Timing of Surgery After Long-Course Neoadjuvant Chemoradiotherapy for Rectal Cancer

Foster, Jake; Jones, Emma; Falk, Stephen; Cooper, E.; Francis, Nader

doi:10.1097/dcr.0b013e31828aedcb

Cited by 86 publications

(60 citation statements)

References 33 publications

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“…In these cases pre-operative MR may not only direct surgical dissection, but also alert the MDT to the need for further upfront systemic chemotherapy, contact radiotherapy or extended surgical resection. In this cohort of patients, the identification of an optimal time for surgery post-NACRT which coincides with maximal oncological down-staging is an urgent question [21,31]. This pilot study suggests that further volume reduction and down-staging occurs between Week 9 and Week 14 post-NACRT, with more favourable ymrT, ymrTRG and volume changes found at Week 14.…”

Section: Interobserver Agreementmentioning

confidence: 80%

“…In addition to these assessment criteria, the MERCURY study group has developed an MRI-based tumor regression grading (ymrTRG) system by applying the principles of histopathology ypTRG [17,18] and showed that MRI assessment of ypTRG following preoperative therapy predicted survival [17]. It has been suggested that there may 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 be benefits in prolonging the interval between end of NACRT and surgery beyond the common 6-8 weeks [19][20][21], but evidence is limited.…”

Section: Introductionmentioning

confidence: 99%

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Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

West

Dimitrov

Moyses

et al. 2016

European Journal of Surgical Oncology (EJSO)

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Purpose: There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT;T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery. Patients and Methods:We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.

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Section: Interobserver Agreementmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

West

Dimitrov

Moyses

et al. 2016

European Journal of Surgical Oncology (EJSO)

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“…Tumor shrinkage in response to radiotherapy is often not apparent radiologically until several weeks after treatment completion [5]. The radiation dose and degree of tumor response required to palliate different pelvic symptoms is unknown, but a recent systematic review of palliative pelvic radiotherapy (PPRT) of RC found symptomatic improvement across a wide range of treatment schedules [2].…”

mentioning

confidence: 99%

Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study

et al. 2016

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Background and purpose: Palliative pelvic radiotherapy (PPRT) is used to treat locally advanced rectal cancer (RC) although symptomatic effects and toxicities are poorly documented. Aims were to evaluate symptom severity, quality of life (QOL) and toxicity after PPRT. Material and methods: Fifty-one patients with symptomatic primary or recurrent RC prescribed PPRT with fractions of 3 Gy to 30-39 Gy were included. Primary outcome was severity of target symptoms (TS) 12 weeks after PPRT. Pelvic symptom burden, toxicity, and QOL were assessed. Response was defined as patient-reported TS improvement or resolution. Results: Pain (n ¼ 24), rectal dysfunction (n ¼ 16), and hematochezia (n ¼ 9) were the most common TSs. Overall response rate among evaluable patients 12 weeks after PPRT was 28/33 (85%). Eighteen patients did not complete the study follow-up, 16 due to deteriorating health. TS responses were 10/13 (77%) for pain, 9/10 (90%) for rectal dysfunction, and 8/8 for hematochezia. Non-target pelvic symptom severity decreased and median QOL scores remained stable. There was no grade 4 toxicity. Median survival was nine months. Conclusions: In the majority of patients with symptomatic primary or recurrent RC, PPRT with 30-39 Gy contributes to pelvic symptom relief, with little toxicity. Patients prescribed PPRT of RC have limited life expectancy. Future studies should investigate simplification of PPRT.

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“…They found limited evidence to support decisions regarding when to resect rectal cancer following chemo-radiotherapy. There may be benefits in prolonging the interval between chemoradiotherapy and surgery beyond the 6 to 8 weeks that is commonly practiced (10). However, there are also data which do not show any down-staging.…”

Section: Discussionmentioning

confidence: 86%

Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study

Eeghen

Boer

Bakker

et al. 2016

J. Gastrointest. Oncol.

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Background: Radiotherapy and surgery have shown to improve local control and survival in rectal cancer.There are two applied schedules; radiotherapy with a long or short waiting period before surgery. The effect on survival and recurrence of both schedules was studied.Methods: All consecutive patients with rectal cancer in the period 2002-2008 were included. Data were gathered on survival, tumour stage, co-morbidity score, and cause of death. The patients were divided in three groups: group 1 patients undergoing surgery without neo-adjuvant radiotherapy; group 2 patients undergoing radiotherapy followed by immediate surgery; and group 3 patients treated with (chemo) radiotherapy followed by a longer waiting period.Results: A total of 113 patients with rectal cancer underwent surgery. Twenty two patients in group 1, 71 patients in group 2, and 20 in group 3. There was no difference in gender, time to recurrence, co-morbidity score, or causes of death. Fifty percent of patients died due to non-cancer related causes. Mean age in patients of group 3 was significantly lower than in groups 1 and 2 (P=0.02). There was a trend towards a lower tumour stage in the patients of group 3. Overall five year survival was 32% in group 1, 48% in group 2, and 35% in group 3.Conclusions: Neo-adjuvant radiotherapy seems to be of benefit in daily practice in patients with rectal cancer. A longer waiting period results in down-staging. Clinicians have to be aware that many patients will die due to other causes than those related to the rectal cancer.

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Timing of Surgery After Long-Course Neoadjuvant Chemoradiotherapy for Rectal Cancer

Cited by 86 publications

References 33 publications

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study

Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study

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