Management Of Rectal Adenocarcinoma Research Articles

Total neoadjuvant treatment for anal adenocarcinoma with inguinal lymph node metastasis: A case report

BackgroundMetastasis of anal adenocarcinoma to inguinal lymph nodes is a rare occurrence and published literature on the optimal management strategy for these patients is limited. Case presentationWe present a case where the use of total neoadjuvant therapy (long course concurrent chemoradiotherapy followed by chemotherapy alone), surgical resection of primary anal disease and selective inguinal lymph nodes is dissection was used to treat a male in his sixties with anal adenocarcinoma with inguinal lymph node metastasis. This was a novel approach in our centre where the management of rectal adenocarcinoma was extrapolated to treat anal adenocarcinoma. ConclusionThere is no clear guideline for management of anal adenocarcinoma with metastasis to inguinal lymph nodes. This case offers an approach for future patients with similar pathology that appears feasible in the short term 1 year follow up.

Rectal Cancer after Prostate Radiation: A Complex and Controversial Disease.

A small proportion of rectal adenocarcinomas develop in patients many years after the treatment of a previous cancer using pelvic radiation, and the incidence of these rectal cancers depends on the length of follow-up from the end of radiotherapy. The risk of radiation-associated rectal cancer (RARC) is higher in patients treated with prostate external beam radiotherapy than it is in patients treated with brachytherapy. The molecular features of RARC have not been fully investigated, and survival is lower compared to non-irradiated rectal cancer patients. Ultimately, it is unclear whether the worse outcomes are related to differences in patient characteristics, treatment-related factors, or tumor biology. Radiation is widely used in the management of rectal adenocarcinoma; however, pelvic re-irradiation of RARC is challenging and carries a higher risk of treatment complications. Although RARC can develop in patients treated for a variety of malignancies, it is most common in patients treated for prostate cancer. This study will review the incidence, molecular characteristics, clinical course, and treatment outcomes of rectal adenocarcinoma in patients previously treated with radiation for prostate cancer. For clarity, we will distinguish between rectal cancer not associated with prostate cancer (RCNAPC), rectal cancer in non-irradiated prostate cancer patients (RCNRPC), and rectal cancer in irradiated prostate cancer patients (RCRPC). RARC represents a unique but understudied subset of rectal cancer, and thus requires a more comprehensive investigation in order to improve its treatment and prognosis.

A tertiary care hospital's 10 years' experience with rectal ultrasound in early rectal cancer.

Background and Objectives:Rectal endoscopic ultrasound (RUS) has become an essential tool in the management of rectal adenocarcinoma because of the ability to accurately stage lesions. The aim of this study was to identify the staging agreement of early RUS-staged rectal adenocarcinoma with surgical resected pathology and ultimately determine how this impacts the management of early rectal cancer (T1–T2).Methods:Retrospective chart review was performed from November 2002 to November 2013 to identify procedure indication, RUS staging data, surgical management, and postoperative surgical pathology data.Results:There were a total of 693 RUS examinations available for review and 282 of these were performed for a new diagnosis of rectal adenocarcinoma. There was staging agreement between RUS and surgical pathology in 19 out of 20 (95%) RUS-staged T1 cases. There was staging agreement between RUS and surgical pathology in 3 out of 9 (33%) RUS-staged T2 cases. There was significantly better staging agreement for RUS-staged T1 lesions compared to RUS staged T2 lesions (P = 0.002). Nearly 60% of T1N0 cancers were referred for transanal excisions (TAEs), and 78% of T2N0 cancers underwent low anterior resection.Conclusions:This study identified only a small number of T1–T2 adenocarcinomas. There was good staging agreement between RUS and surgical pathology among RUS-staged T1 lesions whereas poor staging agreement among RUS-staged T2 lesions. Although TAE is largely indicated by the staging of a T1 lesion, this approach may be less appropriate for T2 lesions due to high reported local recurrence.

Innovation or disparity? National trends in nonoperative management of rectal adenocarcinoma.

688 Background: While surgical resection has always been the cornerstone of curative treatment for rectal cancer, preoperative chemoradiation for stage II/III rectal cancer results in up to 49% of patients with a clinical complete response. As a result, many have questioned whether surgery can be omitted for this group of patients. Currently, there is insufficient evidence on the safety and efficacy of chemoradiation-only, or non-operative management (NOM), to support the wholesale adoption of this treatment paradigm. Despite this, anecdotal evidence suggests there is a trend for increased use of NOM. Our objective was to examine trends in the use of NOM for rectal cancer over time as well as patient- and facility-level factors associated with its use. Methods: We included all incident cases of invasive, non-metastatic, rectal adenocarcinoma reported to the National Cancer Data Base (NCDB) from 1998–2010. We performed univariate and multivariate analyses to assess NOM use over time as well as patient- and facility-level predictors of NOM. Results: 146,135 patients met inclusion criteria: 5,741 had NOM and 140,394 had surgery +/- additional therapy. From 1998-2010, the use of NOM doubled from 2.4% to 5% of all cases annually. Patients who were Black (AOR=1.71, 95%CI=1.57-1.86), uninsured (AOR=2.35, 95%CI=2.08-2.65), Medicaid-enrolled (AOR=2.10, 95%CI=1.90-2.33), and those treated at low-volume facilities (AOR=1.53, 95%CI=1.42-1.64) were more likely to receive NOM than White, privately insured, and high-volume facility patients, respectively. Additionally, NOM was more common in the South (AOR=1.53, 95%CI=1.32-1.76) and Pacific (AOR=1.82, 95%CI=1.57-2.12) as compared with the Northeast. Conclusions: NOM is an innovative approach that demonstrate promise in the treatment of rectal cancer. Pursing this approach in the context of a clinical trial and with well-informed patients would be appropriate. We observed evidence of increasing NOM utilization; however, this increase is occurring more frequently in Black and uninsured/Medicaid patients, raising concern that increased NOM use may actually represent increasing disparities in rectal cancer care rather than innovation.

Current options in chemoradiotherapy for rectal cancer

SUMMARY The management of rectal adenocarcinoma and the role of radiation in the adjuvant and neoadjuvant setting is evolving. Randomized clinical trials established the role of neoadjuvant chemoradiation (CRT), primarily in patients with T3/T4 and/or node-positive tumor presentations. Clinical trials comparing short-course radiotherapy with long-course CRT have been undertaken, and data supporting treatment with definitive CRT-reserving surgery for salvage is emerging. Clinical research to enhance the efficacy of the 5-fluorouracil-based CRT platform is being investigated, incorporating a variety of chemotherapeutics and targeted agents.

7. Improving quality of care of colorectal cancer in Europe

improvement in medical technology and have access to an ever increasing amount of data on cancer. In the past two decades a series of multi-institution clinical trials have done much to define the role of multi-modality treatment in the management of rectal adenocarcinoma. These trials have addressed a number of questions about sequencing of modalities, integration of radiation and chemotherapy, and radiation dose fractionation in the adjunctive management of patients undergoing extirpative surgery Although the findings of large randomized trials have addressed important questions, there remain patient care issues that cannot be addressed by subgroup analyses of existing trials. It is particularly important to develop measures that will allow the treating physician to deliver more tailored choices–as the oncology profession moves into the era of individualized medicine. Consensus guidelines try to help clinicians but very often large areas of controversies are still in place Recent publication on 2795 individual data of patients accrued in preoperative radiochemotherapy randomized trails provided nomograms to predict local recurrence, distant metastases and survival for locally advanced rectal cancer patients treated with long-course CRT followed by surgery These prediction models are structured to allow the integration of new data from molecular imaging and biology, which will help to improve the reliability of their prediction. They also provide an objective subgroup identification to address clinical trial for more homogenous groups of patients.

Magnetic Resonance Imaging in Locoregional Staging of Rectal Adenocarcinoma

A comprehensive overview of the current status of magnetic resonance imaging (MRI) in the locoregional assessment and management of rectal adenocarcinoma is presented. Staging systems for rectal cancer and treatment strategies in its management are discussed to give the reader the context that shapes MRI acquisition techniques and interpretation. Findings on MRI are detailed and their accuracy reviewed based on currently available evidence. Optimization of MRI acquisition and relevant pelvic anatomy are reviewed. A detailed description of our approach in interpreting MRI for locoregional staging of rectal cancer is given and future directions are also introduced.

The place of radiotherapy in the management of rectal adenocarcinoma

The place of radiotherapy in the management of rectal adenocarcinoma