scholarly journals Putting down the scalpel in rectal cancer management - a historical perspective

2018 ◽  
Vol 20 ◽  
pp. 12-15 ◽  
Author(s):  
R. O. Perez ◽  
A. Habr-Gama
Keyword(s):  
Rectal Cancer ◽  
Historical Perspective ◽  
Cancer Management

Submit Manuscript | http://medc rav eonline.co m Introduction Colorectal adenocarcinoma is the third most common malignant neoplasia and the third leading cause of death from cancer in men and women in the United States. Current data show that the incidence of colorectal adenocarcinoma is decreasing in developed countries but increasing in developing countries. 1 The 2018 estimates of the Bra - zilian National Cancer Institute (Instituto Nacional do Câncer–INCA) were 17,380 new cases in men and 18,980 in women, making col - orectal adenocarcinoma the third most common neoplasia in men and the second most common in women in Brazil. 2 In the past 15 years, rectal cancer management has evolved in several aspects. Specifical - ly, a better understanding of the natural history of the disease, more precise radiological staging, multimodal therapeutic intervention, refined surgical techniques, and more detailed histopathological re - ports may have positively influenced patient survival. In this context, multidisciplinary management of colorectal cancer plays an important role and requires the coordinated teamwork of colorectal surgeons, oncologists, radiologists, and radiotherapists. 3 Total mesorectal exci - sion is still the basis of treatment in rectal cancer. However, neoadju - vant therapy and more conservative practices have been adopted in cases of clinical/pathological responses to radiochemotherapy. 4 Ra - diological evaluation of the response is of paramount importance for the selection of patients eligible for alternative treatment strategies, including ‘watch-and-wait’. Diffusion-weighted imaging is already being used routinely in the evaluation of the pathological response of rectal tumour patients submitted to neoadjuvant therapy. Some re - searchers have tried to estimate the tumour regression grade (TRG) using magnetic resonance imaging, as has been described for post-ra - diochemotherapy pathological evaluation, thus rendering it a valuable instrument. Considering the good results obtained with multimodal therapy in extraperitoneal rectal cancer, the evaluation of the pathological re - sponse post-neoadjuvant therapy must be considered as a factor for safe indication, both for the conservative option, in which the organ is preserved, and for radical surgical resection, influencing the choice between sphincter-preserving surgery and abdominoperineal excision. A precise evaluation, by comparing the results of post-neoadjuvant therapy magnetic resonance imaging with those obtained from his - Int J Radiol Radiat Ther. 2018;5(4):254 ‒ 258. 254 © 2018 Oliveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially. Magnetic resonance imaging is effective in assessing tumour regression after neoadjuvancy in rectal adenocarcinoma

2018 ◽  
Vol 5 (4) ◽  
Author(s):  
Fábio Henrique de Oliveira ◽  
Antônio Lacerda-Filho ◽  
Fábio Lopes de Queiroz ◽  
Tatiana Martins Gomide Leite ◽  
Paulo Guilherme Oliveira Sales ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Rectal Cancer ◽  
Magnetic Resonance ◽  
Neoadjuvant Therapy ◽  
Colorectal Adenocarcinoma ◽  
The United States ◽  
Tumour Regression ◽  
Resonance Imaging ◽  
Cancer Management ◽  
The Third

Evaluation of Rectal Cancer Management in El-Minia Oncology Center

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
mina wahba ◽  
Alaal Khalil ◽  
Mohamed Alkilany ◽  
medhat soliman
Keyword(s):  
Rectal Cancer ◽  
Cancer Management ◽  
Oncology Center

scholarly journals Management of Rectal Cancer and Liver Metastatic Disease: Which Comes First?

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Georgios Tsoulfas ◽  
Manousos-Georgios Pramateftakis
Keyword(s):  
Rectal Cancer ◽  
Metastatic Disease ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Hepatic Metastases ◽  
Multimodality Treatment ◽  
Cancer Management ◽  
Metastatic Lesions ◽  
Synchronous Resection ◽  
Multimodality Approach

In the last few decades there have been significant changes in the approach to rectal cancer management. A multimodality approach and advanced surgical techniques have led to an expansion of the treatment of metastatic disease, with improved survival. Hepatic metastases are present at one point or another in about 50% of patients with colorectal cancer, with surgical resection being the only chance for cure. As the use of multimodality treatment has allowed the tackling of more complicated cases, one of the main questions that remain unanswered is the management of patients with synchronous rectal cancer and hepatic metastatic lesions. The question is one of priority, with all possible options being explored. Specifically, these include the simultaneous rectal cancer and hepatic metastases resection, the rectal cancer followed by chemotherapy and then by the liver resection, and finally the “liver-first” option. This paper will review the three treatment options and attempt to dissect the indications for each. In addition, the role of laparoscopy in the synchronous resection of rectal cancer and hepatic metastases will be reviewed in order to identify future trends.

scholarly journals Surgical Quality in Rectal Cancer Management: What Can Be Achieved by a Voluntary Observational Study?

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Łukasz Dziki ◽  
Ronny Otto ◽  
Hans Lippert ◽  
Paweł Mroczkowski ◽  
Olof Jannasch
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Quality Assurance ◽  
Hospital Mortality ◽  
Diagnostic Procedures ◽  
Inclusion Criteria ◽  
Treatment Standards ◽  
Cancer Management ◽  
Quality Assurance Project ◽  
Preoperative Ct

Purpose. Countries with nationwide quality programmes in colorectal cancer report an improved outcome. In Germany, a self-organized and self-financed observational quality assurance project exists, based on voluntary participation. The object of the present study was to ascertain whether this nationwide project also improves the outcome of colorectal cancer. Methods. The German Quality Assurance in Colorectal Cancer Project started in 2000 and by 2012 contained 85,000 patients. Inclusion criteria for the study were participation for the entire period of 13 years and treatment of rectal cancer. The following parameters were analysed: (1) patient related: age, gender, ASA classification, T-stage, and N-stage, (2) system related: frequency of preoperative CT and MRI, and (3) outcome related: CRM status, complications, and hospital mortality. Results. Forty-one of the 345 hospitals treating 11,597 patients fulfilled the inclusion criteria. The median age increased from 67 to 69 years (p=0.002). ASA stages III and IV increased from 32.0% to 37.6% (p=0.005) and from 2.0% to 3.3% (p=0.022), respectively. The use of CT rose from 67.2% to 88.8% (p<0.001) and that of MRI from 5.0% to 35.2% (p<0.001). The proportion of patients suffering from complications decreased from 7.9% to 5.3% (p<0.001) for intraoperative and from 28.0% to 18.6% (p<0.001) for postoperative surgical complications, but general postoperative complications increased from 25.8% to 29.5% (p=0.006). The distribution of histopathological stage, anastomotic leakage, and in-hospital mortality did not change significantly. Conclusion. Participation in a quality assurance project improves compliance with treatment standards, especially for diagnostic procedures. An improvement of surgical results will require further investment in training.

76 RECTAL CANCER MANAGEMENT: URBAN/RURAL CONTRASTS IN KENTUCKY.

2004 ◽  
Vol 52 (Suppl 2) ◽  
pp. S390.2-S390
Author(s):  
M. Hicks ◽  
M. McCafferty ◽  
T. E. Aldrich
Keyword(s):  
Rectal Cancer ◽  
Cancer Management ◽  
Urban Rural

Reproducibility of measurements with a semi-automatic software package for the evaluation of rectal cancer

2019 ◽  
Vol 61 (5) ◽  
pp. 586-594
Author(s):  
Lisa Hörberg ◽  
Daniel Roth ◽  
Peter Leander ◽  
Sven Månsson ◽  
Tobias Fält ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Lymph Nodes ◽  
Software Package ◽  
Cancer Management ◽  
Mri Staging ◽  
Before And After ◽  
Apparent Diffusion ◽  
Chemoradiation Treatment

Background Staging of rectal cancer with MRI has major impact on treatment choice and may be of importance in new cancer management strategies such as “wait-and-see” policy. Purpose To assess the reproducibility of a software package recently developed at our department to measure volumes, apparent diffusion coefficient, and the skewness of apparent diffusion coefficient in lymph nodes and tumors in rectal cancer patients before and after chemoradiation treatment. Material and Methods This study included 20 consecutive patients with biopsy-verified rectal cancer, in whom MRI staging had been performed both before and after chemoradiation treatment. The diffusion-weighted images were transferred to the software. The volume, apparent diffusion coefficient, and skewness were determined for 93 lymph nodes and 40 tumors. The volumes were compared with manual measurements of the volume of the same lymph nodes and tumors. Results The agreement in semi-automatic measurements of lymph nodes was very good (ICC = 0.99), and in tumors good (ICC = 0.88). The agreement in manual measurements of lymph nodes was very good (ICC = 0.95) when all lymph nodes were included, but low (ICC = 0.52) if three outliers were excluded. Bland–Altman plots showed clear agreement between manual and semi-automatic measurements in the lymph nodes, but not in measurements of tumors. The values of apparent diffusion coefficient and skewness in tumors differed before and after treatment but did not differ in lymph nodes as a group. Conclusion The software package showed a high degree of reproducibility in measurements on lymph nodes but requires further development to improve the reproducibility of tumor measurements.

New Technologies in Rectal Cancer Management

2005 ◽  
Vol 16 (2) ◽  
pp. 91-95
Author(s):  
John R. Warmath ◽  
Alan J. Herline
Keyword(s):  
Rectal Cancer ◽  
New Technologies ◽  
Cancer Management

An assessment of dose intensity of the TNT approach on outcomes in locally advanced rectal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 258-258
Author(s):  
Ashley Elizabeth Glode ◽  
Tyler Friedrich ◽  
Gurprataap Singh Sandhu ◽  
Whitney Herter ◽  
Martin McCarter ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Dose Intensity ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Tumor Board ◽  
Treatment Benefit ◽  
Full Dose ◽  
Cancer Management

258 Background: Patients with clinical stage II or III locally advanced rectal cancer may be treated with the total neoadjuvant therapy (TNT) approach; chemotherapy with 4 mths of FOLFOX followed by chemoradiation (chemo/XRT) with capecitabine for 5 wks administered before surgery. We hypothesized that full dose intensity is not necessary for treatment benefit. Methods: A retrospective chart review was conducted on patients with newly diagnosed rectal cancer recommended to receive TNT by the multidisciplinary (multiD) colorectal cancer tumor board at the University of Colorado Cancer Center (UCCC). The primary objective was to evaluate dose intensity of TNT and its impact on response assessed by biopsy and/or imaging (MRI). Results: Between January 31, 2016 and January 31, 2019, 80 patients were recommended the TNT approach for cancer management by the multiD team. Of those, 48 completed their neoadjuvant treatment at UCCC and were included in the analysis. The average age was 55 years (range 23-80) and 61% were male. Thirty-one patients had an ECOG of 0 and 17 had an ECOG of 1. Overall responses were 44% complete response (CR, n = 21), 15% near complete response (nCR, n = 7), 35% partial response (PR, n = 17), and 6% no response (NR, n = 3). See Table for responses seen by dose intensity for chemotherapy. Two patients did not receive their full planned XRT course, and 9 patients had their capecitabine doses held/decreased during chemoradiation. Conclusions: This single center retrospective analysis of patients receiving the TNT approach for rectal cancer provides data supporting that achieving full dose intensity is not necessary to achieve treatment benefit. [Table: see text]

RECTAL CANCER MANAGEMENT: URBAN/RURAL CONTRASTS IN KENTUCKY.

2004 ◽  
Vol 52 ◽  
pp. S390
Author(s):  
M. Hicks ◽  
M. McCafferty ◽  
T. E. Aldrich
Keyword(s):  
Rectal Cancer ◽  
Cancer Management ◽  
Urban Rural
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