Corrections to “Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”

Glynne-Jones, R.; Wyrwicz, Lucjan; Tiret, Emmanuel; Brown, Gina; Rödel, Claus; Cervantes, Andrés; Arnold, D.

doi:10.1093/annonc/mdy161

Cited by 322 publications

(178 citation statements)

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“…Current guidelines for the management of T4 rectal cancers advocate neoadjuvant chemoradiotherapy followed by TME surgery and then adjuvant chemotherapy; this approach confers good local control. The 5‐year cumulative incidence of first failure for distant disease in this series was 18 per cent, compared with 8 per cent for local recurrence, consistent with other studies showing distant recurrence being substantially more common than local recurrence.…”

Section: Discussionsupporting

confidence: 84%

Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

Peacock

Waters

Bressel

et al. 2019

British Journal of Surgery

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Background: Despite advances in the rates of total mesorectal excision (TME) for rectal cancer surgery, decreased local recurrence rates and increased 5-year survival, there still exists large variation in the quality of treatment received. Up to 30 per cent of rectal cancers are locally advanced at presentation and approximately 5-10 per cent still breach the mesorectal plane and invade adjacent structures despite neoadjuvant therapy. With the evolution of extended resections for rectal cancers beyond the TME plane, proponents advocate that these resections should be performed only in specialist centres. The aim was to assess the prognostic factors and patterns of failure after beyond TME surgery for T4 rectal cancers.Methods: Data were collected from prospective databases at three high-volume institutions specializing in beyond TME surgery for T4 rectal cancers between 1990 and 2013. The primary outcome measures were overall survival, local recurrence and patterns of first failure. Results: Three hundred and sixty patients were identified. The negative resection margin (R0) rate was 82⋅8 per cent (298 patients) and the local recurrence rate was 12⋅5 per cent (45 patients). The type of surgical procedure (Hartmann's: hazard ratio (HR) 4⋅49, 95 per cent c.i. 1⋅99 to 10⋅14; P = 0⋅002) and lymphovascular invasion (HR 2⋅02, 1⋅08 to 3⋅77; P = 0⋅032) were independent predictors of local recurrence. The 5-year overall survival rate for all patients was 61 (95 per cent c.i. 55 to 67) per cent. The 5-year cumulative incidence of first failure was 8 per cent for local recurrence, 6 per cent for local and distant disease, and 18 per cent for distant disease.Conclusion: This study has demonstrated that a coordinated approach in specialist centres for beyond TME surgery can offer good oncological and long-term survival in patients with T4 rectal cancers.

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Section: Discussionsupporting

confidence: 84%

Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

Peacock

Waters

Bressel

et al. 2019

British Journal of Surgery

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“…In contrast, the management of nonmetastatic rectal cancer still lacks biomarkers that could refine prognostication and treatment response prediction as currently provided by conventional clinical, pathological and imaging factors . While important advances have been made in the definition of risk categories and implementation of risk‐stratified treatment approaches, much still needs to be done to capture the underlying interindividual tumour heterogeneity and to identify molecular determinants of treatment responsiveness or resistance.…”

Section: Introductionmentioning

confidence: 99%

Analysis of KRAS, NRAS, BRAF, PIK3CA and TP53 mutations in a large prospective series of locally advanced rectal cancer patients

Sclafani

Wilson

Cunningham

et al. 2019

Intl Journal of Cancer

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Little information is available on the clinical significance of cancer‐related genes such as KRAS, NRAS, BRAF, PIK3CA and TP53 in nonmetastatic rectal cancer. We investigated mutations of these genes in a large prospective series of locally advanced rectal cancer (LARC) patients who were recruited into two phase II trials. Mutational analyses were performed with diagnostically validated methods including polymerase chain reaction, capillary electrophoresis single‐strand conformational analysis, Sanger sequencing and next‐generation sequencing. Associations between single or multiple gene mutations and clinicopathological characteristics and treatment outcomes were explored. Of these 269, 210 (78%) patients were assessable. Mutations of KRAS, NRAS, BRAF, PIK3CA and TP53 occurred in 43, 9, 4, 9 and 60% of patients, respectively. Concordance between paired biopsy and resection specimens was 82% for KRAS, 95% for NRAS, 99% for BRAF, 96% for PIK3CA and 63% for TP53. TP53 mutations were associated with extramural venous invasion on baseline MRI (78% vs. 65%, p = 0.04), poor pathological tumour regression (23% vs. 36%, p = 0.05) and a trend toward a worse 5‐year progression‐free survival (PFS; 60% vs. 74%, HR 1.59, p = 0.06). Patients with tumours harbouring mutation of TP53 and either KRAS or NRAS (32%) had a worse 5‐year PFS than those with TP53/KRAS/NRAS wild‐type tumours (54% vs. 72%, HR 1.75, p = 0.02). In univariate analysis, BRAF mutation predicted poor 5‐year overall survival only among patients treated without cetuximab (20% vs. 73%, HR 3.29, p = 0.03). This is one of the largest biomarker studies in a prospective, largely homogeneous, LARC population. Our findings are hypothesis generating and require validation in independent series.

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“…Recent guidelines (2017) from the UK Association of Coloproctology of Great Britain and Ireland (ACPGBI)3 and Australian Cancer Council6 include watch-and-wait as an option, with the caveat that patients must be informed that it remains a new management under evaluation. The European Society of Medical Oncology (ESMO)4 2018 guidelines state that watch-and-wait can be considered in “high risk” patients (without defining criteria) with clinical complete response after long-course chemoradiotherapy. Older guidelines, such as those from the US (2013),5 recommend that resection is standard care, whereas the UK National Institute for Health and Care Excellence (NICE, 2012)2 does not mention clinical complete response.…”

Section: What Should We Do In the Light Of The Uncertainty?mentioning

confidence: 99%

“…Approximately a third of rectal cancers are locally advanced and at high risk of recurrence. Long-course chemoradiotherapy followed by surgical resection is now standard treatment for these tumours in the UK,23 Europe,4 the US,5 and Australia 6. However, surgery is associated with major complications (up to 15%), perioperative mortality (up to 5%), and the need for a permanent stoma in up to a quarter of patients 7…”

mentioning

confidence: 99%

Is “watch-and-wait” after chemoradiotherapy safe in patients with rectal cancer?

Smith

Cresswell

Myint

et al. 2018

BMJ

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Corrections to “Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”

Cited by 322 publications

References 0 publications

Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

Analysis of KRAS, NRAS, BRAF, PIK3CA and TP53 mutations in a large prospective series of locally advanced rectal cancer patients

Is “watch-and-wait” after chemoradiotherapy safe in patients with rectal cancer?

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