Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation

Calvo, Felipe A.; Serrano, Javier García; Díaz-González, J.A.; Gómez-Espí, M.; Lozano, Eloisa Bayo; García, Rafael Pérez; Mata, Dolores de la; Arranz, José Ángel; García‐Alfonso, Pilar; Perez-Manga, G.; Álvarez, E.

doi:10.1093/annonc/mdl085

Cited by 77 publications

(46 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Calvo et al [17] explored short-term, intense induction with FOLFOX4 (two cycles) before conventional CRT in patients with locally advanced rectal cancer, and reported that it improved tumor downstaging in comparison with CRT alone, based on their historical results. This strategy achieved a 29% pathological complete response rate.…”

Section: Discussionmentioning

confidence: 99%

Total mesorectal excision of initially unresectable locally advanced rectal cancer infiltrating the pelvic wall after treatment with FOLFOX4 plus bevacizumab and preoperative chemoradiation: report of a case

et al. 2011

View full text Add to dashboard Cite

A 60-year-old man underwent sigmoid loop colostomy for obstructive rectal cancer. Computed tomography (CT) showed a circumferential thickening of the lower rectal wall caused by a tumor invading the posterior and side pelvic wall. As we considered R0 resection too difficult, we gave the patient bevacizumab plus FOLFOX4 (oxaliplatin, leucovorin, and 5-fluorouracil). After eight courses, CT showed improvement in the rectal wall thickening but linear thickening of the mesorectal fascia remained. We therefore gave the patient chemoradiotherapy (CRT), and then 10 weeks later performed Hartmann's operation laparoscopically. Microscopic examination revealed that the tumor had been almost replaced by fibrous tissue, with only a few cancer cells left in the subserosa. The circumferential resection margin was free of cancer cells. The patient is doing well after 27 months of follow-up. This case suggests that systemic chemotherapy with FOLFOX4 plus bevacizumab prior to conventional preoperative CRT is a promising strategy for patients with initially unresectable locally advanced rectal cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Total mesorectal excision of initially unresectable locally advanced rectal cancer infiltrating the pelvic wall after treatment with FOLFOX4 plus bevacizumab and preoperative chemoradiation: report of a case

et al. 2011

View full text Add to dashboard Cite

show abstract

“…This therapeutic strategy is potentially effective for a select subgroup of patients without early metastasis who are eligible to receive CRT. This approach of introducing systemic treatment (chemotherapy) prior to locoregional treatment (surgery or radiotherapy) has been investigated in other gastrointestinal cancers, such as esophageal, gastric, and rectal cancers, with varying degrees of success [12][13][14][15]. Several studies evaluated the benefit not only of neoadjuvant chemotherapy before surgery in resectable PC, but also of induction chemotherapy before concurrent CRT in locally advanced PC [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Three cases of locally advanced pancreatic cancer successfully treated with chemoradiation and chemotherapy

Taguchi

Nagashio

Kihara

et al. 2010

Clin J Gastroenterol

View full text Add to dashboard Cite

We report three cases with unresectable locally advanced pancreatic cancer (PC) treated with a combination of chemoradiotherapy (CRT) and systemic chemotherapy, using gemcitabine (GEM) and/or S-1. All three cases were diagnosed as having locally advanced unresectable PC without distant metastatic lesions based on computed tomography, endoscopic retrograde pancreatography and/or blushing cytology. In Cases 1 and 2, we applied a so-called sandwich therapy, which consisted of induction chemotherapy before CRT and maintenance chemotherapy after CRT. The induction and maintenance chemotherapy in Cases 1 and 2 used a combination of GEM and S-1, whereas maintenance therapy with GEM or S-1 was applied in Case 3. S-1-based CRT was performed in Cases 1 and 2, and GEM-based CRT in Case 3. Survivals were 27 and 65 months, respectively, in two cases, and the disease remained stable in the other case 30 months after diagnosis. We show three cases with unresectable locally advanced PC who achieved long-term survival (27-65 months) after treatment with a combination of CRT and systemic chemotherapy, using GEM and/or S-1. Our findings indicate that sandwich therapy might be particularly effective for locally advanced PC.

show abstract

“…One of the earliest trials to investigate this assessed the use of 5-FU with concurrent mitomycin-C in the context of neoadjuvant radiotherapy with optimistic results [24]. However, in the era of chemotherapeutic agents with more specific activity against colorectal malignancies, various non-randomized trials have demonstrated a significant benefit of FOLFOX (5-FU/Folinic acid/Oxaliplatin) and CapeOx (Capecitabine and Oxaliplatin) in tumor down-staging, with no demonstrable concern of tumor progression [25,26]. In order to test this, Maréchal and colleagues conducted a trial in which patients with locally advanced rectal cancers were randomized to the control of neoadjuvant chemoradiation with radiosensitizing infusional 5-FU vs short-course induction FOLFOX chemotherapy (2 cycles) followed by neoadjuvant chemoradiation as performed in the control arm.…”

Section: Outcomes With Varying the Type Of Chemotherapymentioning

confidence: 99%

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

Chadi

Berho

Wexner

2015

Langenbecks Arch Surg

View full text Add to dashboard Cite

The initial benefit of adjuvant therapy in the treatment of rectal cancer patients became evident with prospective studies demonstrating improvements in various oncologic survival outcomes. Due to the improved compliance and reduced toxicity, as well as the potential for tumor down-staging and sphincter preservation, neoadjuvant approaches became the preferred method of administering chemotherapy and radiation. Furthermore, a subgroup of patients has been shown to present with complete clinical response to neoadjuvant therapy. This has resulted in the development of the non-operative "watch and wait" approach, which has initiated discussions on changing the interval from the completion of neoadjuvant therapy to surgical resection. The continued development of the multidisciplinary approach will only further improve our ability to provide patients with the best possible oncologic outcomes.

show abstract

Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation

Cited by 77 publications

References 52 publications

Total mesorectal excision of initially unresectable locally advanced rectal cancer infiltrating the pelvic wall after treatment with FOLFOX4 plus bevacizumab and preoperative chemoradiation: report of a case

Total mesorectal excision of initially unresectable locally advanced rectal cancer infiltrating the pelvic wall after treatment with FOLFOX4 plus bevacizumab and preoperative chemoradiation: report of a case

Three cases of locally advanced pancreatic cancer successfully treated with chemoradiation and chemotherapy

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

Contact Info

Product

Resources

About