Patient and Physician Preferences for Surgical and Adjuvant Treatment Options for Rectal Cancer

Harrison, James D.; Solomon, Michael J.; Young, Jane; Meagher, Alan P.; Butow, Phyllis; Salkeld, Glenn; Hruby, George; Clarke, Stephen

doi:10.1001/archsurg.143.4.389

Cited by 86 publications

(89 citation statements)

References 31 publications

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“…A method to reduce polyp size could be useful in cases where an adenoma is too large for endoscopic resection and/ or when the patient, a er being fully informed of treatment options, does not accept the recommended therapy [22].…”

Section: Discussionmentioning

confidence: 99%

Disappearance of an Advanced Adenomatous Colon Polyp aer Intratumoural Injection with Viscum album (European mistletoe) Extract: a Case Report

Schoen-Angerer

Goyert

Vagedes

et al. 2014

JGLD

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Background & Aim: Extracts of Viscum album (European mistletoe) have immune-stimulatory and cytotoxic effects, with trials showing a well-established effect on the quality of life and prolonged survival in patients with advanced pancreatic cancer. Regression of tumours following intratumoural injection with Viscum album extract has been documented in individual cases. However, its influence on colon polyps has not been investigated.Case presentation: We present the case of a 78-year-old Caucasian male who had undergone hemi-colectomy for a stage IIIC colon cancer but who refused adjuvant chemotherapy. Five years later a newly detected highgrade dysplasia colon adenoma was discovered; however, the adenoma could not be resected endoscopically and the patient did not consent to surgery. Intratumoural injections with Viscum album L extract (Quercus; Iscador®Qu) were administered twice in an attempt to limit tumour growth. Eight months after the second intratumoural injection the adenoma had disappeared and biopsy revealed no intraepithelial dysplasia or adenoma.Conclusions: This is the first report showing complete regression of a colon adenoma after intratumoural injection with Viscum album extract. Prospective studies should evaluate if the treatment effect is reproducible and if this approach could be a useful pre-operative measure for colon adenomas too large for endoscopic resection.

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Section: Discussionmentioning

confidence: 99%

Disappearance of an Advanced Adenomatous Colon Polyp aer Intratumoural Injection with Viscum album (European mistletoe) Extract: a Case Report

Schoen-Angerer

Goyert

Vagedes

et al. 2014

JGLD

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“…Clinicians are known to favor interventions with which they are most familiar, or most skilled at in their routine practice. 4,12,13 It was interesting to note that we found several respondents were unable to consider participation in the trial because they lacked the surgical training or experience to be able to offer both procedures. This acknowledged differential surgical expertise provides an argument in favor of revisiting expertise-based randomized trials for surgical research in the future.…”

Section: Discussionmentioning

confidence: 99%

“…The SES has been used successfully in different surgical specialties 26,27 and may be very useful in urogynecological surgery. Increasingly qualitative research methods are being used to assess preferences and views relating to randomization and other factors of trial design in several disease areas 12,13,16,28 and our questionnaire study can be seen as a similar intervention.…”

Section: Discussionmentioning

confidence: 99%

Clinicians' views on the feasibility of surgical randomized trials in urogynecology: Results of a questionnaire survey

Bakali

Pitchforth

Tincello

et al. 2010

Neurourology and Urodynamics

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This study highlights the difference between collective and individual equipoise and their impact upon surgical trials. Clinicians held strong views preventing them from regarding the study favorably. Difficulty with relinquishing control over choice of procedure appeared central. These findings support the growing evidence in favor of detailed qualitative pilot work for surgical trials. The role of expertise-based randomization deserves further consideration.

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“…However, many patients with low cancers will-unless the tumours are very small (T1, early T2)-be treated with an abdominoperineal resection (APR) and a permanent stoma, a mutilating procedure with substantial impact on quality of life [2][3][4]. Patients often express a strong wish to avoid a colostomy if possible [5], and some elderly and heavily co-morbid patients may not be candidates for radical surgery at all [6,7]. Consequently, alternative treatment strategies for local tumour control are currently the focus of significant research efforts.…”

Section: Introductionmentioning

confidence: 99%

Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

Appelt

Jakobsen

2015

Curr Colorectal Cancer Rep

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A fraction of patients with rectal cancer can achieve clinical complete response following longcourse chemoradiotherapy (CRT), and there is accumulating clinical evidence that these patients can be managed non-surgically with acceptable oncological outcome. Consequently, strategies for increasing the proportion of complete responders are actively being explored. Some, although limited, experience with high-dose radiotherapy indicates that there might exist a dose-response relationship for local tumour control after radiotherapy alone. Thus, tumour dose escalation could be indicated for selected patients, particularly in cases with small tumours and limited local disease. This report discusses several radiotherapy techniques for tumour boosting, focusing on technical challenges and clinical experiences with each technique. Specifically, external beam radiotherapy, brachytherapy and contact X-ray treatment for dose escalation are considered. Ultimately, no technique provides definitive advantage over others, and the choice in clinical practice will have to depend on the patient population treated as well as the technical capabilities of the treating department.

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Patient and Physician Preferences for Surgical and Adjuvant Treatment Options for Rectal Cancer

Abstract: Hypothesis Patients and their clinicians hold varying preferences for surgical and adjuvant treatment therapies for rectal cancer. Design Preferences were determined using the Prospective Measure of Preference.

Cited by 86 publications

References 31 publications

Disappearance of an Advanced Adenomatous Colon Polyp aer Intratumoural Injection with Viscum album (European mistletoe) Extract: a Case Report

Disappearance of an Advanced Adenomatous Colon Polyp aer Intratumoural Injection with Viscum album (European mistletoe) Extract: a Case Report

Clinicians' views on the feasibility of surgical randomized trials in urogynecology: Results of a questionnaire survey

Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

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