scholarly journals Utilization of a Transanal TME Platform to Enable a Distal TME Dissection En Bloc with Presacral Fascia and Pelvic Sidewall with Intraoperative Radiotherapy Delivery in a Locally Advanced Rectal Cancer: Advanced Application of taTME

2020 ◽  
Vol 30 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Peadar S. Waters ◽  
Oliver Peacock ◽  
Tomas Larach ◽  
Jordan D. Lee ◽  
Jacob J. McCormick ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Intraoperative Radiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Tme ◽  
En Bloc ◽  
Presacral Fascia

scholarly journals Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Sergey Potemin ◽  
Jens Kübler ◽  
Ivan Uvarov ◽  
Frederik Wenz ◽  
Frank Giordano
Keyword(s):  
Rectal Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intraoperative Radiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
External Beam ◽  
Median Dose ◽  
Limited Access ◽  
Local Progression

Abstract Background Neoadjuvant external-beam radiotherapy (EBRT) with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer. Intraoperative radiotherapy (IORT) is to date only recommended for pelvic recurrences or incompletely resectable tumors. We here report on patients with stage II/III rectal cancer that were treated with IORT in a regional Russian university center due to limited access to EBRT. Methods We retrospectively analyzed data from patients that were diagnosed with locally-advanced rectal cancer and underwent surgery from December 2012 to October 2016 at a regional oncological center in Russia (Krasnodar). During this period, access to EBRT was limited due to a temporary lack of a sufficient number of EBRT facilities. Patients unable to travel to a distant radiotherapy site received IORT alone, those that could travel received neoadjuvant external beam (chemo-) radiotherapy. Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy. We assessed local progression-free survival (L-PFS), PFS and overall survival (OS). Results A total of 172 patients were included in this analysis. Of those, 92 (53.5%) were treated with IORT alone (median dose: 15 Gy [8.4–17 Gy]) and 80 (46.5%) received both neoadjuvant EBRT (median dose: 50.4 Gy [40–50.4 Gy]) and IORT (median dose: 15 Gy [15–17 Gy]). The median age was 65 years [33–82]. The median follow-up was 23 months [0–63 months]. The incidence of toxicity was low in both groups with an overall complication rate of 5.4%. Local PFS at 4 years was comparable with 59.4% in the IORT group and 65.4% in the IORT/EBRT group (p = 0.70). Similarly, there was no difference in OS or PFS (p = 0.66, p = 0.51, respectively). Conclusions IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT.

Value of Intraoperative Radiotherapy in Locally Advanced Rectal Cancer

2006 ◽  
Vol 49 (9) ◽  
pp. 1257-1265 ◽  
Author(s):  
Floris T. J. Ferenschild ◽  
Maarten Vermaas ◽  
Joost J. M. E. Nuyttens ◽  
Wilfried J. Graveland ◽  
Andreas W. K. S. Marinelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Intraoperative Radiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

scholarly journals Anterior-only Partial Sacrectomy for en bloc Resection of Locally Advanced Rectal Cancer

2014 ◽  
Vol 4 (4) ◽  
pp. 273-277 ◽  
Author(s):  
Hector Roldan ◽  
Luis F. Perez-Orribo ◽  
Julio M. Plata-Bello ◽  
Antonio I. Martin-Malagon ◽  
Victor M. Garcia-Marin
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
En Bloc Resection ◽  
Locally Advanced Rectal Cancer ◽  
Bloc Resection ◽  
En Bloc

Extended TME- and MRI-assisted pathology show high incidence of pt4 after neoadjuvant treatment

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15033-e15033
Author(s):  
S. Aamdal ◽  
S. G. Larsen ◽  
K. H. Hole ◽  
K. K. Grøholt ◽  
S. Dueland ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multimodal Treatment ◽  
Histopathological Examination ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
En Bloc ◽  
Pre Treatment ◽  
A New Technique

e15033 Background: The clinical ability of pre- and post neoadjuvant MRI to predict the necessary extension of TME (ETME) in evaluation of the areas at risk in locally advanced rectal cancer (LARC). Evaluation of treatment response to chemo/ radiation in T4 tumours is difficult. MRI cannot discriminate between different tissue components within a voxel. Increasing rate of late local relapses are reported from different studies. Methods: Prospective registration of 92 MRI evaluated T4a cancers undergoing multimodal treatment for rectal cancer between 2002 and 2007 in a tertiary referral cancer centre. MRI was found to predict T- downstaging in 10% after neoadjuvant treatment. In 35% both MRI and histopathological examination staged the patients as T4 after treatment. 55% (n=51) of the patients were downstaged after the routine postoperative pathology work-up. A new technique with MRI- based sampling of areas of infiltration was introduced and dedicated histopathological evaluation of these threatened areas was performed. Results: ETME was performed in 95% of the patients, mostly as en-bloc resections. After MRI focused pathology 50% were reclassified and up scaled to have pT4. Accordingly, at least 2/3 of the MRI staged T4 tumours before treatment still were pT4 after multimodal treatment. Conclusions: The tumours were downsized, but to lesser amount downstaged. If cure is the goal of the treatment, extended TME as en-bloc resections has to be performed. It is necessary to remove tumour as shown in pre-treatment MRI, as well as tumour, fibrosis and mucus as shown in MRI after post neoadjuvant treatment. MRI assisted pathology is an important option for right T-stage classification and for planning the extent of surgical resection. No significant financial relationships to disclose.

scholarly journals TaTME Combined with IORT for the Treatment of Locally Advanced Rectal Cancer：A case report

2021 ◽  
Author(s):  
Yu Guo ◽  
Shuang Wang ◽  
Zeyun Zhao ◽  
Wangsheng Xue ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Control ◽  
Treatment Time ◽  
Locally Advanced ◽  
Intraoperative Radiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Anal Margin ◽  
X Rays

Abstract Transanal total mesorectal excision (taTME) which aims to achieve more accurately complete resection of distal mesorectum has arouse much more attention worldwide. TaTME can significantly improve the local control (LC) and overall survival (OS) of the patients with locally advanced rectal cancer. Intraoperative radiotherapy (IORT), also as a emerging treatment method for locally advanced tumors, can lead to the potential for dose escalation, reduce overall treatment time, and increase patient convenience. Our study firstly combined taTME and IORT for the treatment of locally advanced rectal cancer. The tumor involved 60 mm rectal wall and located 30 mm from anal margin. TaTME and IORT were successfully achieved in this patient. There was no obvious complications occurred, including the anastomotic fistula. The patient recovered well and further systematic systematic chemotherapy and radiotherapy were suggested. We conclude that taTME with low-energy X-rays IORT may not only benefit the circumferential resection margin (CRM) but also improve the local control (LC) for the patient with locally advanced rectal cancer.

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