Anorectic Cancer Patients Research Articles

Health Related Quality of Life (HRQoL) Following APER: Early Effects on Ano Rectal Cancer Patients

Background: Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide. Treatment of rectal cancer had been primarily focused on oncologic outcome, with detailed assessment of survival and local recurrence. Less attention has been given to functional outcome and quality of life (QoL). Methodology: This prospective study was conducted in the Department of Surgical Oncology, National Cancer Research Institute & Hospital, Dhaka from July, 2019 – March, 2021. Total 33 patients who fulfilled the inclusion and exclusion criteria were included in this study by purposive sampling. The scoring formulas supplied by EORTC was used for both the questionnaires (QLQ-C30 and QLQ-CR29) and in accordance to the scoring manual, the questionnaire items were grouped into scales in the categories – global health status QOL, functional scales and symptoms scales and then compiled. The p value was set as significant if p<0.05. Results: Mean age of the patient was 45.1±13.9 years. Physical function, role function, emotional function, cognitive function, social function and global health status were significantly (p=0.001) decreased after treatment group than before treatment group. Fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea and financial difficulties were significantly increased after treatment group than before treatment group. Conclusion: Surgical oncologist can improve the quality of life of patients by saving the neurovascular structures while performing anterior/posterior/lateral dissection of rectum. Multidisciplinary approach including “Tumour Board” as well as performing sphincter saving procedures (AR) rather than APER could drastically improve the quality of life of cancer patients. Preoperative counselling, taking time to explain and understand patients’ concern results in decreased stress and improve ......

P 05 - Efficacy and toxicity of proton beam therapy re-irradiation for primary anorectal cancer patients with prior pelvic radiotherapy

P 05 - Efficacy and toxicity of proton beam therapy re-irradiation for primary anorectal cancer patients with prior pelvic radiotherapy

Possibility of modification of peripheral blood neutrophils functional activity during chemoradiotherapy in patients with anorectal cancer

Background. Ionizing radiation is an effective antitumor therapy, but it has a serious negative effect on the immune system requiring the use of radiation reaction prevention and reduction methods. Neutrophils are a sensitive element of the immune system both in interaction with tumor tissue and in response to radiation injury.Aim. To evaluate functional activity of peripheral blood neutrophils by chemiluminescent analysis in patients with anorectal cancer after radiotherapy.Materials and methods. The study included 80 patients with anorectal cancer. Patients received chemo- and radio-therapy with 3D conformal radiotherapy and radiation therapy under visual control, followed by the use of radioprotector and without it. Neutrophil activity determined by chemiluminescent analysis.Results. In patients with anorectal cancer found maximum spontaneous and induced chemiluminescence acceleration. The chemiluminescence activation index with luminol is lower in patients with anorectal cancer, and with lucigenin shows no differences with the control group. The low luminol chemiluminescence maximum intensity, as well as the decrease in the synthesis of reactive secondary oxygen species in enzymatic systems, is likely regulatory intracellular limitations consequence. After treatment, patients with radioprotector showed a decrease in the number of parameters with statistically significant differences with the control group. Undesirable phenomena associated with sodium deoxyribonucleate therapy not detected in anorectal cancer patients during radiotherapy and subsequent observation period.Conclusion. During treatment, differences in chemiluminescence parameters suggest that ionizing radiation affects them in patients with anorectal cancer receiving standard chemoradiotherapy. Use of chemoradiotherapy with a radioprotector leads to indirect restoration of cellular functional activity. This is confirmed by luminol-dependent chemiluminescence faster reaching its maximum and a decrease in the number of significant differences from the control group after the start of the drug treatment.

The Effect of Radiation Therapy on Malignant Fistulae of Anorectal Cancers

Though fistula formation is a well-studied late toxicity of radiation therapy (RT), malignant fistulae (MF) are often present at the time of diagnosis of locally-advanced anorectal cancers (ARC) and negatively impact quality of life. The effect of RT in the setting of MF has not been evaluated, with practitioners concerned with RT potentially worsening MF. Thus, it may be hypothesized that RT could worsen MF. To test this hypothesis, we report our institutional series. A single institutional retrospective IRB-approved analysis of all patients with primary diagnosis of an ARC receiving RT from 2006-present was performed. These patients were screened for MF, defined as a fistula clearly associated with tumor invasion, including chronic fistula from which cancer developed. To adequately assess effect of RT on MF, patients with MF resected prior to RT, RT not directed at the site of MF, and patients with poor/no follow-up were excluded to yield the final cohort for detailed analysis. Effect was assessed by review of follow-up examination and imaging. Six-hundred-and-thirty-six patients with ARC treated at our institution from 2006-2019 were retrospectively reviewed. Forty-four were found to have MF, yielding an overall MF rate of 7.4% among all patients with ARC referred for RT [24/44 (54.5%) with anal/anal margin squamous cell carcinoma and 20/44 (45.5%) with rectal adenocarcinoma]. In 6/44 (13.6%), cancer arose from pre-existing chronic fistula, most often from long-standing Crohn’s disease (3/6). MF response could be assessed adequately in 27 patients. These patients received a median dose of 50.4 Gy (range 26-59.4 Gy), with 25/27 (93%) also receiving concurrent chemotherapy. With a median follow-up of 30.5 months (range 1.6-123 months), RT improved MF in 14/27 (52%), with 9/27 (33.3%) experiencing complete resolution; median time to improvement was 50 days (range 25-117 days). MF persisted in 13/27 (48%). MF resolved in 1/3 (33.3%) evaluable patients with chronic fistula. RT did not appear to worsen any MF. In this series, 7.4% of a large cohort of anorectal cancer patients presented with malignant fistula. RT led to improvement or resolution of these in more than half of patients. Persistence of malignant fistula was only observed in patients with refractory disease, and RT did not appear to worsen any malignant fistula. Based on our findings, symptomatic malignant fistula is not a contraindication to RT and may be considered as an indication for palliative RT.

EP-1992 Dose warping protocol for interfraction variation in Bladder filling in ano-rectal cancer patients

EP-1992 Dose warping protocol for interfraction variation in Bladder filling in ano-rectal cancer patients

Results of re-irradiation for pelvic recurrence in anorectal cancer patients.

To evaluate outcomes and toxicity profiles after re-irradiation in patients with pelvic recurrence of anorectal cancer. 25 anorectal cancer patients who received re-irradiation for pelvic recurrence between 2005 and 2015 were included. For initial treatment, all patients underwent surgical resection and preoperative or postoperative radiotherapy. The median follow-up duration was 21.5 months (range, 2.9-84.4). After a median of 43.3 months (range, 11.7-218.5), patients received re-irradiation with a median dose of 45 Gy (range, 36-60). The equivalent dose in 2 Gy fractions (EQD2) of re-irradiation-calculated using α/β = 10 Gy-ranged from 34.5 to 84.0 Gy (median, 46.4). Surgical resection was performed for 11 patients, and 14 patients received concurrent chemotherapy with re-irradiation. The 3-year local progression-free survival was 29.7%. The 3-year overall survival was 49.7%. Concurrent chemotherapy with re-irradiation and re-irradiation doses >50 Gy EQD2α/β=10 were significant prognostic factors for local progression free survival and overall survival according to multivariate analysis. 90% (9 of 10) of patients with symptoms had improvement after re-irradiation. Among 23 patients available for evaluation of late toxicity, 12 developed late toxicities. There were no Grade 4 late toxicities, and 6 patients had Grade 3 late toxicities (small bowel obstruction, bowel perforation and fistula). Re-irradiation for pelvic recurrence of anorectal cancer improved symptoms of patients but the rate of late toxicity was high. Further investigation for patient selection is required. Re-irradiation could be considered as a possible option for pelvic recurrence of anorectal cancer in selected patients.

Anorectal Cancer in Crohn's Disease Has a Poor Prognosis Due to its Advanced Stage and Aggressive Histological Features: a Systematic Literature Review of Japanese Patients.

Patients with Crohn's disease (CD) are generally known to be at an increased risk of cancer. The anorectal area is the most frequent cancer site in Japanese CD patients. However, the risks are not well defined. The aim of this study was to clarify the clinicopathological characteristics of Japanese CD-associated anorectal carcinoma patients and to explore screening methods for the detection of cancer at earlier stages. A systematic review of case series and reports of Japanese CD-associated anorectal cancer patients published between 1983 and 2016 was conducted. There were 144 cases of cancer arising from anorectal lesions of CD. The median duration from the onset of CD to the cancer diagnosis was approximately 17 (0-39) years. The most prevalent histological type of cancer was mucinous carcinoma (49.3%), and 82.1% of patients were over T3 invasion. There were only 15.6% cases with early stage disease. A total of 82% patients had enhanced symptoms, whereas 56.3% of the early cancer cases had no symptomatic changes. Approximately 90% of cases were diagnosed preoperatively, and almost all early cancer patients were diagnosed with colonoscopy. The 5-year overall survival rate was 35.8%. CD-associated anorectal carcinoma had a poor prognosis due to the advanced stage of the cases and aggressive histological features. As earlier-stage cancer is associated with a better prognosis than advanced stage disease, and it is also typically diagnosed by colonoscopy, surveillance colonoscopy may therefore help to improve the prognosis in cases without any symptomatic changes.

A Retrospective Analysis of Setup Reproducibility for Anorectal Cancer Patients Treated Prone on a Belly Board

A Retrospective Analysis of Setup Reproducibility for Anorectal Cancer Patients Treated Prone on a Belly Board

Octreotide Acetate in Prevention of Chemoradiation-Induced Diarrhea in Anorectal Cancer: Randomized RTOG Trial 0315

In anorectal cancer patients, an acute side effect of chemoradiotherapy is gastrointestinal toxicity, which often impedes treatment delivery. Based on previous trials, octreotide acetate is widely recommended for the control of chemotherapy-induced diarrhea. However, the effectiveness of octreotide in preventing or controlling radiation- and chemoradiation-induced diarrhea is not known. A randomized, double-blinded, placebo-controlled trial was designed to determine the efficacy of long-acting octreotide acetate (LAO) in preventing the onset of acute diarrhea in patients undergoing chemoradiation therapy for rectal or anal cancer. Between 4 and 7 days before the start of radiation therapy, patients received a 30-mg dose of LAO (109 patients) or placebo (106 patients) via intramuscular injection. A second dose was given on day 22 (+/-3 days) of radiation treatment. A total of 215 patients were included in the final analysis. The primary endpoint was the incidence of grade 2-4 acute diarrhea; secondary endpoints included treatment compliance, medical resource utilization, patient-reported bowel function, and quality of life (QoL). Statistical tests were one- or two-sided, as specified. After a median follow-up time of 9.64 months, incidence rates of grades 2-4 acute diarrhea were similar in both groups (49% placebo vs 44% LAO; P = .21). No statistically significant treatment differences in chemotherapy or radiation delivery, medical resource utilization, patient-reported bowel function, or QoL were observed. In this study, the prophylactic use of LAO did not prevent the incidence or reduce the severity of diarrhea and had no notable impact on patient-reported bowel function or QoL.

Octreotide Acetate Does Not Prevent Treatment-Induced Diarrhea in Anorectal Cancer Patients

Octreotide Acetate Does Not Prevent Treatment-Induced Diarrhea in Anorectal Cancer Patients

Cancer Anorexia

Anorexia is often neglected in cancer care, while it contributes to the development of malnutrition and impinges on quality of life. The pathogenesis of cancer anorexia is multifactorial and involves hormones, neuropeptides, cytokines and neurotransmitters. Cytokines play a key role by inhibiting the hypothalamus to appropriately respond to peripheral signals, more specifically by persistently activating anorexigenic systems and/or inhibiting prophagic pathways. Hypothalamic monoaminergic neurotransmission may significantly contribute to these effects. Thus, the optimal therapeutic approach to anorectic cancer patients should be based on both changes in dietary habits, achieved via nutritional counselling, and drug therapy, aimed at interfering with cytokine expression or hypothalamic monoaminergic neurotransmission.

Improving food intake in anorectic cancer patients.

Anorexia and reduced food intake are important issues in the management of cancer patients. This article discusses the currently proposed hypothesis of its pathogenesis, and reviews the available and future therapeutic options as they relate to the pathogenic mechanisms. Currently available data suggest that the pathogenesis of cancer anorexia is multifactorial, and involves most of the hypothalamic neuronal signaling pathways modulating energy intake. Thus, a number of factors have been proposed as putative mediators of cancer anorexia, including hormones (e.g. leptin), neuropeptides (e.g. neuropeptide Y), cytokines (e.g. IL-1, IL-6, tumor necrosis factor) and neurotransmitters (e.g. serotonin and dopamine). It is unlikely, however, that they represent separate and distinct pathogenic mechanisms, rather it appears that close interrelationships may exist among them. In line with this reasoning, consistent experimental and human data suggest that hypothalamic monoaminergic neurotransmission may represent a major target on which different anorexia-related factors converge. In the pathogenesis of cancer anorexia, cytokines appear to play a key role. Their increased expression during tumor growth inhibits the hypothalamus to appropriately respond to peripheral signals, by persistently activating the melanocortin system and inhibiting the neuropeptide Y neuronal pathway. Hypothalamic monoaminergic neurotransmission may significantly contribute to these effects. Thus, interfering pharmacologically with cytokine expression or hypothalamic monoaminergic neurotransmissions is an effective therapeutic strategy in anorectic cancer patients.

Neuropeptide Y, leptin, and cholecystokinin 8 in patients with advanced cancer and anorexia: a North Central Cancer Treatment Group exploratory investigation.

Anorexia is a noxious symptom, and over half of patients with advanced cancer experience it. Neuropeptide Y (NPY), leptin, and cholecystokinin 8 (CCK8) have been implicated. This exploratory study 1) compared circulating concentrations of NPY and leptin between anorectic cancer patients and historic controls and 2) explored whether NPY, leptin, or CCK8 may serve as correlates of anorexia severity. Cancer patients met predefined eligibility criteria: 1) weight loss > or = 2.3 kg over the preceding 2 months and/or a physician-estimated caloric intake of < 20 calories per kilogram of body weight per day and 2) patient acknowledgment that appetite or weight loss was an ongoing problem. Seventy-three cancer patients were studied, and > 90% reported a > or = 50% decline in appetite from baseline in the preceding 2 months. NPY levels were lower than control values: mean +/- standard deviation, 466 pg/mL +/- 161 pg/mL versus 560 pg/mL +/- 151 pg/mL, respectively (P = 0.004). Because a few (but not all) earlier studies suggested an age-related decline in NPY levels, a subgroup analysis was performed and found no age-adjusted difference in NPY levels between groups. Similarly, leptin concentrations were not different between groups. Significant correlations were not observed between anorexia severity and NPY, leptin, or CCK8 levels. There were no differences in leptin and CCK8 levels between anorectic cancer patients and historic controls. Circulating concentrations of NPY, leptin, and CCK8 did not correlate with anorexia severity. However, the current results suggest a need for further examination of NPY in cancer-associated anorexia.

Total anorectal reconstruction supported by electrostimulation gracilis neosphincter.

To review and to update the results of Total Anorectal Reconstruction with Electrostimulated Graciloplasty (ES-TAR) at the same time as or following abdominoperineal resection (APR). A university hospital in Italy. Retrospective study. A series of 98 consecutive anorectal cancer patients who had undergone ES-TAR (in 88 cases at the same time as APR; in 10 cases following APR), 61 of whom are still evaluable in respect of continence (median follow-up period 55 months). There was no mortality. Thirty-seven percent of patients had postoperative complications with no impact on survival or functional outcome. The 5-year survival rate in 50 patients was 61% and the 5-year estimated cumulative probability of survival in 81 patients was 65%. Local recurrence rate was 16%. Continence was achieved in 87% of patients with a chronically stimulated TAR, and in 69% of patients with short-term stimulation. ES-TAR is a safe and effective method for both curing anorectal cancer and restoring continence. It may be considered a reliable alternative to sphincter-saving procedures in lower rectal cancer patients.

Change in diet composition of anorectic cancer patients

Change in diet composition of anorectic cancer patients

Plasma tryptophan and anorexia in human cancer

A correlation between anorexia and brain levels of serotonin and trytophan (TRP) has been reported in tumor-bearing animals. In the present investigation 45 patients with various types of cancer and 13 control subjects were studied. Prior to the study the patients had received no antineoplastic therapy and were unaware of the malignancy of their disease. Feeding behavior was investigated by means of a questionnaire in which the presence of anorexia (A), aversion to meat (MA), taste (TA) or smell (SA) alterations, nausea and/or vomiting (NV) and early satiety (ES) was assessed. Plasma levels of free TRP, the other neutral amino acids (NAA), albumin and non-esterified fatty acids (NEFA) were assayed. Plasma-free TRP was significantly increased in anorectic cancer patients. The free TRP/competing NAA ratio, which might better predict brain TRP levels, was significantly higher in patients with A, MA, TA, SA, NV and ES than in controls or in non-anorectic (NA) cancer patients. These findings seem to confirm that free TRP may play an important role in human cancer anorexia.