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, Malcolm; Dimitrov, Borislav D.; Moyses, Helen; Kemp, Graham J.; Loughney, Lisa; White, David C.; Grocott, Michael P.W.; Jack, Sandy; Brown, Gina

doi:10.1016/j.ejso.2016.04.003

Cited by 21 publications

(22 citation statements)

References 31 publications

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“…Posttreatment fibrosis may also affect the MRI evaluation of the response [21]. There is some evidence that the relationship between posttreatment MRI regression and histopathological assessment may be greater when surgery is carried out after 14 rather than 9 weeks [27]. The present series included only patients undergoing MVR, and not all patients with a T4 cancer, most of whom had a standard anterior resection or extralevator abdominoperineal excision and were not included in the study.…”

Section: Discussionmentioning

confidence: 99%

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Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence

et al. 2017

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Section: Discussionmentioning

confidence: 99%

“…Posttreatment fibrosis may also affect the MRI evaluation of the response . There is some evidence that the relationship between posttreatment MRI regression and histopathological assessment may be greater when surgery is carried out after 14 rather than 9 weeks .…”

Section: Discussionmentioning

confidence: 99%

Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence

et al. 2017

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“…Central reviewer (Royal Marsden; GB) data were used for the primary analysis based on validated methodology also used by Patel et al [21,24]. Data were described as frequency (percentage) and mean (SD), with 95% confidence intervals (95%CIs), as appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…MR image analysis was carried out, using the terms ymrT (T stage on MRI images obtained after NACRT), ymrTRG (tumor regression grade on MRI images obtained after NACRT), ypT (T stage on post-treatment histopathological examination of the resection specimen) and ypTRG (tumor regression grade on post-treatment histopathological examination of the resection specimen) to describe the data [21,23]. The MRI protocol and image analyses are reported elsewhere [24].…”

Section: Mri Technique and Image Analysesmentioning

confidence: 99%

Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

et al. 2019

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Purpose:We evaluate the effect of an exercised prehabilitation programme on tumour response in rectal cancer patients following neoadjuvant chemoradiotherapy (NACRT). Patients and Methods: Rectal cancer patients with (MRI-defined) threatened resection margins who completed standardized NACRT were prospectively studied in a post hoc, explorative analysis of two previously reported clinical trials. MRI was performed at Weeks 9 and 14 post-NACRT, with surgery at Week 15. Patients undertook a 6-week preoperative exercise-training programme. Oxygen uptake (VO2) at anaerobic threshold (AT) wasmeasured at baseline (pre-NACRT), after completion of NACRT and at week 6 (post-NACRT). Tumour related outcome variables: MRI tumour regression grading (ymrTRG) at Week 9 and 14; histopathological T-stage (ypT); and tumour regression grading (ypTRG)) were compared. Results: 35 patients (26 males) were recruited. 26 patients undertook tailored exercise-training with 9 unmatched controls. NACRT resulted in a fall in VO2 at AT À2.0 ml/kg À1 /min À1 (À1.3,À2.6), p < 0.001. Exercise was shown to reverse this effect. VO2 at AT increased between groups, (post-NACRT vs. week 6) by þ1.9 ml/kg À1 /min À1 (0.6, 3.2), p ¼ 0.007. A significantly greater ypTRG in the exercise group at the time of surgery was found (p ¼ 0.02).

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“…This is not surprising because the elderly population is at higher risk of cancer. 33 It is well established that declines in physical function are an inevitable part of the aging process and are markers of disability risk. 6 Once the elderly become disabled, their physical health declines along with their mental health, their quality of life deteriorates rapidly and they require long-term care.…”

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confidence: 99%

Disability and Quality of Life after Surgery for Cancer

Benítez¹,

García²,

Noyola³

et al. 2017

HPMIJ

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Abbreviations: HRQoL, health related quality of life; ADL, activities of daily living; QoL, quality of life; IOR, institute of oncology and radiobiology; ACCI, adjusted charlson comorbidity index; ASA, american society of anaesthesiology; APCHE, acute physiology and chronic health evaluation; VAS, visual analogue scale; IQR, interquartile range; PS, performance status IntroductionCancer is one of first cause of death around the world and Cuba.1 Surgery is one of most important therapeutic tool for its control, either for curative or palliative purpose. Although surgical intervention can be a life-saviour strategy for these patients, several complications could be present in postoperative period, 2 as well as limitations for activities of daily living (ADL) and derangement in quality of life (QoL).3 Postoperative recovery is a dynamic process where biological, physiological, functional and psychological components play a pivotal role. A rise in physical independence and gradual return to ADL are global indicator of functional recovery after surgery. For most patients, the evaluation of ADL is only performed during their hospital stay. Traditionally, patients should probe their capacity to walking, eating, bathing and dressing without help. 4Elderly patients are a special increasing subgroup.5 Because of the ageing-related characteristics, this population has a decreased functional capacity even before hospital admission.6 According to literature reports, more than 10% of elderly patients develop a severe postoperative disability.7 Postoperative evaluations of functional capacity and health-related QoL (HRQoL) have been become as an important component of long-term surgical outcomes, particularly in the elderly population. 8-11The problem is more serious in the case of cancer patients because a higher prevalence of malignancies among the elderly subgroup. 12,13Frequently, surgical indication for elderly patients with comorbidities is based on subjective judgement according to the personal experience of surgeon. In addition, a negative attitude regarding elderly patients can be see among some physicians, which lead to patients with acceptable functional status could be not surgically treated as usually is indicated for younger patients. Furthermore, radical surgical interventions are neither performed in elderly population. This is significant because currently the primary tumour and regional lymphatic node can only be removed by radical intervention with surgical margin, which guarantees a higher probability of cure. 14,15This study was aimed to assess the prevalence of disability and healthrelated quality of life, as well as related risk factors among patients operated for gastrointestinal or thoracic cancer. Methods Design and settingThis retrospective study was conducted in the oncological ICU (OICU) of the Institute of Oncology and Radiobiology (IOR). This is a 220-bed, university-affiliated, tertiary care referral centre for cancer patients in Havana, Cuba. The OICU has 12 beds and provides care for about 400...

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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

Cited by 21 publications

References 31 publications

Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence

Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence

Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Disability and Quality of Life after Surgery for Cancer

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