Preoperative Radiation and Chemotherapy in the Treatment of Adenocarcinoma of the Rectum

Chari, Ravi S.; Tyler, Douglas S.; Anscher, Mitchell S.; Russell, Linda C.; Clary, Bryan M.; Hathorn, James W.; Seigler, Hilliard F.

doi:10.1097/00000658-199506000-00016

Cited by 240 publications

(108 citation statements)

References 27 publications

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“…We found that patients with pCR had better disease-specific survival than those with either post-treatment stage I or stage IIA disease. Our data is consistent with the previous findings from other carcinoma sites that pCR is associated with better prognosis [24][25][26][27][28][29]. Given the rarity and the limited number of patients with PDA who received neoadjvant CRT had pCR in pancreatectomy reported in this study, future collaborative studies of a larger patient population is needed to confirm the prognostic values of pCR in patients with PDA.…”

Section: Discussionsupporting

confidence: 92%

“…The extent of residual invasive adenocarcinoma in post-therapy specimens has been shown to correlate with the prognosis in patients with several types of carcinomas, including PDA, esophageal cancer, and rectal cancer [24][25][26][27][28][29]. In our previous study of 240 patients with PDA who received neoadjuvant CRT and pancreaticoduodenectomy, we showed that posttherapy tumor stage (ypT), lymph node status (ypN), and the post therapy AJCC pathologic stage were independent prognostic factors of both disease-free and overall survivals in this group of patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…In other tumor sites, patients who achieved pCR after neoadjuvant therapy have better prognosis. Patients with pCR in rectal specimens who received neoadjuvant chemoradiation have better disease-free and overall survival than patients with residual rectal adenocarcinoma [24][25][26][27][28][29]. Similarly, patients with pCR in esophagectomy specimens after neoadjuvant therapy also had better prognosis than those with residual disease [12,14].…”

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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In patients with pancreatic ductal adenocarcinoma (PDA) who received neoadjuvant therapy and pancreatectomy, pathologic complete response (pCR) is rarely observed and the prognostic significance of pCR is not clear. In this study, we reported 11 patients with pCR (2.5%) from 442 patients with PDA who received neoadjuvant treatment and pancreatectomy from 1995 to 2010. There were 6 men and 5 women with median age of 61 years. Four patients had either synchronous or prior history of extra-pancreatic cancer. Five patients received neoadjuvant chemotherapy followed by chemoradiation, and 6 received chemoradiation alone. Ten patients had pancreaticoduodenectomy and one had distal pancreatectomy. Scar and chronic pancreatitis consistent with therapy effect were present in all cases (100%). Pancreatic intraepithelial neoplasia 3 (Pan IN3)/carcinoma in situ was present in 5 cases, PanIN1 and PanIN2 in 5 cases. However, no residual invasive carcinoma or lymph node metastasis was identified in all cases. Follow-up information was available in 10 patients. Follow-up time ranges from 6 to 194 months (median, 63 months). During follow-up, three patients died of other causes and one developed a second primary PDA in the tail of pancreas at 84 months after initial pancreaticoduodenectomy and died at 105 months after the initial diagnosis of PDA. The other 6 patients were alive with no evidence of disease. Patients with pCR had better survival than those who had post-therapy stage I or IIA

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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“…Although highly efficacious, [15][16][17] it is controversial whether the increased use of neoadjuvant chemoradiation therapy in locally advanced operable rectal carcinoma contributes significantly to postoperative mor bid ity. 18,19 In the face of disparate data regarding the morbidity associated with this procedure, we wanted to provide detailed analysis of morbidity and survival of patients with rectal carcinoma who underwent TPE.…”

Section: Discussionmentioning

confidence: 99%

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

Domes

Colquhoun²,

Taylor³

et al. 2011

Can J Surg

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Background:To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. Methods:We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. Results:We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Conclusion:Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.Contexte : Pour pratiquer une résection complète du cancer du rectum avancé au stade local et récidivant, on peut tenter une exentération pelvienne totale (EPT). Nous avons déterminé des résultats liés à la maladie et des facteurs de pronostic. Méthodes :Nous avons procédé à une étude unicentrique portant sur des patients qui ont subi une EPT pour un cancer du rectum au cours d'une période de 10 ans.

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“…After a follow-up period of 22 to 39 months, local recurrence rate was between 0 and 5% and grade 3 toxicity rate was 21%. [27][28][29][30] Despite all of these studies showing that neoadjuvant CRT is an effective treatment modality in the treatment of colorectal cancer, risk for potential negative effects of antineoplastics and RTs on wound healing leads to a reluctance in using them. El-Malt et al 31 reported that preoperative CRT had no harmful effect on the mechanical strength of colonic anastomosis.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

Yıldız¹,

Can²,

Yağcı³

et al. 2013

International Surgery

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The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female WistarAlbino rats were divided into 5 groups and underwent left colon resection and end-toend anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.Key words: Anastomosis -Chemoradiotherapy -Hyperbaric oxygen -Rat -Burst pressure 2 Although adjuvant therapy has been a well-accepted procedure to prevent metastasis and local recurrence after surgical resection, more recently neoadjuvant therapy has gained popularity to enable secondary curative resection with clear surgical margin and to prolong overall and recurrence-free survival.2 It has been reported that local recurrence rate is lower, toxicity is rare, and the anal sphincter is more likely to be preserved in those undergoing preoperative radiation. 1,2Despite the current advances in surgical techniques, anastomotic leakage is a severe complication leading to morbidity and mortality after intestinal surgery.3-6 Chemoradiotherapy (CRT) has the potential to lead to inadequate vascularization in tissues, a well-known risk factor for intestinal anastomosis leak. Impaired oxygenation as a result of hampered vascularization may lead to delay in wound healing, which ultimately impairs anastomotic durability. Studies on factors that enhance wound healing to prevent anastomotic leakage in colon anastomosis have been accelerated in the past decade. In a limited number of studies performed for this purpose, hyperbaric oxygen therapy (HBOT), which is applied by means of intermittent inhalation of 100% oxygen under 1 atmosphere pressure, has been reported to have favorable effects on intestinal anastomotic healing.7-9 However, whether HBOT can reverse potential side effects of CRT on would healing and anastomotic durability is unclear. The aim of the present study was to investigate the effects of HBOT on the bioche...

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Preoperative Radiation and Chemotherapy in the Treatment of Adenocarcinoma of the Rectum

Cited by 240 publications

References 27 publications

Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

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