Sphincter Preservation in Four Consecutive Phase II Studies of Preoperative Chemoradiation: Analysis of 247 T3 Rectal Cancer Patients

Gambacorta, Maria Antonietta; Valentini, Vincenzo; Coco, Claudio; Manno, Alberto; Doglietto, Giovanni Battista; Ratto, Carlo; Cosimelli, Maurizio; Miccichè, Francesco; Maurizi, Francesca; Tagliaferri, Luca; Mantini, Giovanna; Boccadoro, Mario; Torre, Giuseppe La; Barbaro, Brunella; Picciocchi, Aurelio

doi:10.1177/030089160709300209

Cited by 15 publications

(5 citation statements)

References 40 publications

(51 reference statements)

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“…The pathological complete response occurred in 10 patients (8.8%), like observed by Grann et al in 9% of cases [9]. However, if the cancer has been shown to have a pathological downstaging, the latter can provide related benefits to the resection of the tumor and the improvement of the oncological results [26, 27].…”

Section: Resultsmentioning

confidence: 95%

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Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

et al. 2019

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AbstractBackgroundNeoadjuvant chemoradiotherapy has a significant role in downstaging cancer. It improves the local control of the disease and can make conservative resection of rectal cancer possible.MethodsWe enrolled 114 patients with subperitoneal rectal cancer who underwent neoadjuvant chemoradio-therapy and radical excision with total mesorectal excision (TME). The primary endpoint was oncological outcomes and the secondary endpoint was surgical outcomes.We evaluate the experience of a multidisciplinary team and the role of neoadjuvant chemoradiotherapy in integrated treatment of cancer of the subperitoneal rectum.ResultsSurgical procedures performed were abdominal perineal resection in 4 cases (3.5%), anterior resection in 89 cases (78%), Hartmann’s procedure in 5 cases (4.4%), and ultralow resection with coloanal anastomosis and diverting stoma in 16 patients (14%).Local recurrence occurred in 6 patients (5.2%), the overall survival was 71.9% at 5 years and disease-free survival was about 60%.ConclusionsThe effect of pathological downstaging amounted to 58.8%, including cPR. The pathologic complete remission occurred in 8.8% of cases.The outcomes of neoadjuvant therapy can be achieved when this treatment is associated with correct surgical technique with TME and the prognosis is defined by an anatomopathological examination performed according to Quirke’s protocol.

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Section: Resultsmentioning

confidence: 95%

“…In locally advanced rectal carcinoma, this combined treatment approach aims to improve resectability, local control and overall survival. It does so by reducing the tumor volume thus favoring surgical resection and longterm oncological results [26, 27, 28,].…”

Section: Resultsmentioning

confidence: 99%

Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

et al. 2019

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“…Considering the distance between the lower pole of the tumor from the anorectal ring, as reported at diagnostic work-up, our patients were split into three subgroups to evaluate possible surgical procedure: Very low location when the distance was <30 mm (candidates for an APR procedure); low location when the distance was 31-50 mm (potential candidates for an APR procedure); and mid-high location when the distance was >50 mm (candidates for a sphincter-saving procedure) (13).…”

Section: Methodsmentioning

confidence: 99%

Treatment Intensification for Locally Advanced Rectal Cancer: Impact on Pathological Complete Response and Outcomes

Tommaso

Rosa

Caravatta

et al. 2020

In Vivo

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Aim: Pathological complete response (pCR) and clinical outcomes [overall survival (OS), disease-free survival (DFS), locoregional control (LC)] were evaluated in a single-institution experience of different schedules of neoadjuvant chemoradiotherapy (CRT) for patients with locally advanced rectal cancer (LARC). Patients and Methods: Data for 322 patients with LARC were retrospectively analyzed. pCR was evaluated according to Mandard tumor regression grade (TRG). The Kaplan-Meier method was used to estimate OS, DFS and LC. Results: Three hundred and three (94.1%) patients underwent surgery. pCR was observed in 81 patients (26.7%), with TRG1-2 rate of 41.

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“…This effect can be compounded with the addition of preoperative chemotherapy when there is a definitive plan for sphincter preservation [95][96][97][98] . Although there clearly is a distinct "anterior resection syndrome" with some reported improvement of incontinence over time 83 , persistent (sometimes disabling) symptoms after low coloanal anastomosis will have a cumulative effect on quality of life; an effect typically amplified in elderly cases [99][100][101][102] .…”

Section: Functional Effects Of Chemoradiationmentioning

confidence: 99%

Functional outcome following restorative rectal cancer surgery

2009

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The trend towards preoperative adjuvant and neoadjuvant therapies in selected patients with rectal cancer has led to increases in sphincter preservation with a limited understanding of the factors governing unsatisfactory functional outcomes. Data would suggest the need for a more selective use of standard radiotherapeutic fields in low- to intermediate-risk cases where there appears to be limited survival or locoregional recurrence benefit and where there is under-reported toxicity. This article discusses the complex factors which impact on functional outcome following open rectal cancer surgery particularly when it is accompanied by adjuvant therapy.

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Sphincter Preservation in Four Consecutive Phase II Studies of Preoperative Chemoradiation: Analysis of 247 T3 Rectal Cancer Patients

Abstract: Even though the surgeons' skill in performing sphincter-saving surgery could be improved with time, the high rate of this procedure in the latest schedules suggests an impact of the new drugs in promoting tumor downsizing and therefore sphincter-saving surgery.

Cited by 15 publications

References 40 publications

Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy

Treatment Intensification for Locally Advanced Rectal Cancer: Impact on Pathological Complete Response and Outcomes

Functional outcome following restorative rectal cancer surgery

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