Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.007
Filtrar
1.
Int J Mol Sci ; 23(11)2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35682714

RESUMO

According to current guidelines, the current treatment for locally advanced rectal cancer is neoadjuvant therapy, followed by a total mesorectal excision. However, radiosensitivity tends to differ among patients due to tumor heterogeneity, making it difficult to predict the possible outcomes of the neoadjuvant therapy. This review aims to investigate different types of tissue-based biomarkers and their capability of predicting tumor response to neoadjuvant therapy in patients with locally advanced rectal cancer. We identified 169 abstracts in NCBI PubMed, selected 48 reports considered to meet inclusion criteria and performed this systematic review. Multiple classes of molecular biomarkers, such as proteins, DNA, micro-RNA or tumor immune microenvironment, were studied as potential predictors for rectal cancer response; nonetheless, no literature to date has provided enough sufficient evidence for any of them to be introduced into clinical practice.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia , Humanos , Estadiamento de Neoplasias , Neoplasias Retais/metabolismo , Neoplasias Retais/radioterapia , Reto/patologia , Resultado do Tratamento , Microambiente Tumoral
2.
Rev Esc Enferm USP ; 56: e20210378, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35723900

RESUMO

OBJECTIVE: to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption. METHOD: a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics. RESULTS: 99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis. CONCLUSION: there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.


Assuntos
Radiodermatite , Neoplasias Retais , Idoso , Canal Anal/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Radiodermatite/complicações , Radiodermatite/etiologia , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Estudos Retrospectivos
3.
Sci Rep ; 12(1): 7290, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508498

RESUMO

Although preoperative chemoradiation therapy can down-stage locally advanced rectal cancer (LARC), it has little effect on distant metastases. Metformin exerts an anti-cancer effect partly through the activation of host immunity. LuM1, a highly lung metastatic subclone of colon 26, was injected subcutaneously (sc) in BALB/c mice and treated with metformin and/or local radiation (RT). Lung metastases and the primary tumors were evaluated and the phenotypes of immune cells in the spleen and lung metastases were examined with flow cytometry and immunohistochemistry. Local RT, but not metformin, partially delayed the growth of sc tumor which was augmented with metformin. Lung metastases were unchanged in metformin or RT alone, but significantly reduced in the combined therapy. The ratios of splenic T cells tended to be low in the RT group, which were increased by the addition of metformin. IFN-γ production of the splenic CD4(+) and CD8(+) T cells was enhanced and CD49b (+) CD335(+) activated NK cells was increased after combined treatment group. Density of NK cells infiltrating in lung metastases was increased after combination treatment. Metformin effectively enhances local and abscopal effects of RT though the activation of cell-mediated immunity and might be clinically useful for LARC.


Assuntos
Neoplasias Pulmonares , Metformina , Neoplasias Retais , Animais , Linfócitos T CD8-Positivos , Neoplasias Pulmonares/patologia , Metformina/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia
4.
Phys Med ; 99: 55-60, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35617817

RESUMO

PURPOSE: Radiotherapy is essential in the treatment of locally advanced rectal cancer. Side effects of radiotherapy in the treatment of rectal cancer have a great effect on quality of life. The aim of this retrospective study is to evaluate the correlation between dosimetric parameters and acute toxicity in rectal cancer patients. METHODS: We analyzed the Dose Volume Histogram parameters for both the target structures and the Organs at risk of 89 patients. A dedicated statistical analysis was performed for all the acute toxicities showing a frequency rate higher than 20%. A linear logistic regression model was elaborated using the variable showing the highest level of significance at the univariate analysis. RESULTS: The occurrence of proctitis was significantly correlated with three dosimetric parameters: D98% of low ano-rectum, D98% and Dmean of low ano-rectum wall. A predictive linear logistic regression model reports that the D98% of the wall of the low ano-rectum must be < 38.5 Gy to decrease the rate of proctitis. A general analysis on grade 2 acute toxicity occurrence reported that it was correlated with D98% of low ano rectum. CONCLUSIONS: Two dose constraints were elaborated: D98%<33.5 Gy for low ano rectum to prevent grade 2 acute toxicity and D98%<25 Gy for low ano-rectum wall to prevent proctitis (grade 1 or superior).


Assuntos
Proctite , Lesões por Radiação , Neoplasias Retais , Humanos , Proctite/etiologia , Qualidade de Vida , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Neoplasias Retais/radioterapia , Reto , Estudos Retrospectivos
5.
J Invest Surg ; 35(7): 1526-1535, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35618267

RESUMO

Background A predictive tool is required to identify the cancer-specific survival in rectal cancer (RC) patients who have opted to receive preoperative radiotherapy.Methods A database containing the data on RC patients' records of Surveillance, Epidemiology, and End Results (SEER) receiving surgery during 2000-2014 was selected. All patients received neoadjuvant radiotherapy (NR). The correlation of clinicopathological parameters was analyzed using the Chi-square test and the survival risk factors were analyzed using the Cox proportional hazards analysis (univariate and multivariate). Finally, the nomogram was developed and validated to visually represent an accurate prediction of the probability of 3- and 5-year cancer-specific survival (CSS) based on the screened variables of the cohort.Results 11,499 rectal cancer patients were included in our cohort. Patients' records were randomly allocated to either the development or validation cohorts based on an equal ratio (1:1). Performing the multivariate Cox regression analysis incorporating these variables in the development cohort determined 11 independent prognostic factors. Statistically significant differences were recorded among subgroups using log-rank tests, which confirmed the appropriateness and acceptability of factor stratifications. Then, the nomogram was constructed and its concordance index (C-index) values in the development cohort (0.720) and validation cohort (0.717) were evaluated to be higher (P<0.05) than those of the AJCC stage (0.631 and 0.633 respectively). Also, the 3-year AUC values of this nomogram were higher than those of the AJCC stage in both the development cohort (0.746 vs. 0.631) and the validation cohort (0.745 vs. 0.640). Using DCA curves, the predictive potential of the currently developed nomogram outperformed the conventional AJCC staging system.Conclusion The nomogram model might be a more reliable tool to predict prognosis accurately in rectal cancer patients receiving preoperative radiotherapy.


Assuntos
Nomogramas , Neoplasias Retais , Humanos , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Programa de SEER
6.
Lancet Oncol ; 23(6): 793-801, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35512720

RESUMO

BACKGROUND: Selection of patients for preoperative treatment in rectal cancer is controversial. The new 2020 National Institute for Health and Care Excellence (NICE) guidelines, consistent with the National Comprehensive Cancer Network guidelines, recommend preoperative radiotherapy for all patients except for those with radiologically staged T1-T2, N0 tumours. We aimed to assess outcomes in non-irradiated patients with rectal cancer and to stratify results on the basis of NICE criteria, compared with known MRI prognostic factors now omitted by NICE. METHODS: For this retrospective cohort study, we identified patients undergoing primary resectional surgery for rectal cancer, without preoperative radiotherapy, at Basingstoke Hospital (Basingstoke, UK) between Jan 1, 2011, and Dec 31, 2016, and at St Marks Hospital (London, UK) between Jan 1, 2007, and Dec 31, 2017. Patients with MRI-detected extramural venous invasion, MRI-detected tumour deposits, and MRI-detected circumferential resection margin involvement were categorised as MRI high-risk for recurrence (local or distant), and their outcomes (disease-free survival, overall survival, and recurrence) were compared with patients defined as high-risk according to NICE criteria (MRI-detected T3+ or MRI-detected N+ status). Kaplan-Meier and Cox proportional hazards analyses were used to compare the groups. FINDINGS: 378 patients were evaluated, with a median of 66 months (IQR 44-95) of follow up. 22 (6%) of 378 patients had local recurrence and 68 (18%) of 378 patients had distant recurrence. 248 (66%) of 378 were classified as high-risk according to NICE criteria, compared with 121 (32%) of 378 according to MRI criteria. On Kaplan-Meier analysis, NICE high-risk patients had poorer 5-year disease-free survival compared with NICE low-risk patients (76% [95% CI 70-81] vs 87% [80-92]; hazard ratio [HR] 1·91 [95% CI 1·20-3·03]; p=0·0051) but not 5-year overall survival (80% [74-84] vs 88% [81-92]; 1·55 [0·94-2·53]; p=0·077). MRI criteria separated patients into high-risk versus low-risk groups that predicted 5-year disease-free survival (66% [95% CI 57-74] vs 88% [83-91]; HR 3·01 [95% CI 2·02-4·47]; p<0·0001) and 5-year overall survival (71% [62-78] vs 89% [84-92]; 2·59 [1·62-3·88]; p<0·0001). On multivariable analysis, NICE risk assessment was not associated with either disease-free survival or overall survival, whereas MRI criteria predicted disease-free survival (HR 2·74 [95% CI 1·80-4·17]; p<0·0001) and overall survival (HR 2·44 [95% CI 1·51-3·95]; p=0·00027). 139 NICE high-risk patients who were defined as low-risk based on MRI criteria had similar disease-free survival as 118 NICE low-risk patients; therefore, 37% (139 of 378) of patients in this study cohort would have been overtreated with NICE 2020 guidelines. Of the 130 patients defined as low-risk by NICE guidelines, 12 were defined as high-risk on MRI risk stratification and would have potentially been missed for treatment. INTERPRETATION: Compared to previous guidelines, implementation of the 2020 NICE guidelines will result in significantly more patients receiving preoperative radiotherapy. High-quality MRI selects patients with good outcomes (particularly low local recurrence) without radiotherapy, with little margin for improvement. Overuse of radiotherapy could occur with this unselective approach. The high-risk group, with the most chance of benefiting from preoperative radiotherapy, is not well selected on the basis of NICE 2020 criteria and is better identified with proven MRI prognostic factors (extramural venous invasion, tumour deposits, and circumferential resection margin). FUNDING: None.


Assuntos
Margens de Excisão , Neoplasias Retais , Estudos de Coortes , Extensão Extranodal , Humanos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Estudos Retrospectivos
7.
BMC Med Genomics ; 15(Suppl 2): 107, 2022 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534879

RESUMO

BACKGROUND: Tumor microenvironment plays pivotal roles in carcinogenesis, cancer development and metastasis. Composition of cancer immune cell subsets can be inferred by deconvolution of gene expression profile accurately. Compositions of the cell types in cancer microenvironment including cancer infiltrating immune and stromal cells have been reported to be associated with the cancer outcomes markers for cancer prognosis. However, rare studies have been reported on their association with the response to preoperative radiotherapy for rectal cancer. METHODS: In this paper, we deconvoluted the immune/stromal cell composition from the gene expression profiles. We compared the composition of immune/stromal cell types in the RT responsive versus nonresponsive for rectal cancer. We also compared the peripheral blood immune cell subset composition in the stable diseases versus progressive diseases of rectal cancer patients with fluorescence-activated cell sorting from our institution. RESULTS: Compared with the non-responsive group, the responsive group showed higher proportions of CD4+ T cell (0.1378 ± 0.0368 vs. 0.1071 ± 0.0373, p = 0.0215), adipocytes, T cells CD4 memory resting, and lower proportions of CD8+ T cell (0.1798 ± 0.0217 vs. 0.2104 ± 0.0415, p = 0.0239), macrophages M2, and preadipocytes in their cancer tissue. The responsive patients showed a higher ratio of CD4+/CD8+ T cell proportions (mean 0.7869 vs. 0.5564, p = 0.0210). Consistently, the peripheral blood dataset showed higher proportion of CD4+ T cells and higher ratio of CD4+/CD8+ T cells, and lower proportion of CD8+ T cells for favorable prognosis. We validated these results with a pooled dataset of GSE3493 and GSE35452, and more peripheral blood data, respectively. Finally, we imported these eight cell features including eosinophils and macrophage M1 to Support Vector Machines and could predict the pre-radiotherapy responsive versus non-responsive with an accuracy of 76%, ROC AUC 0.77, 95% confidential interval of 0.632-0.857, better than the gene signatures. CONCLUSIONS: Our results showed that the proportions of tumor-infiltrating subsets and peripheral blood immune cell subsets can be important immune cell markers and treatment targets for outcomes of radiotherapy for rectal cancer.


Assuntos
Linfócitos T CD8-Positivos , Neoplasias Retais , Humanos , Prognóstico , Neoplasias Retais/radioterapia , Microambiente Tumoral
8.
BMJ Open ; 12(5): e061397, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501084

RESUMO

INTRODUCTION: Colorectal cancer remains the second leading cause of cancer-related death in 60-79 years old and the third leading cause of death in patients aged 80 and above. Rectal cancer accounts for approximately a third of colorectal cancer diagnoses. The current standard of care for managing locally advanced rectal cancer involves a multimodal combined approach with neoadjuvant treatment, surgery with total mesorectal excision and adjuvant chemotherapy. Neoadjuvant treatment can be in the form of short-course radiotherapy, long-course concurrent radiotherapy with chemotherapy or total neoadjuvant chemotherapy with concurrent chemoradiotherapy followed by chemotherapy. This scoping aims to assess the toxicity and outcome of the different neoadjuvant treatment modalities in elderly patients. METHODS AND ANALYSIS: We will use Arksey and O'Malley's five scoping review methodology framework stages. Searches will be conducted in Ovid Medline, Embase, Cochrane database and CINAHL. In addition, the researcher will hand search for all registered trials, using a combination of terms such as "locally advanced rectal cancer", "neoadjuvant treatment", and "elderly patients." Two independent reviewers will screen titles and abstracts and then full text based on predefined inclusion and exclusion criteria. Publications will be extracted using a customised data extraction tool to include study characteristics, research topics, exposures and outcomes. ETHICS AND DISSEMINATION: Ethics approval is not required as the data will be collected from the existing literature. The findings of this study will help with future clinical research on the topic. We will publish the findings of this review in a peer-reviewed journal and present them at academic conferences targeting geriatric oncology service providers.


Assuntos
Segunda Neoplasia Primária , Neoplasias Retais , Idoso , Quimiorradioterapia , Quimioterapia Adjuvante , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Pacientes , Neoplasias Retais/radioterapia , Literatura de Revisão como Assunto
9.
Niger J Clin Pract ; 25(4): 448-453, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35439903

RESUMO

Background and Aims: Preoperative long-course radio-chemotherapy (LC-RCHT) or preoperative short-course radiotherapy (SC-RT) are widely used in the treatment of locally advanced rectal cancer (LARC). This study aimed to evaluate the 100 most-cited research articles focused on preoperative radiotherapy for rectal cancer to reveal existing academic trends and the direction of therapeutic research. Materials and Methods: This was a retrospective study based on publicly accessible data. The Web of Science database was used to identify the 100 most-cited articles. Results: The median values for total citation and average citation per year (CPY) were 240.50 (range, 150-3787) and 17.32 (5.03-222.76), respectively. Randomized (median: 24.88 vs 13.32, P = 0.001) and funded (median: 27.33 vs 14.73, P = 0.002) studies had more CPY than those with opposite characteristics. No significant difference was found between studies using SC-RT and LC-RCHT, in terms of average CPY (median: 15.27 for SC-RT vs 18.36 for LC-RCHT, P = 0.303). In terms of the primary aim of the investigation, studies investigating non-operative treatment strategies had higher CPY than those investigating other subcategories (p = 0.029). Conclusion: Randomized studies, funded studies, and studies investigating non-operative treatment were associated with more CPY. There remains equal interest in preoperative SC-RT and LC-RCHT for rectal cancer.


Assuntos
Neoplasias Retais , Bibliometria , Humanos , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
Soins Gerontol ; 27(154): 23-27, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35393032

RESUMO

Rectal cancer is a common disease of the elderly. Current treatment recommendations are established for young subjects in good general health condition, without taking into account the frailty, comorbidities and polymedications inherent in patients over 75 years old. For locally advanced lower and middle rectal cancers (T3, T4 or N+), these are based on variations of regimens including neoadjuvant chemoradiotherapy, surgery of the rectum with total removal of the mesorectum, and a possibility of adjuvant chemotherapy. This restrictive treatment presents a problem of compliance and is not without adverse effects. Treatment by short exclusive radiotherapy or chemoradiotherapy with close monitoring according to the Watch and Wait strategy can be proposed to fragile patients not eligible for surgery, even if there is a non-negligible risk of recurrence.


Assuntos
Neoplasias Retais , Idoso , Quimiorradioterapia , Humanos , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/radioterapia , Reto/cirurgia , Resultado do Tratamento
11.
BMJ Open ; 12(4): e049119, 2022 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-35487526

RESUMO

INTRODUCTION: The standard of care for patients with localised rectal cancer is radical surgery, often combined with preoperative neoadjuvant (chemo)radiotherapy. While oncologically effective, this treatment strategy is associated with operative mortality risks, significant morbidity and stoma formation. An alternative approach is chemoradiotherapy to try to achieve a sustained clinical complete response (cCR). This non-surgical management can be attractive, particularly for patients at high risk of surgical complications. Modern radiotherapy techniques allow increased treatment conformality, enabling increased radiation dose to the tumour while reducing dose to normal tissue. The objective of this trial is to assess if radiotherapy dose escalation increases the cCR rate, with acceptable toxicity, for treatment of patients with early rectal cancer unsuitable for radical surgery. METHODS AND ANALYSIS: APHRODITE (A Phase II trial of Higher RadiOtherapy Dose In The Eradication of early rectal cancer) is a multicentre, open-label randomised controlled phase II trial aiming to recruit 104 participants from 10 to 12 UK sites. Participants will be allocated with a 2:1 ratio of intervention:control. The intervention is escalated dose radiotherapy (62 Gy to primary tumour, 50.4 Gy to surrounding mesorectum in 28 fractions) using simultaneous integrated boost. The control arm will receive 50.4 Gy to the primary tumour and surrounding mesorectum. Both arms will use intensity-modulated radiotherapy and daily image guidance, combined with concurrent chemotherapy (capecitabine, 5-fluorouracil/leucovorin or omitted). The primary endpoint is the proportion of participants with cCR at 6 months after start of treatment. Secondary outcomes include early and late toxicities, time to stoma formation, overall survival and patient-reported outcomes (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires QLQ-C30 and QLQ-CR29, low anterior resection syndrome (LARS) questionnaire). ETHICS AND DISSEMINATION: The trial obtained ethical approval from North West Greater Manchester East Research Ethics Committee (reference number 19/NW/0565) and is funded by Yorkshire Cancer Research. The final trial results will be published in peer-reviewed journals and adhere to International Committee of Medical Journal Editors guidelines. TRIAL REGISTRATION NUMBER: ISRCTN16158514.


Assuntos
Neoplasias Retais , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Ensaios Clínicos Fase II como Assunto , Humanos , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/radioterapia , Síndrome
12.
Technol Cancer Res Treat ; 21: 15330338221086085, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35296187

RESUMO

Background: A retrospective evaluation of tolerance and efficacy of two schemes of neoadjuvant treatment in patients (pts) with unresectable rectal cancer: radiochemotherapy (CRT) and radiotherapy (RT), including conventional and accelerated hyperfractionation. Material and Method: A total of 145 consecutive pts with unresectable, locally advanced rectal cancer. The schemes used are RT in 73 (50%) or CRT in 72 (50%). In CRT, 54 Gy in 1.8 Gy fractions was given with chemotherapy, In the RT group, conventional fractionation (CFRT) and hyperfractionated accelerated radiotherapy (HART). HART was introduced at first as an alternative to CFRT, after radiobiological studies suggesting a therapeutic gain of hyperfractionation in other cancers, and second to administer relatively high dose needed in unresectable cancer, which is not feasible in hypofractionation because of critical organs sensitivity to high fraction doses (fd). HART was an alternative option in pts with medical contraindications to chemotherapy and to shorten overall treatment time with greater radiobiological effectiveness than CFRT. Results: Objective response (OR) in the RT and CRT group was 60% versus 75%. Resection rate (RR) in RT and CRT: 37% versus 65%. Tumor mobility and laparotomy-based unresectability were significant factors for OR. Performance status (PS), tumor mobility, and neoadjuvant treatment method were significant for RR.


Assuntos
Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/efeitos adversos , Fracionamento da Dose de Radiação , Humanos , Terapia Neoadjuvante/efeitos adversos , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Estudos Retrospectivos
13.
Sci Rep ; 12(1): 4617, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35301380

RESUMO

This study was to verify the long-term survival efficacy of preoperative radiotherapy (preRT) for locally advanced rectal cancer (LARC) patients and identify potential long-term survival beneficiary. Using the Surveillance, Epidemiology, and End Results (SEER) database, 7582 LARC patients were eligible for this study between 2011 and 2015 including 6066 received preRT and 1516 received surgery alone. Initial results showed that preRT prolonged the median overall survival (OS) of LARC patients (HR 0.86, 95% CI 0.75-0.98, P < 0.05), and subgroup analysis revealed that patients with age > 65 years, stage III, T3, T4, N2, tumor size > 5 cm, tumor deposits, and lymph nodes dissection (LND) ≥ 12 would benefit more from preRT (all P < 0.05). A prognostic predicting nomogram was constructed using the independent risk factors of OS identified by multivariate Cox analysis (all P < 0.05), which exhibited better prediction of OS than the 8th American Joint Cancer Committee staging system on colorectal cancer. According to the current nomogram, patients in the high-risk subgroup had a shorter median OS than low-risk subgroup (HR 2.62, 95% CI 2.25-3.04, P < 0.001), and preRT could benefit more high-risk patients rather than low-risk patients. Hence, we concluded that preRT might bring long-term survival benefits to LARC patients, especially those with high risk.


Assuntos
Neoplasias Retais , Idoso , Humanos , Excisão de Linfonodo , Estadiamento de Neoplasias , Nomogramas , Prognóstico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Estados Unidos
14.
J Wound Ostomy Continence Nurs ; 49(2): 180-183, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35255072

RESUMO

BACKGROUND: As new treatment options for colorectal cancer (CRC) emerge, physicians and WOC nurses must be prepared to assist patients to choose care that meets their needs and preferences. A patient with T2N0M0 rectal adenocarcinoma was offered the US current standard of practice; he was not offered alternative treatment options. This case study emphasizes the need to ensure patients are offered all reasonable options for treatment. Shared decision-making is a process that helps patients actively participate in their heath choices rather than exclusively relying on the judgment of a health care provider. CASE: Mr J was a 70-year-old man with operable CRC who sought care at a health care facility in his community. He was offered a single option, based on standard of care for this tumor stage: long-course neoadjuvant chemoradiotherapy followed by surgery and additional chemotherapy. After seeking a second opinion at a cancer care center in another state, Mr J chose to undergo a viable alternative treatment option (short-course radiotherapy, followed by surgery, with chemotherapy contingent on his nodal status post-surgery). No nodal involvement was found post- surgery (T2N0M0) enabling him to avoid postoperative chemotherapy. CONCLUSIONS: This case illustrates the need for all health care providers and carers to regularly engage in shared decision-making when choosing among treatment options. In this case, short-course radiotherapy offered Mr J a shorter duration of treatment and avoided the risk for adverse side effects associated with chemotherapy, resulting in improved health-related quality of life. Initial omission to disclose all treatment options to Mr J may have reflected the preferences of the surgeon, institutional financial pressures, or discomfort with shared decision-making, but it failed to provide him with full range of options, given his diagnosis and tumor stage. All members of the patient's care team, including the WOC nurse, play a pivotal role in ensuring transparency in medical care, including advocating for shared decision-making where patients are made aware of all viable treatments, followed by supporting the patient as they reach a decision.


Assuntos
Adenocarcinoma , Neoplasias Retais , Adenocarcinoma/radioterapia , Idoso , Tomada de Decisões , Tomada de Decisão Compartilhada , Humanos , Masculino , Direitos do Paciente , Qualidade de Vida , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia
15.
Technol Cancer Res Treat ; 21: 15330338221074501, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35235486

RESUMO

Objective: To evaluate if the Halcyon(2.0) Intensity Modulation Radiotherapy (IMRT) technique has an advantage in the long-course rectal cancer radiotherapy. Methods: A total of 20 clinical IMRT plans of Halcyon(2.0) for long-course (2Gy in 25 fractions) rectal cancer radiotherapy were randomly selected. Based on the parameters of these plans, 20 TrueBeam (with the Millennium 120 MLC) plans were redesigned, respectively. The dosimetry indexes, field complexity parameters, the Gamma Passing Rates (GPR), and the delivery time of the 2 groups of plans were obtained as measures of the plan quality, the modulation complexity, the delivery accuracy, and the delivery efficiency. The differences between the 2 groups of parameters were analyzed, with P < .05 means statistically significant. Results: In terms of dosimetry, there was no significant or clinical difference between the 2 groups in critical dosimetry parameters. The Monitor Unit of the Halcyon(2.0) fields is lower than the TrueBeam fields by 26.39, while the modulation complexity score (MCS), the mean aperture area variability (AAV), and the mean leaf sequence variability (LSV) of the Halcyon(2.0) fields were 23.8%, 20%, and 2.3% larger than those of the TrueBeam fields, respectively. Neither the ArcCheck-based GPRs nor the portal-dosimetry-based GPRs in both 3%/3 mm and 2%/2 mm criteria showed the difference between the Halcyon(2.0) fields and the TrueBeam fields. The Pearson correlation coefficient between GPR(2%/2 mm) and MCS of the Halcyon(2.0) fields was 0.335, while that of the TrueBeam fields was 0.502. The mean total delivery time of the TrueBeam plans was 195.55 ± 22.86 s, while that of Halcyon(2.0) was 124.25 ± 10.42 s (P < .001), which was reduced approximatively by 36%. Conclusion: For long-course rectal cancer radiotherapy, the Halcyon(2.0) IMRT plans behave almost the same in dosimetry and delivery accuracy as the TrueBeam plans. However, the lower MU and the field modulation complexity, combined with the higher delivery efficiency, make Halcyon(2.0) a feasible and reliable platform in long-course radiotherapy for the rectal cancer.


Assuntos
Radioterapia de Intensidade Modulada , Neoplasias Retais , Humanos , Radiometria/métodos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Neoplasias Retais/radioterapia
16.
Molecules ; 27(3)2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-35163861

RESUMO

The aim of this study is to reveal the potential roles of apoptosis markers (Bcl2 and p53), proliferation markers (Ki-67 and CyclD1), and the neuroendocrine marker Chromogranin A as markers for the radioresistance of rectal cancer. Statistically significant differences were found in the expression of p53, Ki-67, and Chromogranin A in groups of patients with and without a favorable prognosis after radiotherapy. The survival analysis revealed that the marker of neuroendocrine differentiation, Chromogranin A, also demonstrated a high prognostic significance, indicating a poor prognosis. Markers of proliferation and apoptosis had no prognostic value for patients who received preoperative radiotherapy. Higher Chromogranin A values were predictors of poor prognosis. The results obtained from studying the Chromogranin A expression suggest that the secretion of biologically active substances by neuroendocrine cells causes an increase in tumor aggressiveness.


Assuntos
Adenocarcinoma/patologia , Biomarcadores Tumorais/metabolismo , Imuno-Histoquímica/métodos , Células Neuroendócrinas/patologia , Neoplasias Retais/patologia , Adenocarcinoma/metabolismo , Adenocarcinoma/radioterapia , Adulto , Idoso , Cromogranina A/metabolismo , Ciclina D1/metabolismo , Feminino , Seguimentos , Humanos , Antígeno Ki-67/metabolismo , Masculino , Pessoa de Meia-Idade , Células Neuroendócrinas/metabolismo , Prognóstico , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Neoplasias Retais/metabolismo , Neoplasias Retais/radioterapia , Taxa de Sobrevida , Proteína Supressora de Tumor p53/metabolismo
17.
Sci Rep ; 12(1): 1845, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-35115612

RESUMO

Carbon ion radiotherapy (CIRT) has garnered interest for the treatment of locoregional rectal cancer recurrence. No study has compared CIRT and X-ray radiotherapy (XRT) for reirradiation (reRT) in such cases. We analyzed and compared the clinical outcomes such as local control, overall survival, and late toxicity rate between CIRT and XRT, for treating locoregional rectal cancer recurrence. Patients with rectal cancer who received reRT to the pelvis by CIRT or XRT from March 2005 to July 2019 were included. The CIRT treatment schedule was 70.4 Gy (relative biological effectiveness) in 16 fractions. For the XRT group, the median reRT dose was 50 Gy (range 25-62.5 Gy) with a median of 25 fractions (range 3-33). Thirty-five and 31 patients received CIRT and XRT, respectively. Tumour and treatment characteristics such as recurrence location and chemotherapy treatment differed between the two groups. CIRT showed better control of local recurrence (adjusted hazard ratio [HR] 0.17; p = 0.002), better overall survival (HR 0.30; p = 0.004), and lower severe late toxicity rate (HR 0.15; p = 0.015) than XRT. CIRT was effective for treating locoregional rectal cancer recurrence, with high rates of local control and survival, and a low late severe toxicity rate.


Assuntos
Radioterapia com Íons Pesados , Recidiva Local de Neoplasia/radioterapia , Reirradiação , Neoplasias Retais/radioterapia , Terapia por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Radioterapia com Íons Pesados/mortalidade , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Reirradiação/efeitos adversos , Reirradiação/mortalidade , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Seul , Fatores de Tempo , Resultado do Tratamento , Terapia por Raios X/efeitos adversos , Terapia por Raios X/mortalidade
18.
Cancer Cell ; 40(2): 122-124, 2022 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-35120597

RESUMO

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide. Still, the molecular mechanisms that drive CRC therapy resistance are incompletely understood. In this issue of Cancer Cell, Nicolas et al. combine several approaches to unravel a critical role for inflammatory cancer-associated fibroblasts (iCAFs) and interleukin 1α (IL1α) signaling in radiotherapy resistance.


Assuntos
Fibroblastos Associados a Câncer , Neoplasias Retais , Fibroblastos , Humanos , Neoplasias Retais/radioterapia
20.
Radiat Oncol ; 17(1): 14, 2022 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-35073940

RESUMO

BACKGROUND: The addition of consolidation chemotherapy to preoperative short-course radiotherapy during the prolonged interval between the completion of radiation and surgery in locally advanced rectal cancer (LARC) could enhance pathologic response and might act on potential micrometastasis. We performed this meta-analysis to evaluate whether short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) could be a neoadjuvant treatment option compared with conventional long-course chemoradiotherapy (LCCRT). METHODS: We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library databases. The primary endpoints were pathological outcomes, and the secondary endpoints included survival rate, sphincter preservation rate, R0 resection rate and toxicity. RevMan 5.3 was used to calculate pooled risk ratio (RRs) and 95% confidence intervals (CIs). RESULTS: A total of seven eligible studies and 1865 participants were included in this meta-analysis. Compared with the LCCRT, SCRT/CCT increased pathologic complete response (pCR) rate [RR = 1.74, 95% CI (1.41, 2.15), P < 0.01] and led to a lower proportion of patients with adjuvant pathologic tumor stage 3-4 (ypT3-4) disease [RR = 0.88, 95% CI (0.80, 0.97), P = 0.01] or lymph node positive (ypN +) disease [RR = 0.83, 95% CI (0.71, 0.98), P = 0.02]. In addition, the disease-free survival (DFS) was better in SCRT/CCT group [RR = 1.10, 95% CI (1.02, 1.18), P = 0.01], while overall survival rate and toxicity and surgical procedures were similar between two groups. CONCLUSION: Based on better pathological outcomes and DFS in SCRT/CCT group, we recommended preoperative short-course radiotherapy followed by consolidation chemotherapy as the optional neoadjuvant treatment for LARC.


Assuntos
Quimioterapia de Consolidação , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Terapia Combinada , Humanos , Estadiamento de Neoplasias , Período Pré-Operatório , Radioterapia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...