
- Graduate School, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xiaofei Cheng
- Department of Colorectal Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xinke Li
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xuan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xiangming Xu
- Department of Colorectal Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Jianjiang Lin
- Department of Colorectal Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xin Chen
- Institute of Pharmaceutical Biotechnology and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China.
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96
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Coratti F, Bisogni D, Montanelli P, Cianchi F. Transanal endoscopic operation for rectal lesion: a rapid initial experience. MINERVA CHIR 2020; 75:153-156. [PMID: 32083411 DOI: 10.23736/s0026-4733.20.08260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In recent decades, transanal surgery for rectal lesions has become a valid alternative treatment for the treatment of small lesions of the rectum. Significant benefits in terms of morbidity and mortality are confirmed. There are multiple platforms for transanal surgery but the TEO system® is one of the best known. METHODS Between November 2017 and July 2019, 25 patients with rectal lesions suitable to transanal treatment came to our observation. In all reported cases, full-thickness rectum resections were performed. Demographic, histopathological, surgical morbidity/mortality and clinical outcome in all patients who underwent TEO were retrospectively evaluated from a prospectively collected database. RESULTS For a period of less than 2 years, 25 rectal lesions were excised by TEO. Sixteen lesions (64%) were low (<4 cm), 7 (28%) were mid-rectal (4-8 cm) and 2 (8%) were in the proximal rectum (>8 cm). Postoperative complications included: 3 (12%) bleedings, and 8 (32%) post-polipectomy syndrome. CONCLUSIONS Our initial experience suggests TEO is safe and feasible. Full-thickness resection guarantees adequate deep margins. Moreover, the limited number of cases requires the development of adequate reference centers.
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Affiliation(s)
- Francesco Coratti
- Department of Digestive Surgery, Careggi University Hospital, Florence, Italy -
| | - Damiano Bisogni
- Department of Digestive Surgery, Careggi University Hospital, Florence, Italy
| | - Paolo Montanelli
- Department of Digestive Surgery, Careggi University Hospital, Florence, Italy
| | - Fabio Cianchi
- Department of Digestive Surgery, Careggi University Hospital, Florence, Italy
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97
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Sakin A, Sahin S, Sengul Samanci N, Yasar N, Demir C, Geredeli C, Erhan SS, Akboru MH, Cihan S. The impact of tumor regression grade on long-term survival in locally advanced rectal cancer treated with preoperative chemoradiotherapy. J Oncol Pharm Pract 2020; 26:1611-1620. [PMID: 32046577 DOI: 10.1177/1078155219900944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to investigate the prognostic effect of tumor regression grade (TRG) on long-term survival in locally advanced rectal cancer treated with preoperative chemoradiotherapy. METHODS Medical records of 182 patients with locally advanced rectal cancer, who were treated with preoperative chemoradiotherapy followed by surgery between 2002 and 2016, were retrospectively reviewed. TRG was classified into five categories based on the pathological response as follows - TRG1: no viable cancer cell, TRG2: single cancer cell or small groups of cancer cells, TRG3: residual tumor outgrown by fibrosis, TRG4: residual tumor outgrowing fibrosis, TRG5: diffuse residual tumor without regression. TRG1, (TRG2+TRG3), and (TRG4+TRG5) were grouped as complete response, intermediate response, and no response, respectively. RESULTS Of the 182 patients with locally advanced rectal cancer, 112 (61.5%) were male. The mean age was 54.4 (range, 25-87) years. The total number of patients in complete response, intermediate response, and no response group was 24 (13.2%), 105 (57.7%), and 53 (29.1%), respectively. The corresponding five-year relapse-free survival and overall survival rates were 79.8%-92.3%, 74.7%-79.4%, and 55.7%-55.8%, respectively (p < 0.05 for relapse-free survival, p < 0.05 for overall survival). According to ypTNM stage, there was no significant difference in relapse-free survival among TRG groups in ypStage I and II patients (p > 0.05). In ypStage III patients, relapse-free survival was 62 months in no response group vs. not reached in intermediate response group (p < 0.05). According to the ypTNM, there was no significant difference in overall survival among TRG groups in ypStage I, II, and III patients (p > 0.05). In the multivariate analysis, pathological complete response was found to be an independent variable for relapse-free survival and overall survival (hazard ratio (95% confidence interval), 0.34 (0.17-6.77), 0.39 (0.18-0.83), respectively). CONCLUSION This study showed that patients with pathological complete response to preoperative chemoradiotherapy had longer relapse-free survival and overall survival rates than those with residual disease.
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Affiliation(s)
- Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Suleyman Sahin
- Department of Medical Oncology, University of Health Sciences, Van Training and Research hospital, Van, Turkey
| | - Nilay Sengul Samanci
- Department of Medical Oncology, Cerrahpasa University Faculty of Medicine, Istanbul, Turkey
| | - Nurgul Yasar
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Demir
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Caglayan Geredeli
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Selma Sengiz Erhan
- Department of Patology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Halil Akboru
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Sener Cihan
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
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98
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Ferrando L, Cirmena G, Garuti A, Scabini S, Grillo F, Mastracci L, Isnaldi E, Marrone C, Gonella R, Murialdo R, Fiocca R, Romairone E, Ballestrero A, Zoppoli G. Development of a long non-coding RNA signature for prediction of response to neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma. PLoS One 2020; 15:e0226595. [PMID: 32023246 PMCID: PMC7001901 DOI: 10.1371/journal.pone.0226595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
Standard treatment for locally advanced rectal adenocarcinoma (LARC) includes a combination of chemotherapy with pyrimidine analogues, such as capecitabine, and radiation therapy, followed by surgery. Currently no clinically useful genomic predictors of benefit from neoadjuvant chemoradiotherapy (nCRT) exist for LARC. In this study we assessed the expression of 8,127 long noncoding RNAs (lncRNAs), poorly studied in LARC, to infer their ability in classifying patients’ pathological complete response (pCR). We collected and analyzed, using lncRNA-specific Agilent microarrays a consecutive series of 61 LARC cases undergoing nCRT. Potential lncRNA predictors in responders and non-responders to nCRT were identified with LASSO regression, and a model was optimized using k-fold cross-validation after selection of the three most informative lncRNA. 11 lncRNAs were differentially expressed with false discovery rate < 0.01 between responders and non-responders to NACT. We identified lnc-KLF7-1, lnc-MAB21L2-1, and LINC00324 as the most promising variable subset for classification building. Overall sensitivity and specificity were 0.91 and 0.94 respectively, with an AUC of our ROC curve = 0.93. Our study shows for the first time that lncRNAs can accurately predict response in LARC undergoing nCRT. Our three-lncRNA based signature must be independently validated and further analyses must be conducted to fully understand the biological role of the identified signature, but our results suggest lncRNAs may be an ideal biomarker for response prediction in the studied setting.
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Affiliation(s)
- Lorenzo Ferrando
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Gabriella Cirmena
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Anna Garuti
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | | | - Federica Grillo
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | - Luca Mastracci
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | - Edoardo Isnaldi
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
| | - Ciro Marrone
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Roberta Gonella
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Roberto Fiocca
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, Università degli Studi di Genova, Genova, Italy
| | | | - Alberto Ballestrero
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- * E-mail: (AB); (GZ)
| | - Gabriele Zoppoli
- Department of Internal Medicine, Università degli Studi di Genova, Genova, Italy
- IRCSS Ospedale Policlinico San Martino, Genova, Italy
- * E-mail: (AB); (GZ)
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99
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Wen-Pei C, Hsiu-Ju J. Changes in fatigue in rectal cancer patients before and after therapy: a systematic review and meta-analysis. Support Care Cancer 2020; 28:2513-2522. [PMID: 32002618 DOI: 10.1007/s00520-020-05325-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is a common problem among rectal cancer patients and can affect their quality of life. This study conducted a systematic review to better understand changes in fatigue severity in rectal cancer patients before, during, and after they undergo therapy. METHODS We used preset keywords to search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and ProQuest databases for relevant studies published between 2000 and 2018, and data analysis was performed using Comprehensive Meta-Analysis (CMA) software (version 2.2.048) and SPSS software (version 19.0). In total, nine articles with complete data were included in our meta-analysis. RESULTS Fatigue conditions were compared before the start of therapy (baseline) and at 1 month (time 1), 3 months (time 2), 6 months (time 3), and 12 months (time 4) after the start of therapy. The standardized mean differences (SMDs) of the pooling effects size were 1.013 (95% confidence interval (CI) 0.217-1.810), - 0.551 (95% CI - 0.647 to - 0.456), - 0.330 (95% CI - 0.427 to - 0.233), and - 0.149 (95% CI - 0.221 to - 0.078), respectively. Subsequent analysis with a linear mixed effect model revealed that the estimate of the time variable was - 0.226 (p = 0.047), which indicates that the severity of fatigue varies over time and over the course of treatment. The results reveal that fatigue affects rectal cancer patients even before they start therapy. CONCLUSION Although fatigue worsened during the first month after cancer therapy, it gradually improved thereafter.
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Affiliation(s)
- Chang Wen-Pei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. .,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Jen Hsiu-Ju
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
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100
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Potemin S, Kübler J, Uvarov I, Wenz F, Giordano F. Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy. Radiat Oncol 2020; 15:11. [PMID: 31924250 PMCID: PMC6954580 DOI: 10.1186/s13014-020-1458-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neoadjuvant external-beam radiotherapy (EBRT) with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer. Intraoperative radiotherapy (IORT) is to date only recommended for pelvic recurrences or incompletely resectable tumors. We here report on patients with stage II/III rectal cancer that were treated with IORT in a regional Russian university center due to limited access to EBRT. METHODS We retrospectively analyzed data from patients that were diagnosed with locally-advanced rectal cancer and underwent surgery from December 2012 to October 2016 at a regional oncological center in Russia (Krasnodar). During this period, access to EBRT was limited due to a temporary lack of a sufficient number of EBRT facilities. Patients unable to travel to a distant radiotherapy site received IORT alone, those that could travel received neoadjuvant external beam (chemo-) radiotherapy. Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy. We assessed local progression-free survival (L-PFS), PFS and overall survival (OS). RESULTS A total of 172 patients were included in this analysis. Of those, 92 (53.5%) were treated with IORT alone (median dose: 15 Gy [8.4-17 Gy]) and 80 (46.5%) received both neoadjuvant EBRT (median dose: 50.4 Gy [40-50.4 Gy]) and IORT (median dose: 15 Gy [15-17 Gy]). The median age was 65 years [33-82]. The median follow-up was 23 months [0-63 months]. The incidence of toxicity was low in both groups with an overall complication rate of 5.4%. Local PFS at 4 years was comparable with 59.4% in the IORT group and 65.4% in the IORT/EBRT group (p = 0.70). Similarly, there was no difference in OS or PFS (p = 0.66, p = 0.51, respectively). CONCLUSIONS IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT.
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Affiliation(s)
- Sergey Potemin
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Jens Kübler
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ivan Uvarov
- Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Krasnodar, Russia
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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