Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

Journal of Clinical Oncology, Journal Year: 2018, Volume and Issue: 37(1), P. 33 - 43

Published: Nov. 7, 2018

Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control rectal cancer; however, we been unable to eradicate recurrence (LR). Even face TME negative resection margins (R0), a significant proportion patients with enlarged lateral lymph nodes (LLNs) suffer from LR (LLR). Japanese studies suggest that addition an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims ascertain whether LLNs actually pose problem LLND results fewer LLRs.Data 1,216 consecutive cT3/T4 cancers up 8 cm anal verge who underwent surgery 5-year period were collected. was performed 142 (12%). MRIs re-evaluated standardized protocol assess features.On pretreatment MRI, 703 (58%) had visible LLN, 192 (16%) short axis at least 7 mm. One hundred eight developed (5-year rate, 10.0%), which 59 (54%) LLRs LLR 5.5%). After multivariable analyses, mm resulted significantly higher risk (hazard ratio, 2.060; P = .045) compared less than In mm, (C)RT plus 5.7%, lower LLR, 19.5%; .042).LLR is still after on MRI. The rate.

Language: Английский

---

Neoadjuvant Chemotherapy Without Routine Use of Radiation Therapy for Patients With Locally Advanced Rectal Cancer: A Pilot Trial

Journal of Clinical Oncology, Journal Year: 2014, Volume and Issue: 32(6), P. 513 - 518

Published: Jan. 14, 2014

Although neoadjuvant chemoradiotherapy achieves low local recurrence rates in clinical stages II to III rectal cancer, it delays administration of optimal chemotherapy. We evaluated preoperative infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX)/bevacizumab with selective rather than consistent use chemoradiotherapy.Thirty-two patients cancer participated this single-center phase trial. All were candidates for anterior resection total mesorectal excision (TME). Patients receive six cycles FOLFOX, bevacizumab included 1 4. stable/progressive disease have radiation before TME, whereas responders immediate TME. Postoperative was planned if R0 not achieved. FOLFOX × 6 recommended, but adjuvant regimens left clinician discretion. The primary outcome rate.Between April 2007 December 2008, 32 (100%) study participants had resections. Two did complete chemotherapy secondary cardiovascular toxicity. Both then Of 30 completing chemotherapy, all tumor regression TME without chemoradiotherapy. pathologic response rate alone 8 (25%; 95% CI, 11% 43%). 4-year 0% (95% 11%); the disease-free survival 84% 67% 94%).For selected does seem compromise outcomes. Preoperative Radiation or Selective Evaluation Before Chemotherapy (PROSPECT), a randomized trial validate experience, is now open US cooperative group network.

Language: Английский

---

Modified FOLFOX6 With or Without Radiation Versus Fluorouracil and Leucovorin With Radiation in Neoadjuvant Treatment of Locally Advanced Rectal Cancer: Initial Results of the Chinese FOWARC Multicenter, Open-Label, Randomized Three-Arm Phase III Trial

Journal of Clinical Oncology, Journal Year: 2016, Volume and Issue: 34(27), P. 3300 - 3307

Published: Aug. 2, 2016

Total mesorectal excision with fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy is a standard treatment of locally advanced rectal cancer. This study investigated the addition oxaliplatin without radiotherapy.In this multicenter, open-label, phase III trial, we randomly assigned (1:1:1) Chinese adults (age 18 to 75 years) stage II/III cancer three treatments: five 2-week cycles infusional fluorouracil (leucovorin 400 mg/m(2), 2.4 g/m(2) over 48 h) plus radiotherapy (46.0 50.4 Gy delivered in 23 25 fractions during 2 through 4) followed by surgery seven fluorouracil, same intravenous 85 mg/m(2) on day 1 each cycle (modified FOLFOX6 [mFOLFOX6]), or four six mFOLFOX6 eight mFOLFOX6. Random assignment was performed using computer-generated block randomization codes. The primary end point 3-year disease-free survival. Secondary points histopathologic response toxicity are reported.A total 495 patients were enrolled from June 2010 February 2015; 475 evaluable (fluorouracil-radiotherapy, n = 155; mFOLFOX6-radiotherapy, 157; mFOLFOX6, 163). In fluorouracil-radiotherapy, groups, rate pathologic complete (pCR) 14.0%, 27.5%, 6.6%, downstaging (ypStage 0 1) achieved 37.1%, 56.4%, 35.5% patients, respectively. Higher more complications observed who received radiotherapy.mFOLFOX6-based results higher pCR than treatment. Perioperative alone had inferior lower but led similar as less fewer complications.

Language: Английский

---

Total neoadjuvant therapy for rectal cancer: An emerging option

Cancer, Journal Year: 2017, Volume and Issue: 123(9), P. 1497 - 1506

Published: March 10, 2017

The treatment of locally advanced rectal cancer (LARC) has benefited from improved surgical techniques and the implementation neoadjuvant chemoradiotherapy (CRT), which have markedly decreased rates local recurrence. However, distant metastatic disease remains most significant cause death for these patients. Although adjuvant chemotherapy (ChT) after CRT definitive surgery is commonly recommended, value systemic therapy less clear. Trials evaluating ChT been handicapped by poor compliance inconsistent survival results. Shifting delivery to setting promise improve rates, reduce toxicity, decrease relapse rates. Recently, multiple prospective trials reported on use total (TNT) patients with LARC, incorporating both in setting. Here, authors review promising results those trials. Because studies largely focused pathologic outcomes (primarily complete response rates), ongoing phase 2 3 are now underway assessing long-term disease-related TNT. In addition improving survival, TNT potential increase pool LARC who eligible organ preservation, also being evaluated. Cancer 2017;123:1497-1506. © 2017 American Society.

Language: Английский

---

Efficacy and safety of PD-1 blockade plus long-course chemoradiotherapy in locally advanced rectal cancer (NECTAR): a multi-center phase 2 study

Signal Transduction and Targeted Therapy, Journal Year: 2024, Volume and Issue: 9(1)

Published: March 11, 2024

Adding PD-1 blockade in the neoadjuvant regimens for locally advanced rectal cancer (LARC) patients with microsatellite stable (MSS) / mismatch repair-proficient (pMMR) tumors is an attractive, but debatable strategy. This phase 2, multicenter, prospective, single-arm study enrolled from 6 centers June 2021 to November 2022. Locally (LARC, cT

Language: Английский

---

Effects of microsatellite instability on recurrence patterns and outcomes in colorectal cancers

British Journal of Cancer, Journal Year: 2016, Volume and Issue: 115(1), P. 25 - 33

Published: May 26, 2016

Among colorectal cancers (CRCs), high-frequency microsatellite instability (MSI-H) is associated with a better prognosis, compared low-frequency MSI or stability (MSI-L/MSS). However, it unclear whether affects the prognosis of recurrent CRCs. This study included 2940 patients stage I–III CRC who underwent complete resection. The associations status recurrence patterns, disease-free survival (DFS), overall from diagnosis to death (OS1), and (OS2) were analysed. A total 261 (8.9%) had MSI-H CRC. Patients DFS, MSI-L/MSS (hazard ratio (HR): 0.619, P<0.001). High-frequency was more frequent local (30.0% vs 12.0%, P=0.032) peritoneal metastasis (40.0% 12.3%, P=0.003), less lung (10.0% 42.5%, P=0.004) liver metastases (15.0% 44.7%, P=0.01). Recurrent worse OS1 (HR: 1.363, P=0.035) OS2 2.667, An analysis colon cancer yielded similar results. Recurrence patterns differed between CRC, CRCs prognosis.

Language: Английский

---

The current status of treatment for colorectal cancer in China

Medicine, Journal Year: 2017, Volume and Issue: 96(40), P. e8242 - e8242

Published: Oct. 1, 2017

Background: Colorectal cancer (CRC) is one of the most common cancers all over world, but its epidemiology obviously different in various regions. Methods: The treatment CRC also has varying characteristics due to differences economy, geography, disease onset, chemotherapy, and other factors, although international guidelines are used guide China. Results: This paper summarizes current status treatment, including surgical therapy, neoadjuvant radiotherapy postoperative targeted maintenance immunotherapy, according clinical situation China, so as provide better therapy improve practice for patients with CRC. Conclusion: research shows that colorectal continues progress, patient's efficacy quality life have improved.

Language: Английский

---

Association Between Adjuvant Chemotherapy and Overall Survival in Patients With Rectal Cancer and Pathological Complete Response After Neoadjuvant Chemotherapy and Resection

JAMA Oncology, Journal Year: 2018, Volume and Issue: 4(7), P. 930 - 930

Published: April 19, 2018

Importance

Although American guidelines recommend use of adjuvant chemotherapy in patients with locally advanced rectal cancer, individuals who achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy are less likely to receive treatment than incomplete responders. The association and resection survival pCR is unclear.

Objective

To determine whether cancer after chemoradiation therapy benefit from the administration chemotherapy.

Design, Setting, Participants

This retrospective propensity score–matched cohort study identified National Cancer Database 2006 through 2012. We selected nonmetastatic invasive achieved resection.

Exposures

matched received did not 1:1 ratio. separately subgroups node-positive disease before node-negative investigate for effect modification by pretreatment nodal status.

Main Outcome Measures

compared overall between groups using Kaplan-Meier methods Cox proportional hazards models.

Results

2455 (mean age, 59.5 years; 59.8% men) 667 at least 8 weeks follow-up surgery treatment. Over median 3.1 years (interquartile range, 1.94-4.40 years), treated demonstrated better those (hazard ratio, 0.44; 95% CI, 0.28-0.70). When stratified status, only exhibited improved 0.24; 0.10-0.58).

Conclusions Relevance

associated survival, particularly disease. this suggests beneficial on pCR, these results limited presence potential unmeasured confounding nonrandomized study.

Language: Английский

---

Clinical lymph node staging in colorectal cancer; a flip of the coin?

European Journal of Surgical Oncology, Journal Year: 2018, Volume and Issue: 44(8), P. 1241 - 1246

Published: April 17, 2018

Language: Английский

---

Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial

Annals of Surgical Oncology, Journal Year: 2018, Volume and Issue: 26(3), P. 746 - 755

Published: Dec. 7, 2018

Language: Английский

---