Induction Chemoradiation for Rectal Cancer

Han, Nancy; Galandiuk, Susan

doi:10.1001/archsurg.141.12.1246

Cited by 12 publications

(9 citation statements)

References 53 publications

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“…10 Recently, preoperative chemoradiation therapy for low rectal cancer has been shown to increase the probability of tumor resectability, improve sphincter preservation rate, decrease local recurrence, and improve both disease-free and overall survival. [11][12][13] However, recent studies have reported that operating time, blood loss, and the postoperative complication rate increase in TME with preoperative irradiation. [14][15][16] However, there are few reports about the effect of preoperative chemoradiation therapy on laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Safety of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer with Preoperative Chemoradiation Therapy

Akiyoshi

Kuroyanagi

Oya

et al. 2009

Journal of Gastrointestinal Surgery

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Section: Introductionmentioning

confidence: 99%

Safety of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer with Preoperative Chemoradiation Therapy

Akiyoshi

Kuroyanagi

Oya

et al. 2009

Journal of Gastrointestinal Surgery

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“…1 This combined modality approach has led to a reduction in local recurrence rates and an increase in sphincter preservation, presumably because of tumor down-staging before surgery. 2 However, patients whose tumors fail to respond to neoadjuvant therapy may not derive any benefit.…”

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confidence: 99%

Tumor Hypoxia Detected by Positron Emission Tomography with 60Cu-ATSM as a Predictor of Response and Survival in Patients Undergoing Neoadjuvant Chemoradiotherapy for Rectal Carcinoma: A Pilot Study

Dietz¹,

Dehdashti²,

Grigsby³

et al. 2008

Diseases of the Colon &Amp; Rectum

150

106

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PURPOSE The response of rectal cancers to neoadjuvant chemoradiotherapy is variable. Tumor hypoxia reduces the effectiveness of both radiation therapy and chemotherapy and is a well-known risk factor for tumor radioresistence. We hypothesized that imaging with the novel hypoxia-detecting agent, 60Cu-diacetyl-bis (N4-methylthiosemicarbazone) (60Cu-ATSM), previously validated in cervical and lung cancers, would predict the response of rectal cancers to neoadjuvant chemoradiotherapy and prognosis. METHODS Patients with locally invasive (T2–4) primary or node-positive rectal cancer located <12 cm from the anal verge were recruited for this pilot study. Pretreatment tumor size and stage were determined by endorectal ultrasonography, CT, and magnetic resonance imaging. Eleven patients also underwent clinical positron emission tomography with 18F-fluorodeoxyglucose at the discretion of the treating clinician. The primary tumor was imaged by positron emission tomography with 60Cu-ATSM, and accumulation of the tracer was measured semiquantitatively by determining the tumor-to-muscle activity ratio. Neoadjuvant chemoradiotherapy was then administered (within 2 weeks of 60Cu-ATSM-positron emission tomography) and consisted of 45 Gy given in 25 fractions to the pelvis with continuous intravenous infusion of 5-fluorouracil (225 mg/m2/day). Proctectomy was performed six to eight weeks after neoadjuvant chemoradiotherapy and the tumor submitted to pathology for size measurement and staging. Tumor-to-muscle activity ratios were compared with tumor 18F-fluorodeoxyglucose uptake, tumor response to neoadjuvant chemoradiotherapy, and with patient survival. RESULTS Nineteen patients were enrolled in the study, two of whom were excluded from final analysis (1 death during neoadjuvant chemoradiotherapy and 1 tumor perforation during neoadjuvant chemoradiotherapy requiring emergent surgery). Of the 17 remaining patients, 14 had a reduction in tumor size and 13 were downstaged. The median tumor-to-muscle activity ratio of 2.6 discriminated those with worse prognosis from those with better prognosis. Both overall and progression-free survivals were worse with hypoxic tumors (tumor-to-muscle activity ratio >2.6) than with nonhypoxic tumors (tumor-to-muscle activity ratio ≤2.6; both P<0.05). In addition, 2 of the 3 tumors with no change in size had tumor-to-muscle activity ratios >2.6 (positive predictive value 66 percent), whereas 6 of 14 with decreased size had tumor-to-muscle activity ratios >2.6 (negative predictive value 57 percent). Three of the 4 tumors not downstaged had tumor-to-muscle activity ratios >2.6 (positive predictive value 75 percent), whereas 5 of 13 downstaged tumors had tumor-to-muscle activity ratios >2.6 (negative predictive value 62 percent). The mean tumor-to-muscle activity ratio for downstaged tumors (2.2) was significantly lower than that of nondownstaged tumors (3.3) (P=0.03). The difference in mean tumor-to-muscle activity ratio between downsized (2.3) and nondownsized (2.9) tumors did not reach statisti...

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“…This assessment is usually done several weeks after the therapy so that an appreciable reduction in tumor size can be observed; however, metastasis might also occur during this time interval. In addition, a large proportion of early-stage patients still develop distant metastasis even though they undergo surgical removal of the tumor mass [6]. Consequently, a reliable method to detect cancer cells prior to metastatic tumor formation could improve the treatment decisions for colorectal cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Early Assessment of Colorectal Cancer by Quantifying Circulating Tumor Cells in Peripheral Blood: ECT2 in Diagnosis of Colorectal Cancer

Chen

Sung

Chen

et al. 2017

IJMS

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Circulating tumor cells (CTCs) in peripheral blood is an indication of poor prognosis for patients with different cancer types. However, most of the available technologies for detecting CTCs show low sensitivity and specificity. Therefore, we attempted to find an alternative marker for CTCs of colorectal cancer. We have directly extracted RNA from CTCs contained in 1.5 mL peripheral blood from 90 colorectal cancer patients and 151 healthy donors, and screened these samples for candidate marker genes by nested real-time quantitative polymerase chain reaction (PCR). From genes selected from a public database of microarray analyses, we successfully identified epithelial cell transforming sequence 2 oncogene (ECT2) as a gene that exhibits high differential expression ratios (p < 0.01). ECT2 displays good sensitivity and specificity, with an area under the curve (AUC) value of 0.821. This marker gene also has a high detection rate in patients with serum carcinoembryonic antigen (CEA) concentrations below the diagnostic threshold of 5 ng/mL. The expression of ECT2 can therefore serve as an alternative measurement that can compensate for the inadequacy of the current CEA test in the diagnosis and monitoring of colorectal cancer patients.

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Induction Chemoradiation for Rectal Cancer

Cited by 12 publications

References 53 publications

Safety of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer with Preoperative Chemoradiation Therapy

Safety of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer with Preoperative Chemoradiation Therapy

Tumor Hypoxia Detected by Positron Emission Tomography with 60Cu-ATSM as a Predictor of Response and Survival in Patients Undergoing Neoadjuvant Chemoradiotherapy for Rectal Carcinoma: A Pilot Study

Early Assessment of Colorectal Cancer by Quantifying Circulating Tumor Cells in Peripheral Blood: ECT2 in Diagnosis of Colorectal Cancer

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