Re-exploring the pelvic neuroanatomy from a new perspective and a potential guidance for TaTME: a "bottom-up" approach

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Simple Summary

Both short- and long-course neoadjuvant radiotherapy (NA-RT) followed by surgery have been adopted as standard treatments for locally advanced rectal cancer (LARC). We hypothesized that a modified short-course radiotherapy (mSC-RT) using an accelerated hyperfractionated regimen, with a dose of 2.5 Gy twice daily up to a total dose of 25 Gy in 10 fractions, can provide a favorable therapeutic ratio in comparison with the conventional regimens. Ninety-seven consecutive LARC patients undergoing mSC-RT followed by delayed surgery were analyzed in this retrospective study. Additionally, potential prognostic factors for overall survival (OS) were also assessed. The results showed that mSC-RT followed by delayed surgery achieved equivalent anti-tumor efficacy and acute toxicity that were comparable with long- and short-course NA-RT, respectively. A neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 was independently associated with poor OS in LARC patients receiving mSC-RT. Thus, mSC-RT can be a promising alternative to both standard long- and short-course NA-RT regimens.

Abstract

This study aimed to assess the clinical outcomes and predictive factors of neoadjuvant modified short-course radiotherapy (mSC-RT) for locally advanced rectal cancer (LARC). Data from 97 patients undergoing mSC-RT followed by radical surgery for LARC were retrospectively analyzed. A 2.5 Gy dose twice daily up to a total dose of 25 Gy in 10 fractions was administered through mSC-RT, and this was delivered with oral chemotherapy in 95 (97.9%) patients. Radical surgery was performed 6 (range, 3–13) weeks after mSC-RT. The median follow-up among surviving patients was 43 (8–86) months. All patients completed neoadjuvant radiotherapy with no acute toxicity grade ≥ 3. Three- and five-year local control rates were 96.3% and 96.3%, respectively. Three- and five-year overall survival (OS) rates were 92.7% and 79.8%, respectively. Univariate analyses revealed that poor OS was associated with no concurrent administration of capecitabine, C-reactive-protein-to-albumin ratio ≥ 0.053, carcinoembryonic antigen ≥ 3.4 ng/mL, and neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 (P = 0.045, 0.001, 0.041, and 0.001, respectively). Multivariate analyses indicated that NLR ≥ 1.83 was independently associated with poor OS (p = 0.018). mSC-RT followed by delayed surgery for LARC was deemed feasible and resulted in good clinical outcomes, whereas poor OS was associated with high NLR.

Oxidative Stress Level as a Predictor of Anastomotic Leakage after Rectal Surgery

Background

Early diagnosis of anastomotic leakage (AL) after rectal surgery can reduce the adverse effects of AL, thereby reducing morbidity and mortality. Currently, there are no accepted indicators or effective scoring systems that can clearly identify patients at risk of anastomotic leakage.

Methods

A prospective study with assessment of the diagnostic accuracy of oxidative stress level (CAT, SOD, MDA) in serum and drain fluid compared to white blood cell count (WBC), C-reactive protein (CRP), and neutrophil percentage (NEUT) in prediction of AL in patients undergoing elective rectal surgery with anastomosis.

Results

Most of the oxidative stress indicators we detected are of considerable significance in the diagnosis of anastomotic leakage. The level of MDA on postoperative day (POD)3 (areas under the curve (AUC): 0.831) and POD5 (AUC: 0.837) in the serum and on POD3 (AUC: 0.845) in the drain fluid showed the same excellent diagnostic accuracy as the level of CRP on the POD3 (AUC: 0.847) and POD5 (AUC: 0.896).

Conclusions

The overall level of oxidative stress in serum and drain fluid is a reliable indicator for the early diagnosis of anastomotic leakage after rectal surgery. More specifically, among the redox indicators analyzed, MDA has almost the same predictive value as CRP, which provides another useful biomarker for the early diagnosis of anastomotic leakage.

Baseline Differences in Anxiety Affect Attention and tDCS-Mediated Learning

Variable responses to transcranial direct current stimulation (tDCS) protocols across individuals are widely reported, but the reasons behind this variation are unclear. This includes tDCS protocols meant to improve attention. Attentional control is impacted by top-down and bottom-up processes, and this relationship is affected by state characteristics such as anxiety. According to Attentional Control Theory, anxiety biases attention towards bottom-up and stimulus-driven processing. The goal of this study was to explore the extent to which differences in state anxiety and related measures affect visual attention and category learning, both with and without the influence of tDCS. Using discovery learning, participants were trained to classify pictures of European streets into two categories while receiving 30 min of 2.0 mA anodal, cathodal, or sham tDCS over the rVLPFC. The pictures were classifiable according to two separate rules, one stimulus and one hypothesis-driven. The Remote Associates Test (RAT), Profile of Mood States, and Attention Networks Task (ANT) were used to understand the effects of individual differences at baseline on subsequent tDCS-mediated learning. Multinomial logistic regression was fit to predict rule learning based on the baseline measures, with subjects classified according to whether they used the stimulus-driven or hypothesis-driven rule to classify the pictures. The overall model showed a classification accuracy of 74.1%. The type of tDCS stimulation applied, attentional orienting score, and self-reported mood were significant predictors of different categories of rule learning. These results indicate that anxiety can influence the quality of subjects' attention at the onset of the task and that these attentional differences can influence tDCS-mediated category learning during the rapid assessment of visual scenes. These findings have implications for understanding the complex interactions that give rise to the variability in response to tDCS.