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Gollub MJ, Costello JR, Ernst RD, Lee S, Maheshwari E, Petkovska I, Wasnik AP, Horvat N. A primer on rectal MRI in patients on watch-and-wait treatment for rectal cancer. Abdom Radiol (NY) 2023; 48:2836-2873. [PMID: 37099182 PMCID: PMC11210452 DOI: 10.1007/s00261-023-03900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/27/2023]
Abstract
Total neoadjuvant treatment (TNT) for rectal cancer is becoming an accepted treatment paradigm and is changing the landscape of this disease, wherein up to 50% of patients who undergo TNT are able to avoid surgery. This places new demands on the radiologist in terms of interpreting degrees of response to treatment. This primer summarizes the Watch-and-Wait approach and the role of imaging, with illustrative "atlas-like" examples as an educational guide for radiologists. We present a brief literature summary of the evolution of rectal cancer treatment, with a focus on magnetic resonance imaging (MRI) assessment of response. We also discuss recommended guidelines and standards. We outline the common TNT approach entering mainstream practice. A heuristic and algorithmic approach to MRI interpretation is also offered. To illustrate management and common scenarios, we arranged the illustrative figures as follows: (I) Clinical complete response (cCR) achieved at the immediate post-TNT "decision point" scan time; (II) cCR achieved at some point during surveillance, later than the first post-TNT MRI; (III) near clinical complete response (nCR); (IV) incomplete clinical response (iCR); (V) discordant findings between MRI and endoscopy where MRI is falsely positive, even at follow-up; (VI) discordant cases where MRI seems to be falsely positive but is proven truly positive on follow-up endoscopy; (VII) cases where MRI is falsely negative; (VIII) regrowth of tumor in the primary tumor bed; (IX) regrowth outside the primary tumor bed; and (X) challenging scenarios, i.e., mucinous cases. This primer is offered to achieve its intended goal of educating radiologists on how to interpret MRI in patients with rectal cancer undergoing treatment using a TNT-type treatment paradigm and a Watch-and-Wait approach.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - James R Costello
- Department of Diagnostic Imaging and Intervention, Motiff Cancer Center, Tampa, FL, 33612, USA
| | - Randy D Ernst
- Division of Diagnostic Imaging, Department of Abdominal Imaging, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sonia Lee
- Department of Radiology, University of California, Irvine, Orange, CA, 92868, USA
| | - Ekta Maheshwari
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ashish P Wasnik
- Department of Radiology, University of MI-Michigan Medicine, Ann Arbor, MI, 48109, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Integrated Intensified Chemoradiation in the Setting of Total Neoadjuvant Therapy (TNT) in Patients with Locally Advanced Rectal Cancer: A Retrospective Single-Arm Study on Feasibility and Efficacy. Cancers (Basel) 2023; 15:cancers15030921. [PMID: 36765878 PMCID: PMC9913523 DOI: 10.3390/cancers15030921] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
While surgery is considered the main treatment for early-stage rectal cancer, locally advanced rectal cancer needs to be handled with a multidisciplinary approach. Based on literature data suggesting promising advantages of total neoadjuvant therapy (TNT), we performed a retrospective, single-arm, single-center study on 45 patients affected by histologically and radiologically proven locally advanced rectal cancer, with the aim of analyzing the feasibility and short-term efficacy of an integrated intensified treatment in the setting of TNT. Each analyzed patient performed three cycles of FOLFOX4 or De Gramont induction chemotherapy (iCT), followed by concurrent chemoradiotherapy (CRT) with long course radiotherapy (LCRT) plus concomitant boost and continuous 5-FU infusion, followed by three cycles of FOLFOX4 or De Gramont consolidation chemotherapy (conCT) and then surgery with total mesorectal excision. At a median follow-up of 30 months, this strategy has shown to be feasible and effective in terms of pathological complete response (pCR) and short-term disease-free survival (DFS).
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Assessment of Radiation-Induced Bladder and Bowel Cancer Risks after Conventionally and Hypo-Fractionated Radiotherapy for the Preoperative Management of Rectal Carcinoma. J Pers Med 2022; 12:jpm12091442. [PMID: 36143227 PMCID: PMC9503780 DOI: 10.3390/jpm12091442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Preoperative management of rectal carcinoma can be performed by employing either conventionally or hypo-fractionated Radiotherapy (CFRT or HFRT, respectively), delivered by Intensity Modulated Radiotherapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) plans, employing 6 MV or 10 MV photon beams. This study aims to dosimetrically and radiobiologically compare all available approaches, with emphasis on the risk of radiation-induced second cancer to the bladder and bowel. Computed Tomography (CT) scans and relevant radiotherapy contours from 16 patients were anonymized and analyzed retrospectively. For each case, CFRT of 25 × 2 Gy and HFRT of 5 × 5 Gy were both considered. IMRT and VMAT plans using 6 MV and 10 MV photons were prepared. Plan optimization was performed, considering all clinically used plan quality indices and dose–volume constraints for the critical organs. Resulting dose distributions were analyzed and compared. Moreover, the Lifetime Attributable Risk (LAR) for developing radiation-induced bladder and bowel malignancies were assessed using a non-linear mechanistic model, assuming patient ages at treatment of 45, 50, 55 and 60 years. All 128 plans created were clinically acceptable. Risk of second bladder cancer reached 0.26% for HFRT (5 × 5 Gy) and 0.19% for CFRT (25 × 2 Gy) at the age of 45. Systematically higher risks were calculated for HFRT (5 × 5 Gy) as compared to CFRT (25 × 2 Gy), with 6 MV photons resulting in slightly increased LAR, as well. Similar or equal bowel cancer risks were calculated for all techniques and patient ages investigated (range 0.05–0.14%). This work contributes towards radiotherapy treatment protocol selection criteria for the preoperative irradiation of rectal carcinoma. However, more studies are needed to establish the associated radiation-induced risk of each RT protocol.
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Xiao Y, Qiu M, Huang W, Hu S, Tan C, Nan F, Jiang X, Wu D, Li M, Li Q, Qin C. Global status of research on radiotherapy for rectal cancer: A bibliometric and visual analysis. Front Public Health 2022; 10:962256. [PMID: 36003628 PMCID: PMC9393343 DOI: 10.3389/fpubh.2022.962256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy for rectal cancer has received increasing research attention in recent years; however, no bibliometric assessment has been conducted on the progress of research in this field. This study aimed to visualize the research evolution and emerging research hotspots in the field of rectal cancer radiotherapy using bibliometric methods. Data were collected from the Web of Science Core Collection database, including countries, institutions, authors, keywords, and co-citations of references, and the CiteSpace software was used for bibliometric analysis. A total of 5,372 publications on radiotherapy for rectal cancer, published between January 2000 and January 2022, were included. An increasing trend in the number of published articles was observed. There is an overall upward trend in the number of publications published, with the US publishing the most in this field, followed by China and the Netherlands. Italian writer Vincenzo Valentini and German writer R. Sauer ranked first in terms of published articles and co-cited authors, respectively. Literature co-citation and keyword co-occurrence analyses showed that early studies focused on topics such as preoperative radiotherapy, combined radiotherapy and chemotherapy, and total mesorectal excision. In recent years, gradually increasing attention has been paid to short-course radiotherapy, x-ray brachytherapy, and stereotactic systemic radiotherapy. Burst analysis suggested that magnetic resonance (MR)-guided neoadjuvant radiotherapy studies, mechanistic studies, and clinical trials may emerge as new research hotspots. Rectal cancer radiotherapy has been widely studied and the research hotspots have considerably changed in recent years. Future research hotspots may include MR-guided neoadjuvant radiotherapy studies, mechanistic studies, and clinical trials.
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Affiliation(s)
- Yafei Xiao
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
- Ruida Pharmaceutical Clinical Medicine Postgraduate Education Innovation Training Base of Henan University, Kaifeng, China
| | - Mengyuan Qiu
- Department of Neurology, Peking University People's Hospital, Peking University School of Medicine, Beijing, China
| | - Wanting Huang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaowen Hu
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Cong Tan
- Cell Signal Transduction Laboratory, School of Basic Medical Sciences, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, Institute of Biomedical Informatics, Henan University, Kaifeng, China
| | - Fangmei Nan
- Cell Signal Transduction Laboratory, School of Basic Medical Sciences, Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, Institute of Biomedical Informatics, Henan University, Kaifeng, China
| | - Xiaowei Jiang
- Department of Pediatric Orthopaedics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dapeng Wu
- Department of Radiology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Mengmeng Li
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Quanying Li
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
| | - Changjiang Qin
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng, China
- Ruida Pharmaceutical Clinical Medicine Postgraduate Education Innovation Training Base of Henan University, Kaifeng, China
- *Correspondence: Changjiang Qin
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Goffredo P, Quezada-Diaz FF, Garcia-Aguilar J, Smith JJ. Non-Operative Management of Patients with Rectal Cancer: Lessons Learnt from the OPRA Trial. Cancers (Basel) 2022; 14:3204. [PMID: 35804975 PMCID: PMC9264788 DOI: 10.3390/cancers14133204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, the management of locally advanced rectal cancer (LARC) has progressively become more complex. The introduction of total neoadjuvant treatment (TNT) has increased the rates of both clinical and pathological complete response, resulting in excellent long-term oncological outcomes. As a result, non-operative management (NOM) of LARC patients with a clinical complete response (cCR) after neoadjuvant therapy has gained acceptance as a potential treatment option in selected cases. NOM is based on replacement of surgical resection with safe and active surveillance. However, the identification of appropriate candidates for a NOM strategy without compromising oncologic safety is currently challenging due to the lack of an objective standardization. NOM should be part of the treatment plan discussion with LARC patients, considering the increasing rates of cCR, patient preference, quality of life, expectations, and the potential avoidance of surgical morbidity. The recently published OPRA trial showed that organ preservation is achievable in half of rectal cancer patients treated with TNT, and that chemoradiotherapy followed by consolidation chemotherapy may an appropriate strategy to maximize cCR rates. Ongoing trials are investigating optimal algorithms of TNT delivery to further expand the pool of patients who may benefit from NOM of LARC.
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Affiliation(s)
- Paolo Goffredo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.G.); (J.G.-A.)
| | - Felipe F. Quezada-Diaz
- Colorectal Unit, Department of Surgery, Complejo Asistencial Doctor Sótero del Río, Santiago 8150215, Chile;
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.G.); (J.G.-A.)
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.G.); (J.G.-A.)
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Slevin F, Hanna CR, Appelt A, Cunningham C, Marijnen CAM, Sebag-Montefiore D, Muirhead R. The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e210-e217. [PMID: 34955376 DOI: 10.1016/j.clon.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.
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Affiliation(s)
- F Slevin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C R Hanna
- Beatson West of Scotland Cancer Centre, Glasgow, UK; CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A Appelt
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C Cunningham
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C A M Marijnen
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Fundowicz M, Aguiar A, de Castro CL, Torras MG, Deantonio L, Konstanty E, Kruszyna-Mochalska M, Macia M, Canals E, Caro M, Pisani C, Zwierzchowska D, Molero J, Eraso A, Lencart J, Muñoz-Montplet C, Carvalho L, Krengli M, Malicki J, Guedea F. Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project. Radiat Oncol 2020; 15:208. [PMID: 32854730 PMCID: PMC7453535 DOI: 10.1186/s13014-020-01648-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. MATERIALS AND METHODS Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. RESULTS The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. CONCLUSIONS This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.
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Affiliation(s)
| | - Artur Aguiar
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carla Lopes de Castro
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Maria Glòria Torras
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Letizia Deantonio
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Marta Kruszyna-Mochalska
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Miquel Macia
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni Canals
- Institut Català d’Oncologia, Avinguda de França, S/N 17007, Girona, Spain
| | - Monica Caro
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Carla Pisani
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Jaume Molero
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Arantxa Eraso
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joana Lencart
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carles Muñoz-Montplet
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Carvalho
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Marco Krengli
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | - Julian Malicki
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Ferran Guedea
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
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Xue W, Wang S, Zhao Z, Li Y, Shang A, Li D, Yang J, Wang T, Wang M. Short-term outcomes of laparoscopic intersphincteric resection with intraoperative radiotherapy using low-energy X-rays for primary locally advanced low rectal cancer: a single center experience. World J Surg Oncol 2020; 18:26. [PMID: 32013978 PMCID: PMC6998155 DOI: 10.1186/s12957-020-1799-x] [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: 10/29/2019] [Accepted: 01/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background Even with the augmentative application of anal-preservation surgery in low rectal cancer, the role and indications of laparoscopic intersphincteric resection (Lap ISR) are still under debate, especially for T3 or node-positive (T3N0M0, T1–3N+M0) cancer, mainly due to the oncological safety and functional outcomes. INTRABEAM (Carl Zeiss, Germany) intraoperative radiotherapy (IORT) using low-energy X-rays features in accurate irradiation, less exposure, and reduced complications. Taking advantages of Lap ISR and INTRABEAM IORT, this innovative approach aims to increase the probability of the anal preservation with acceptable postoperative outcomes. Materials and methods From December 2015 to August 2019, we retrospectively analyzed the short-term outcomes of 12 patients evaluated preoperatively with T3 or node-positive (T3N0M0, T1–3N+M0) primary locally advanced low rectal cancer. They all had received Lap ISR and INTRABEAM IORT with a dose of 16–18 Gy applied by an applicator through the anus (natural orifice). Then, with no pre- or postoperative radiotherapy given, the patients were suggested to receive 6–8 cycles of the XELOX chemotherapy regimen (oxaliplatin, 130 mg/m2 and capecitabine, 1000 mg/m2). Results All patients achieved R0 resection. The median radiation time was 27 min and 15 s, and the mean radiative dose was 17.3 Gy (range 16–18 Gy). The median follow-up time was 18.5 months (range 3–45 months). Two patients experienced local recurrence. Two male patients experienced anastomotic stenosis. Furthermore, one of them experienced perianal abscess and the other one experienced pulmonary metastasis after refusing to receive chemotherapy. One female patient with internal anal sphincter invasion experienced distant metastases to the liver and gluteus maximus muscle 35 months after IORT. No acute radiation injuries or symptoms were observed. Although they experienced a reduction in anal function, every patient was satisfied with the postoperative outcomes. Conclusions For patients evaluated preoperatively with T3 or node-positive (T3N0M0, T1–3N+M0) primary locally advanced low rectal cancer, Lap ISR with INTRABEAM IORT may be a safe and feasible approach for anal preservation without compromising oncological outcomes.
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Affiliation(s)
- Wangsheng Xue
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Shuang Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zeyun Zhao
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yongbo Li
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - An Shang
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Donglin Li
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jianzheng Yang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tiejun Wang
- Department of Radiology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Min Wang
- Department of the General Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Ma B, Gao P, Song Y, Huang X, Wang H, Xu Q, Zhao S, Wang Z. Short-Course Radiotherapy in Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-analysis. Clin Colorectal Cancer 2018; 17:320-330.e5. [DOI: 10.1016/j.clcc.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 02/07/2023]
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10
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Khwaja SS, Roy A, Markovina S, Dewees TA, Hunt S, Tan B, Myerson RJ, Olsen JR, Parikh PJ. Quality of Life Outcomes From a Phase 2 Trial of Short-Course Radiation Therapy Followed by FOLFOX Chemotherapy as Preoperative Treatment for Rectal Cancer. Int J Radiat Oncol Biol Phys 2016; 95:1429-1438. [DOI: 10.1016/j.ijrobp.2016.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 01/03/2023]
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11
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Complete Pathological Response After Neoadjuvant Long-Course Chemoradiotherapy for Rectal Cancer and Its Relationship to the Degree of T3 Mesorectal Invasion. Dis Colon Rectum 2016; 59:361-8. [PMID: 27050597 DOI: 10.1097/dcr.0000000000000564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many studies have shown significantly improved outcomes (reduced local recurrence and improved overall survival) for patients achieving a complete pathological response from neoadjuvant chemoradiotherapy. OBJECTIVE This study aimed to document the complete pathological response rate and outcomes in patients receiving preoperative long-course chemoradiotherapy stratified for the extent of T3 mesorectal invasion measured on preoperative imaging. DESIGN This is a retrospective study of prospectively collected data, of patients with rectal cancer in the Cabrini Monash University Department of Surgery colorectal neoplasia database, incorporating data from Cabrini Hospital and The Alfred Hospital, identifying patients entered between January 2010 and June 2014. PATIENTS AND SETTINGS One hundred eighteen patients with T3 rectal cancer met the selection criteria for the study; 26 achieved complete pathological response (22%). MAIN OUTCOME MEASURES Outcomes in terms of complete pathological response and oncological outcomes such as disease-free and overall survival were analyzed. RESULTS Patients with complete pathological response had significantly less preoperative invasion than those with no complete pathological response (p < 0.001). Depth of invasion was the only variable associated with complete pathological response (p < 0.002), and the likelihood of complete pathological response decreased by 35% for every millimeter of invasion. Complete pathological response was associated with increased disease-free survival (p = 0.018) and a lower risk of cancer progression (p = 0.046). Depth of invasion was associated with an increased risk of death after surgery; HR increased by 1.07 (95% CI, 1.00-1.15) for each 1-mm increase in invasion. LIMITATIONS This was a retrospective study with the usual limitations, although these were minimized through the use of a clinician-driven prospective database. CONCLUSIONS The smaller the degree of T3 invasion, the higher the chance of achieving complete pathological response (up to 35%), which is associated with improved disease-free and overall survival. A higher complete pathological response rate is observed in early T3 disease in comparison with more extensive T3 invasion.
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Thavaneswaran S, Price TJ. Optimal therapy for resectable rectal cancer. Expert Rev Anticancer Ther 2015; 16:285-302. [PMID: 26652907 DOI: 10.1586/14737140.2016.1130627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A lot can be gained by improving our understanding of the optimal sequence of existing therapies in rectal cancer, with the more difficult task of balancing the morbidity of recurrence with the morbidity of prescribed therapies that are particularly toxic owing to tumour location. This review aims to highlight a recent shift in treatment strategies in the opposite direction, with a focus on earlier, more intense systemic treatments with reduced local therapies. Understanding the rationale for and evidence to support this shift will help identify gaps, shape future trials, and ultimately answer the question of whether this is indeed the right path to follow with regards to maintaining local control rates and long-term outcomes for patients, and improving distal disease control and local treatment-related morbidities without compromising quality of life.
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Affiliation(s)
| | - Timothy J Price
- b The Queen Elizabeth Hospital , University of Sydney and University of Adelaide , Woodville , SA , Australia
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Zhou ZR, Liu SX, Zhang TS, Chen LX, Xia J, Hu ZD, Li B. Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: A systematic review and meta-analysis. Surg Oncol 2014; 23:211-21. [DOI: 10.1016/j.suronc.2014.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/17/2014] [Indexed: 01/14/2023]
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