Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer

Pucciarelli, Salvatore; Giandomenico, Francesca; Paoli, Antonino De; Gavaruzzi, Teresa; Lotto, Lorella; Mantello, G.; Barba, Carmen; Zotti, Paola; Flora, Silvia; Bianco, Paola Del

doi:10.1002/bjs.10318

Cited by 48 publications

(36 citation statements)

References 35 publications

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“…The results indicate that LE plus CRT is clearly superior to TME in terms of maintaining patients’ anal function. Pucciarelli et al 27 showed that patients who underwent CRT followed by LE had better QoL and bowel function than those who underwent CRT followed by mesorectal excision. Their study used the QoL questionnaire-specific colorectal module of the European Organization for Research and Treatment of Cancer and the Memorial Sloan–Kettering Cancer Center Bowel Function Instrument.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial

Sasaki

Ito

Ohue

et al. 2017

Diseases of the Colon &Amp; Rectum

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BACKGROUND:After treatment with local excision for TNM stage I low rectal cancer, the risk of local recurrence is not only high for T2 lesions but also for T1 lesions with features of massive invasion to the submucosal layer and/or lymphovascular invasion.OBJECTIVE:The purpose of this study was to determine the efficacy of chemoradiotherapy combined with local excision in the treatment of T1 to T2 low rectal cancer.DESIGN:We conducted a prospective, single-arm, phase II trial.SETTINGS:This was a multicenter study.PATIENTS:From April 2003 to October 2010, 57 patients were treated with local excision after additional external beam irradiation (45 Gy) plus continuous 5-week intravenous injection of 5-fluorouracil (250 mg/m2 per day) at 10 domestic hospitals. Fifty-three patients had clinical T1N0 lesions, and 4 had T2N0 lesions in the low rectum, located below the peritoneal reflection.MAIN OUTCOMES MEASURES:The primary end point was disease-free survival at 5 years.RESULTS:The completion rate for full-dose chemoradiotherapy was 86% (49/57). Serious, nontransient treatment-related complications were not reported. With a median follow-up of 7.3 years after local excision, the 5-year disease-free survival rate was 94% for the 53 patients with T1 lesions and 75% for the 4 patients with T2 lesions. There were 2 local recurrences during the entire observation period. Anal function after local excision and chemoradiation were kept at almost the same levels as observed before treatment.LIMITATIONS:The study was limited by the small number of registered T2 rectal cancers, retrospective evaluations of quality of life, and the exclusion of poorly differentiated adenocarcinoma (a high-risk feature of T1 lesions).CONCLUSIONS:The addition of chemoradiotherapy to local excision of T1 rectal adenocarcinomas with poor prognostic features including deep submucosal invasion and lymphovascular invasion could improve on less favorable historic oncologic outcomes of local excision alone in this high-risk group for lymph node metastasis. See Video Abstract at http://links.lww.com/DCR/A421.

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Section: Discussionmentioning

confidence: 99%

Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial

Sasaki

Ito

Ohue

et al. 2017

Diseases of the Colon &Amp; Rectum

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“…Recently, there has been an increasing interest in organ‐preserving treatment strategies, such as the watch‐and‐wait approach and transanal local excision for patients who show an excellent response to preoperative CRT. Organ‐preserving treatment can significantly improve patient quality of life by reducing TME‐related surgical morbidity, bowel and urogenital dysfunction, and the risk of definitive colostomy. On the other hand, there is a need to develop a new treatment strategy to improve CRT effects in non‐responders.…”

Section: Introductionmentioning

confidence: 99%

Immunogenomic profiles associated with response to neoadjuvant chemoradiotherapy in patients with rectal cancer

Akiyoshi

Tanaka

Kiyotani

et al. 2019

British Journal of Surgery

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Background Accumulating evidence suggests that radiotherapy success has an immune‐associated component. The immunogenomic profiles associated with responses to chemoradiotherapy (CRT) were assessed in patients with locally advanced rectal cancer in this study. Methods CD8+ tumour‐infiltrating lymphocyte (TIL) and stromal lymphocyte densities were assessed by immunohistochemistry using pretreatment biopsies from patients with advanced rectal cancer who had preoperative CRT. Whole‐exome sequencing and gene expression microarray analysis were conducted to investigate the genomic properties associated with the response to CRT and CD8+ TIL density. Response to CRT was determined based on Dworak tumour regression grade (TRG); tumours with complete (TRG 4) or near‐complete (TRG 3) regression were grouped as good responders, and those with TRG 1 as non‐responders. Results Immunohistochemical examinations (275 patients) showed that pre‐CRT CD8+ TIL density was associated with better response to CRT and improved recurrence‐free survival, whereas pre‐CRT stromal CD8+ cell density was not associated with either response to CRT or recurrence‐free survival. Whole‐exome sequencing (74 patients) showed that the numbers of single‐nucleotide variations (SNVs) and neoantigens predicted from SNVs were higher in good responders than in non‐responders, and these correlated positively with CD8+ TIL density (rS = 0·315 and rS = 0·334 respectively). Gene expression microarray (90 patients) showed that CD8A expression correlated positively with the expression of programmed cell death 1 (PDCD1) (rS = 0·264) and lymphocyte‐activation gene 3 (LAG3) (rS = 0·507). Conclusion Pre‐CRT neoantigen‐specific CD8+ T cell priming may be a key event in CRT responses where immune checkpoint molecules could be useful targets to enhance tumour regression.

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“…There are some pros and cons of a NOM in these cases. Firstly, avoiding surgery prevents, at least temporarily, the patient from facing the possible consequences of a triple-modality treatment on bowel, urinary and sexual function and its impact on quality of life [ 24 ]. The low anterior resection syndrome (LARS), which is characterised by symptoms such as faecal incontinence, emptying difficulties, urgencies and fragmented bowel movements, is a recognised entity and is seen in as much as 90% of patients who undergo an anterior resection [ 25 – 27 ].…”

Section: Patient Selection For Preoperative Therapymentioning

confidence: 99%

Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer

Bernier

Balyasnikova

Tait

et al. 2018

Curr Colorectal Cancer Rep

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Purpose of ReviewPathological complete response is seen in approximately one fifth of rectal cancer patients following neoadjuvant chemoradiation. Since these patients have excellent oncological outcomes, there has been a rapidly growing interest in organ preservation for those who develop a clinical complete response. We review the watch-and-wait strategy and focus on all aspects of this hot topic, including who should be considered for this approach, how should we identify treatment response and what are the expected outcomes.Recent FindingsThe major challenges in interpreting the data on watch-and-wait are the significant heterogeneity of patients selected for this approach and of methods employed to identify them. The evidence available comes mostly from retrospective cohort studies, but has shown good oncological outcomes, including the rate of successful salvage surgery, locoregional control and overall survival.SummaryThere is currently not enough and not robust enough evidence to support watch-and-wait as a standard approach, outside a clinical trial, for patients achieving clinical complete response following neoadjuvant chemoradiation. Furthermore, there is a lack of data on long-term outcomes. However, the results we have so far are promising, and there is therefore an urgent need for randomised control studies such as the TRIGGER trial to confirm the safety of this strategy.

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Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer

Abstract: Patients who underwent local excision had a better quality of life and bowel function than those who underwent mesorectal excision.

Cited by 48 publications

References 35 publications

Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial

Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial

Immunogenomic profiles associated with response to neoadjuvant chemoradiotherapy in patients with rectal cancer

Watch-and-Wait as a Therapeutic Strategy in Rectal Cancer

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