Neoadjuvant Strategies: Locally Advanced Rectal Cancer

Ahmed, Shahab; Eng, Cathy

doi:10.1055/s-0037-1606372

Cited by 10 publications

(18 citation statements)

References 17 publications

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“…Locally advanced (T3/T4 or N1/N2) rectal cancer patients are at an increased risk of local recurrence and distant metastasis. Neoadjuvant therapy has been accepted as a standard treatment for locally advanced rectal carcinoma and can significantly improve the prognosis of these patients[25]. However, we observed that only 13.6% of patients had received preoperative radiotherapy and 20.3% of patients had received preoperative chemotherapy.…”

Section: Discussionmentioning

confidence: 62%

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Wang¹,

Tao²,

Chen³

et al. 2019

WJGO

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BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group ( P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation ( P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95%CI: 1.808-16.042; P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

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Section: Discussionmentioning

confidence: 62%

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Wang¹,

Tao²,

Chen³

et al. 2019

WJGO

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“…Clinical factors previously reported independently associated with CRC prognosis were entered in a Cox proportional hazards regression model: age, gender, primary tumor sites, metastatic synchronicity, metastatic lesion number, metastatic tumor size, surgical margin, pre-operative carcinoembryonic antigen (CEA), together with the number of mutated DDR signaling pathways. The known prognostic biomarkers, KRAS and PIK3CA ( 21 – 25 ), which were consistently proved significantly correlated with worse OS in our study population ( Supplementary Figure 3 ), were also taken into analysis. Carrying more than one mutated DDR pathways maintained significant negative correlation with OS (HR, 9.14; 95% CI, 1.21–68.9), but not with DFS.…”

Section: Resultsmentioning

confidence: 99%

Mutated DNA Damage Repair Pathways Are Prognostic and Chemosensitivity Markers for Resected Colorectal Cancer Liver Metastases

et al. 2021

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Deficiency of the DNA damage repair (DDR) signaling pathways is potentially responsible for genetic instability and oncogenesis in tumors, including colorectal cancer. However, the correlations of mutated DDR signaling pathways to the prognosis of colorectal cancer liver metastasis (CRLM) after resection and other clinical applications have not been fully investigated. Here, to test the potential correlation of mutated DDR pathways with survival and pre-operative chemotherapy responses, tumor tissues from 146 patients with CRLM were collected for next-generation sequencing with a 620-gene panel, including 68 genes in 7 DDR pathways, and clinical data were collected accordingly. The analyses revealed that 137 of 146 (93.8%) patients had at least one mutation in the DDR pathways. Mutations in BER, FA, HRR and MMR pathways were significantly correlated with worse overall survival than the wild-types (P < 0.05), and co-mutated DDR pathways showed even more significant correlations (P < 0.01). The number of mutated DDR pathways was also proved an independent stratifying factor of overall survival by Cox multivariable analysis with other clinical factors and biomarkers (hazard ratio = 9.14; 95% confidence interval, 1.21–68.9; P = 0.032). Additionally, mutated FA and MMR pathways were positively and negatively correlated with the response of oxaliplatin-based pre-operative chemotherapy (P = 0.0095 and 0.048, respectively). Mutated DDR signaling pathways can predict pre-operative chemotherapy response and post-operative survival in CRLM patients.

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“…In a study of the American College of Surgeons – National Surgical Quality Improvement Project (ACS‐NSQIP) database, which contains data on tumor location in the rectum, Hill et al 21 found nGBC to be associated with lower rectal tumors. This can be attributed attempt to preserve sphincter function in low‐lying rectal cancers independent of stage 22,23 . Unfortunately, the NCDB data lack the granularity to determine if this was a deciding influence in providing nGBC as it does not provide data on tumor height.…”

Section: Discussionmentioning

confidence: 99%

Evaluating disparities in delivery of neoadjuvant guideline‐based chemoradiation for rectal cancer: A multicenter, propensity score‐weighted cohort study

Lau

Kethman

Bingmer

et al. 2021

Journal of Surgical Oncology

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Background Despite guideline recommendations, some patients still receive care inappropriate for their clinical stage of disease. Identification of factors that contribute to variation in guideline base care may help eradicate disparities in the treatment of early and locally advanced rectal cancer. Methods The American College of Surgeons National Cancer Database from 2010 to 2015 was analyzed with propensity score weighting to identify factors associated with delivery and omission of neoadjuvant guideline‐based chemoradiation (GBC) for those with early and locally advanced rectal cancer. Results Only 74% of patients with rectal cancer received stage‐appropriate neoadjuvant chemoradiation; 4544 (88%) of those with early stage disease and 8675 (68%) in locally advanced disease. Chemotherapy and radiotherapy were not planned in 27% and 34% respectively, of those who did not receive GBC. Factors associated with receipt of non‐guideline‐based neoadjuvant chemoradiation were age >65 years, Medicare insurance, treatment at a community facility, West‐South‐Central geography, having locally advanced disease, and Charlson–Deyo score >3. Receipt of ideal guideline‐based neoadjuvant chemoradiation conferred a survival benefit at 5 years. Conclusion Patient and non‐patient factors contribute to disparities in guideline‐based delivery of neoadjuvant chemoradiation in the treatment of rectal cancer. Identification of these risk factors are important to help standardize care and improve survival outcomes

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Neoadjuvant Strategies: Locally Advanced Rectal Cancer

Cited by 10 publications

References 17 publications

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Mutated DNA Damage Repair Pathways Are Prognostic and Chemosensitivity Markers for Resected Colorectal Cancer Liver Metastases

Evaluating disparities in delivery of neoadjuvant guideline‐based chemoradiation for rectal cancer: A multicenter, propensity score‐weighted cohort study

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