Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum:Clinicopathologic correlation and implications for adjuvant therapy

Gunderson, Leonard L.; Sosin, Henry

doi:10.1002/1097-0142(197410)34:4<1278::aid-cncr2820340440>3.0.co;2-f

Cited by 710 publications

(167 citation statements)

References 38 publications

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“…Chemoradiotherapy (CRT) followed by total mesorectal excision is the standard for care when MRI staging demonstrates threatened surgical margins in locally advanced rectal cancer (LARC) [1,2]. Radiotherapy planning for rectal cancer uses conventional orthogonal simulation with standardised radiation fields based on patterns of loco-regional relapse in relation to pelvic bony anatomy [3]. Three-field conventional orthogonal planning is considered an acceptable technique for planning preoperative CRT and major trials evaluating long-course chemoradiation for rectal cancer have permitted the use of conventional planning within their protocols [4,5].…”

Section: Objectivesmentioning

confidence: 99%

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Corner

Khimji²,

Tsang³

et al. 2011

BJR

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Objectives:We assessed the impact of three-dimensional (3D) conformal planning vs conventional planning of preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) on small bowel and bladder sparing and in optimising coverage of tumour target volume. Methods: Conformal and conventional plans were created for 50 consecutive patients. The conformal plan delineated a gross tumour volume (GTV), a clinical target volume (CTV) 1 to cover potential subclinical disease spread, a CTV2 to outline the mesorectum and lymph node areas at risk, and a planning target volume (PTV) to cover set-up error and organ movement. The conventional plan was created using digitally reconstructed radiographs (DRRs). Patients were treated with a dose of 45 Gy in 25 fractions with concurrent chemotherapy over 5 weeks. Dose-volume histograms (DVHs) were created and compared for GTV, PTV, small bowel and bladder. The GTV was covered by the conventional plan in all patients. Results: Significant differences were shown for median PTV coverage with conformal planning compared with conventional planning: 99.2% vs 94.2% (range 95.9-100% vs 75.5-100%); p,0.05. The median volume of irradiated small bowel was significantly lower for CT plans at all DVH levels. Median bladder doses did not differ significantly. Conclusion: 3D conformal CT planning is superior to conventional planning in terms of coverage of the tumour volume. It significantly reduces the volume of small bowel irradiated with no decrease in the rate of R0 resection compared with published data, and at the present time should be considered as the standard of care for rectal cancer planning. Chemoradiotherapy (CRT) followed by total mesorectal excision is the standard for care when MRI staging demonstrates threatened surgical margins in locally advanced rectal cancer (LARC) [1,2]. Radiotherapy planning for rectal cancer uses conventional orthogonal simulation with standardised radiation fields based on patterns of loco-regional relapse in relation to pelvic bony anatomy [3]. Three-field conventional orthogonal planning is considered an acceptable technique for planning preoperative CRT and major trials evaluating long-course chemoradiation for rectal cancer have permitted the use of conventional planning within their protocols [4,5]. In recent years, the treatment of rectal cancer has improved through advances in the planning and delivery of radiotherapy as well as improved preoperative imaging with MRI, the development of surgical techniques using total mesorectal excision (TME) and more accurate histopathological reporting [6]. Radiotherapy planning must ensure all clinically and radiologically identifiable disease is encompassed while still minimising the dose to the surrounding organs at risk, particularly the small bowel and bladder. Potential areas of microscopic spread and the appropriate pelvic lymph nodes should also be treated.Preoperative MRI has improved the knowledge of pelvic anatomy and identification of pelvic lymph nodes at risk according to tumour l...

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Section: Objectivesmentioning

confidence: 99%

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Corner

Khimji²,

Tsang³

et al. 2011

BJR

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“…Probably, the true incidence of the surgical seeding is not well known, but it seems to be an uncommon event, with an overall incidence rate of 5% or less, that rarely results in identifiable metastases. [22][23][24][25][26][27] Concerning skull base tumour sites, Moore et al 23 reported an actuarial risk of incisional relapse of 3% at 1 year in a series of 70 patients treated for sinonasal malignancies with midface and anterior skull base surgery. The possible mechanism of surgical pathway recurrence may be a direct implantation of tumour cells at the time of the surgical procedure or also a haematogenous spread to this particular location in which the increased blood flow and concentration of unknown chemotactic factors may increase the likelihood of tumour cells implantation.…”

Section: Discussionmentioning

confidence: 99%

Tumour seeding in the surgical pathway after resection of skull base chordoma

Krengli

Poletti

Ferrara

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…Hepatic and peritoneal metastases have been reported to be the most frequent failure patterns in resected colorectal cancer patients [26][27][28]. Local peritoneal recurrence and hematological toxicity were lower when 5-FU was administered intraperitoneally [29].…”

Section: Discussionmentioning

confidence: 99%

Healing of experimental colonic anastomoses: Effects of combined preoperative high‐dose radiotherapy and intraperitoneal 5‐fluorouracil

El-Malt

Ceelen

Broecke

et al. 2001

Intl Journal of Cancer

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SUMMARY To study the effects of preoperative radiochemotherapy (RCT) on the healing of colonic anastomosis, the rectosigmoid colon in male Wistar rats was irradiated up to an end dose of 41.6 Gy (RT) or sham-irradiated (SR). During the last 5 days of the irradiation schedule, 5-fluorouracil (5-FU) was administered intraperitoneally in either a high dose (20 mg/kg, chemotherapy-high dose [CH]) or a low dose (10 mg/kg, chemotherapy-low dose [CL]). Animals were randomly arranged into six groups: group I, control (SR + saline intraperitoneally); group II, RT only; group III, SR + CL; group IV, RT + CL; group V, SR + CH; group VI, RT + CH. Four days after RCT, a side-to-side anastomosis was constructed between the irradiated rectosigmoid and the nonirradiated caecum. Animals were killed 10 days postoperatively. No significant differences were found in the anastomotic bursting pressure or the bursting wall tension. In group VI, mitoses were less (P < 0.01) and mucosal ulceration was more (P = 0.03) pronounced compared to group I. Sclerotic arteries were seen in all irradiated groups and in animals that received high-dose 5-FU alone. 5-FU administration in high or low dose, with or without RT, induced more inflammation in the submucosa compared to controls (P < 0.05). Conclusively, RCT has no detrimental effect on the mechanical strength of colonic anastomosis in this rat model. However, RCT with high-dose 5-FU induces more histological alterations at the anastomotic site.

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Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum:Clinicopathologic correlation and implications for adjuvant therapy

Cited by 710 publications

References 38 publications

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Tumour seeding in the surgical pathway after resection of skull base chordoma

Healing of experimental colonic anastomoses: Effects of combined preoperative high‐dose radiotherapy and intraperitoneal 5‐fluorouracil

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