Neo adjuvant chemo-radiotherapy and rectal cancer: Can India follow the West?

Bansal, Vivek; Bhutani, Ritu; Doval, Dinesh Chandra; Kumar, Kapil; Pande, Pankaj; Kumar, Gaurav

doi:10.4103/0973-1482.98972

Cited by 5 publications

(1 citation statement)

References 21 publications

(22 reference statements)

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“…Available evidence from India suggests that rectal cancers are commoner than colonic primaries, the age at incidence is younger and there is an advanced stage at presentation as compared to available data from North American and European countries (9)(10)(11). Previous data published from our institution (patients treated between June 2006 and December 2010) and other centres in India have shown curative resection ranging from 72% to 98%, though overall survivals (OS) have been similar (12)(13)(14) post treatment with long course chemoradiation (LCRT) in LARC. However, all the Indian studies used computerized tomography (CT) based imaging for rectal primary, whereas the current imaging standard for local rectal primary should be MRI based due to its superiority in assessment of primary, mesorectal nodes and extramesorectal nodes (15)(16)(17).…”

Section: Introductionmentioning

confidence: 85%

Low prevalence of deficient mismatch repair (dMMR) protein in locally advanced rectal cancers (LARC) and treatment outcomes

Ostwal

Pande

Saklani

et al. 2018

J. Gastrointest. Oncol

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Background: The available evidence in locally advanced rectal cancer (LARC) suggests a low prevalence of deficient mismatch repair (dMMR) protein status, approximating 1-3%.Methods: Patients with LARC who were offered long course chemoradiation (LCRT), as per institution protocol during the period of 1st January 2014 to 31st December 2015 at Tata Memorial Hospital (TMH) in Mumbai were evaluated for outcomes and assessment of MMR status.Results: A total of 419 patients were evaluated for LARC in TMH, of whom 354 were treated with LCRT.Of these 354 patients, 296 were assessable for MMR status based on tissue adequacy for testing. Three patients (1.01%) has dMMR status, while the remaining 293 patients had proficient MMR status. A total of 240 patients (67.8%) underwent curative intent resections. With a median follow-up of 32 months, estimated 3-year recurrence free survival (RFS) and overall survival (OS) for the resected group was 63.5% and 85.2%, respectively, while 3-year event free survival and OS for the unresected cohort was 15.2% and 15.8%, respectively. Signet ring histology, higher ypT stage, involved margin status post resection, and delays (>1 week) in LCRT were associated with inferior OS on multivariate analysis. Conclusions:In a large LARC cohort, a majority of tumors had proficient MMR status, suggesting that MSI as a biomarker may have limited applicability in the management of rectal cancers. Signet ring histology, CRM involvement post resection, higher ypT stage and interruptions in LCRT predicted for inferior OS.

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Section: Introductionmentioning

confidence: 85%

Low prevalence of deficient mismatch repair (dMMR) protein in locally advanced rectal cancers (LARC) and treatment outcomes

Ostwal

Pande

Saklani

et al. 2018

J. Gastrointest. Oncol

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Composite Antropyloric Valve and Gluteus Maximus Muscle Wrap for Neoanal Reconstruction: Initial Results

Chandra

Mishra

Kumar

et al. 2019

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Severe fecal incontinence has a significant negative impact on patient well-being. Current surgical methods of total anorectal reconstruction to substitute a colostomy have suboptimal results. A composite graft using antropyloric valve transposition and gracilis wrap has been described with good outcomes. However, this procedure requires extensive training of patients. Gluteus maximus, an accessory muscle for continence, may be better suited for this purpose. OBJECTIVE: The purpose of this study was to evaluate the outcomes of composite antropylorus–gluteus graft for intractable fecal incontinence. DESIGN: Patients underwent a 3-stage procedure: antropyloric transposition with diversion stoma followed by gluteus wrap. Stoma was closed after ensuring the anatomic and functional integrity of the graft. SETTINGS: This study was conducted at a single tertiary care institution. PATIENTS: Patients who were on permanent colostomy for intractable incontinence or would have had one after abdominoperineal resection were included. MAIN OUTCOME MEASURES: Endoultrasonography, MRI, loopogram, saline holding test, anal manometry, St. Mark’s fecal incontinence score, and personal interviews were used for measurement. RESULTS: Eleven patients underwent the procedure with a median follow-up of 16 months (range, 13–34 mo). Digital rectal examination revealed a resting tone with a distinct squeeze provided by the composite graft. Radiological imaging confirmed healthy grafts. There was a significant improvement in mean anal manometry values (resting pressure: preoperative = 10.25 mm Hg vs postoperative = 20.45 mm Hg; squeeze pressure: preoperative = 22.63 mm Hg vs postoperative = 105.18 mm Hg) and mean incontinence score postprocedure (preoperative = 22.8 vs postoperative = 8.6). On personal interview, majority of the patients were continent and expressed satisfaction with the procedure. LIMITATIONS: The study was limited by its small sample size with no control group. CONCLUSIONS: Composite graft in patients with intractable fecal incontinence can serve as a viable novel method for total anorectal reconstruction. However, it should only be recommended for a highly select group of individuals in a surveillance setting. Its long-term outcomes remain to be determined as well as its risk versus benefit.

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Recent Management in Patients of Carcinoma Rectum With Respect to Quality of Lifea Retrospective and Prospective Study

Mahajan¹,

Mathur²,

Lubana³

et al. 2018

jemds

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BACKGROUND Colorectal cancer is a major health problem worldwide. CRC remains in the top three of all cancer deaths and after its diagnosis and treatment the quality of life in patient of colorectal carcinoma is major morbidity issue worldwide, but the neoadjuvant treatment has come to overcome this morbidity in population. The aim of this review is to discuss important issues surrounding rectal cancer including its surgical and medical management with respect to quality of life. The aim of this study was to assess the quality of life in carcinoma rectum patients undergoing recent management with neoadjuvant chemotherapy in MY Hospital and Cancer Hospital, Indore from Oct. 2011 to Sep. 2015. MATERIALS AND METHODS 40 patients were treated with only surgical management and 26 patients were treated with neoadjuvant treatment followed by surgery retrospectively and prospectively followed up. All patients were treated in curative attempt. Quality of life was assessed 6 months after the surgery using anonymous questionnaire. RESULTS Main effect on the factors for the variables Physical function, Role function, Emotional function, Cognitive function and Social function show significant improvement in Neoadjuvant group. Both groups showed a major difference in Role function and a consistent increase in Emotional well-being and Social functioning perspective across the time of the study. CONCLUSION Based on the results of earlier studies of QoL cases undergoing Neoadjuvant treatment versus Non-Neoadjuvant and our own findings, we deduced that cases undergoing Neoadjuvant treatment do have some restriction in their post-treatment QoL such as nausea, vomiting and financial difficulties. Otherwise, their quality of life is better than patient not undergoing Neoadjuvant treatment and equally important is the fact that cases undergoing Neoadjuvant treatment have more benefit in QoL as better surgical correction and post-operative disease free survival is the most important outcome of our study.

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Neo adjuvant chemo-radiotherapy and rectal cancer: Can India follow the West?

Cited by 5 publications

References 21 publications

Low prevalence of deficient mismatch repair (dMMR) protein in locally advanced rectal cancers (LARC) and treatment outcomes

Low prevalence of deficient mismatch repair (dMMR) protein in locally advanced rectal cancers (LARC) and treatment outcomes

Composite Antropyloric Valve and Gluteus Maximus Muscle Wrap for Neoanal Reconstruction: Initial Results

Recent Management in Patients of Carcinoma Rectum With Respect to Quality of Lifea Retrospective and Prospective Study

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