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1.
Br J Radiol ; 93(1114): 20200543, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32877210

RESUMO

OBJECTIVES: To evaluate interobserver agreement for T2 weighted (T2W) and diffusion-weighted MRI (DW-MRI) contours of locally advanced rectal cancer (LARC); and to evaluate manual and semi-automated delineations of restricted diffusion tumour subvolumes. METHODS: 20 cases of LARC were reviewed by 2 radiation oncologists and 2 radiologists. Contours of gross tumour volume (GTV) on T2W, DW-MRI and co-registered T2W/DW-MRI were independently delineated and compared using Dice Similarity Coefficient (DSC), mean distance to agreement (MDA) and other metrics of interobserver agreement. Restricted diffusion subvolumes within GTVs were manually delineated and compared to semi-automatically generated contours corresponding to intratumoral apparent diffusion coefficient (ADC) centile values. RESULTS: Observers were able to delineate subvolumes of restricted diffusion with moderate agreement (DSC 0.666, MDA 1.92 mm). Semi-automated segmentation based on the 40th centile intratumoral ADC value demonstrated moderate average agreement with consensus delineations (DSC 0.581, MDA 2.44 mm), with errors noted in image registration and luminal variation between acquisitions. A small validation set of four cases with optimised planning MRI demonstrated improvement (DSC 0.669, MDA 1.91 mm). CONCLUSION: Contours based on co-registered T2W and DW-MRI could be used for delineation of biologically relevant tumour subvolumes. Semi-automated delineation based on patient-specific intratumoral ADC thresholds may standardise subvolume delineation if registration between acquisitions is sufficiently accurate. ADVANCES IN KNOWLEDGE: This is the first study to evaluate the feasibility of semi-automated diffusion-based subvolume delineation in LARC. This approach could be applied to dose escalation or 'dose painting' protocols to improve delineation reproducibility.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Retais/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Variações Dependentes do Observador , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Carga Tumoral
2.
Medicine (Baltimore) ; 99(35): e21304, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871861

RESUMO

To determine the efficacy of neoadjuvant chemoradiotherapy (NCRT) between young and old patients with locally advanced rectal cancer (LARC) in terms of tumor response and survival outcome.LARC patients undergoing NCRT and radical surgery from 2011 to 2015 were included and divided into: young (aged ≤50 years) and old group (aged >50 years). Multivariate analyses were performed to identify risk factors for local recurrence. Least absolute shrinkage and selection operator analysis was performed to identify risk factors for overall survival. Predicting nomograms and time-indepent receiver operating characteristic curve analysis were performed to compare the models containing with/withour age groups.A total of 572 LARC patients were analyzed. The young group was associated with higher pathological TNM stage, poorly differentiated tumors, and higher rate of positive distal resection margin (P = .010; P = .019; P = .023 respectively). Young patients were associated with poorer 5-year disease-free survival and local recurrence rates (P = .023, P = .003 respectively). Cox regression analysis demonstrated that age ≤50 years (Hazard ratio = 2.994, P = .038) and higher pathological TNM stage (Hazard ratio = 3.261, P = .005) were significantly associated with increased risk for local recurrence. Least absolute shrinkage and selection operator analysis and the time-indepent receiver operating characteristic curve analysis demonstrated that including the age group were superior than that without age group.Young patients were associated with poorer disease free survival (DFS) and a higher risk for local recurrence in LARC following NCRT. The predicting model basing based on the age group had a better predictive ability. More intense adjuvant treatment could be considered to improve DFS and local control for young patients with LARC following NCRT.


Assuntos
Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/mortalidade , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Adulto , Idoso , Quimiorradioterapia/métodos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Nomogramas , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Gan To Kagaku Ryoho ; 47(8): 1241-1243, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32829364

RESUMO

A 77-year-old woman underwent preoperative chemoradiotherapy for rectal cancer in the Rb region(3 cm from the anal verge). The treatment regimen consisted of tegafur, gimeracil, and oteracil potassium(80 mg/m2/day, administered on days 1 to 5)and irinotecan(80 mg/m2, administered on day 1). A 1-week regimen was regarded a 1 course. In total, 4 courses were administered. Radiotherapy was administered with a margin of 1 cm around the tumor, with a daily dose of 1.8 Gy for 25 days. After treatment, evaluations were performed. Lower gastrointestinal endoscopy, barium enema examination, and computed tomography of the chest and abdomen were performed at 6 to 7 weeks, and a clinical complete response was observed. At the patient's request, we decided to carefully follow-up the patient. Currently, 10 years 8 months after treatment, the patient still has a clinical complete response.


Assuntos
Quimiorradioterapia , Neoplasias Retais , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Feminino , Humanos , Irinotecano , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Retais/terapia , Tegafur , Resultado do Tratamento
4.
Nat Commun ; 11(1): 4308, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32855399

RESUMO

Distant metastasis (DM) is the main cause of treatment failure in locally advanced rectal cancer. Adjuvant chemotherapy is usually used for distant control. However, not all patients can benefit from adjuvant chemotherapy, and particularly, some patients may even get worse outcomes after the treatment. We develop and validate an MRI-based radiomic signature (RS) for prediction of DM within a multicenter dataset. The RS is proved to be an independent prognostic factor as it not only demonstrates good accuracy for discriminating patients into high and low risk of DM in all the four cohorts, but also outperforms clinical models. Within the stratified analysis, good chemotherapy efficacy is observed for patients with pN2 disease and low RS, whereas poor chemotherapy efficacy is detected in patients with pT1-2 or pN0 disease and high RS. The RS may help individualized treatment planning to select patients who may benefit from adjuvant chemotherapy for distant control.


Assuntos
Antineoplásicos/uso terapêutico , Nomogramas , Protectomia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Adulto , Idoso , Quimioterapia Adjuvante/estatística & dados numéricos , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/prevenção & controle , Estadiamento de Neoplasias , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
9.
Chirurgia (Bucur) ; 115(3): 365-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614292

RESUMO

Introduction: Pathologic response following neoadjuvant chemoradiotherapy (nCRT) can vary from pathologic complete response (pCR), to tumour downstaging or minimum to no response. Our goal was to evaluate the parameters that could predict response to neoadjuvant therapy for patients with rectal cancer. Method: We performed a retrospective study and reviewed the medical documentation for patients that received treatment for rectal cancer in our surgical department between 2014-2018 and received nCRT. Results: A total of 98 patients were included in the study. 66 patients were males (67,3%) and 32 were females (32,7%). The mean age was 64,6 (39-87). The 48 months overall survival rate was 81,63% and the 48 months disease-free survival rate was 69,38%. Tumour grading was considered as a statisti cally significant parameter for evaluating the pathologic response. The tumours most likely to respond to radio-chemotherapy were G1 or G2 grade. T4 tumours compared with lesser T stages were less likely to achieve pathologic complete response. Elevated CEA levels predicted a poor pathologic response to nCRT. Conclusion: Our study concluded that tumour related factors, biologic and imagistic findings such as tumour stage, lymph node, tumour differentiation grade and CEA levels can be used as parameters for predicting the tumour response following neoadjuvant therapy.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/terapia , Estudos Retrospectivos , Resultado do Tratamento
10.
Chirurgia (Bucur) ; 115(3): 373-379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614293

RESUMO

Introduction: Standard treatment rectal cancer according to numerous international guidelines recommends neoadjuvant chemoradiotherapy (nCRT). Literature data suggests that a better response to nCRT (greater tumour regression) leads to improved overall survival rates (OS) and disease-free survival rates (DFS). Tumour response to nCRT can be assessed either through clinical or pathological examination. The clinical tumour response is evaluated via a digital rectal examination, endoscopy (with or without ultrasound) and DWI-MRI. Our goal was to see if, when evaluating the clinical response to neoadjuvant chemoradiotherapy we can rely on the endoscopic findings and if it could have a predictive value for the overall outcomes. Method: A retrospective study was performed on 43 patients that were treated for rectal cancer in our clinic following neoadjuvant chemoradiotherapy. We divided the patients into two groups regarding the endoscopy grading. Results: Patients with a better response (endoscopy good grade) had a better disease free survival rate and lower recurrence rate compared to patients with a endoscopy low grade (86,5% vs 56,6%) and (10.34% vs 42,85%). Conclusion: Endoscopy could be a useful tool in appreciating the tumour response to nCRT, and further research is needed in determining the best method for evaluating clinical response to neo adjuvant therapy in patients with rectal cancer.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia , Colonoscopia , Humanos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Retais/terapia , Estudos Retrospectivos , Resultado do Tratamento
11.
Zhonghua Wai Ke Za Zhi ; 58(8): 586-588, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727187

RESUMO

Since the 21st century, with the development of minimally invasive surgical technology, the update of comprehensive treatment strategies and the progress of clinical research, colorectal surgery has developed rapidly. However, in recent years, some disputable issues still exist in colorectal surgery, such as transanal total mesorectal excision, pelvic cavity lateral lymph node dissection, the "wait and observe" strategy for clinical complete remission of rectal cancer after neoadjuvant therapy, and robotic colorectal surgical operation. In addition, the application of three dimensions imaging, 4K resolution, 5th generation wireless systems, virtual reality, artificial intelligence and other new techniques may provide extensive space and new opportunity for the development of colorectal surgery. The therapic outcome could be optimized by more relevant clinical research and evidence, which contribute to the standardization of surgical treatment of colorectal cancer.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Inteligência Artificial , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/tendências , Terapia Combinada/tendências , Promoção da Saúde , Humanos , Imageamento Tridimensional , Invenções , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos/tendências , Conduta Expectante
12.
Medicine (Baltimore) ; 99(29): e21215, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702890

RESUMO

RATIONALE: Penile metastasis in rectal cancer is very rare and often originates from prostatic or bladder cancer. The prognosis of penile metastasis is poor and its treatments are more often palliative than curative due to association with disseminated metastases. Pathologic complete response (pCR) in rectal cancer with neoadjuvant chemoradiotherapy (CRT) has been shown to be surrogate marker of favorable long-term outcomes and currently has no report of penile metastasis. Here, we first report isolated penile metastasis in rectal cancer with pCR after neoadjuvant CRT. PATIENT CONCERN: The patient was a 74-year-old male with metastasis to the glans penis from rectal cancer diagnosed 9 months after abdominoperineal resection. Physical examination revealed palpable multiple nodules on the glans penis. DIAGNOSIS: Penile biopsy revealed metastatic carcinoma from the rectal cancer. INTERVENTION: Chemotherapy was started as soon as possible, because patient suffered urinary discomfort by rapid growing metastatic lesions. He is currently receiving palliative chemotherapy with modified FOLFOX-6 (mFOLFOX-6; oxaliplatin with 5-fluorouracil and folinic acid) plus bevacizumab. OUTCOME: The patient is still alive 4 months after diagnosis with markedly decreased metastatic lesions. LESSON: We propose that although penile metastasis in rectal cancer with pCR after preoperative neoadjuvant CRT is extremely rare, it might help to start early palliative chemotherapy and clinicians should be aware of this possibility.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Penianas/diagnóstico , Pênis , Neoplasias Retais/diagnóstico , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia , Diagnóstico Diferencial , Humanos , Masculino , Terapia Neoadjuvante , Metástase Neoplásica , Neoplasias Penianas/secundário , Neoplasias Penianas/terapia , Neoplasias Retais/patologia , Neoplasias Retais/terapia
14.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32656628

RESUMO

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Betacoronavirus/isolamento & purificação , Quimioterapia Adjuvante/normas , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Controle de Infecções/normas , Irã (Geográfico)/epidemiologia , Oncologia/métodos , Terapia Neoadjuvante/normas , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Protectomia/normas , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia
15.
Anticancer Res ; 40(6): 3579-3587, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487661

RESUMO

BACKGROUND/AIM: Neoadjuvant chemoradiation/radiation therapy in locally advanced (LA) upper rectal adenocarcinoma management remains unclear. The aim of this study was to compare outcomes between neoadjuvant chemoradiation therapy (CRT) and upfront surgery (US). PATIENTS AND METHODS: A total of 127 patients were retrospectively included from 5 centers (79 treated with US and 48 with CRT). CRT and US groups were compared in terms of postoperative complications and long-term oncological and functional results. RESULTS: Total mesorectal excision (TME) was more frequent in CRT (58% vs. 20% in US, p<0.001). CRT was associated with more overall and severe postoperative complications (60% vs. 30%, p<0.001 and 17% vs. 1%, p=0.002, respectively), and was the only risk factor [OR=18.8 (2.2-160.2), p=0.007]. Five-year overall survival and 5-year recurrence-free survival were similar between CRT and US (96% vs. 91% p=0.256 and 85.4% vs. 85%, p=0.495). The functional results were similar between the two groups. CONCLUSION: CRT did not improve long-term oncological outcomes in patients with LA upper rectal adenocarcinoma, but increased postoperative complications compared with US.


Assuntos
Neoplasias Retais/patologia , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/mortalidade , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(22): e20245, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481390

RESUMO

BACKGROUND: The aim of this study is to compare the postoperative quality of life (QoL) and survival outcomes in lower rectal cancer (LRC) patients who undergo either laparoscopic- intersphincteric resection or extralevator abdominoperineal excision (L-ELAPE) after long-course neoadjuvant chemoradiation therapy (nCRT). METHODS: This prospective, single-center, non-randomized, controlled, non-blinded, phase I/II clinical trial is designed to enroll 159 eligible LRC patients who achieved favorable response to long-course nCRT (2 × 25 Gy). After informed consent, the patients will be assigned into the laparoscopic intersphincteric resection group or L-ELAPE group according to their own will. Standard radical laparoscopic surgeries will be performed for every participant. Then every participant will be followed up for 3 years. The primary outcomes are scores of QoL questionnaire-core 30, QoL questionnaire-colorectum 29, Wexner incontinence score, International Prostate Symptom Score (for male), International Index of Erectile Function-5 (for male) and Female Sexual Function Index (for female). The secondary outcomes consist of incomplete circumferential resection margin rate, 3-year local recurrence, 3-year disease-free survival, 3-year overall survival and other surgical outcomes. DISCUSSION: This is the first prospective clinical controlled trial to assess postoperative QoL and efficacy for LRC patients after favorable long-course nCRT. The result is expected to provide new evidence for a more detailed individualized treatment guideline for LRC. TRIAL REGISTRATION: This trial was registered at Chinese Clinical Trial Registry (ChiCTR1800017512; ChiCTR.org) on August 2, 2018.


Assuntos
Laparoscopia , Protectomia , Qualidade de Vida , Neoplasias Retais/cirurgia , Adolescente , Adulto , Idoso , Quimiorradioterapia , Intervalo Livre de Doença , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Protectomia/efeitos adversos , Estudos Prospectivos , Neoplasias Retais/terapia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 572-577, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521977

RESUMO

Objective: To explore the feasibility of using faster regional convolutional neural network (Faster R-CNN) to evaluate the status of circumferential resection margin (CRM) of rectal cancer in the magnetic resonance imaging (MRI). Methods: This study was registered in the Chinese Clinical Trial Registry (ChiCTR-1800017410). Case inclusion criteria: (1) the positive area of CRM was located between the plane of the levator ani, anal canal and peritoneal reflection; (2) rectal malignancy was confirmed by electronic colonoscopy and histopathological examination; (3) positive CRM was confirmed by postoperative pathology or preoperative high-resolution MRI. Exclusion criteria: patients after neoadjuvant therapy, recurrent cancer after surgery, poor quality images, giant tumor with extensive necrosis and tissue degeneration, and rectal tissue construction changes in previous pelvic surgery. According to the above criteria, MRI plain scan images of 350 patients with rectal cancer and positive CRM in The Affiliated Hospital of Qingdao University from July 2016 to June 2019 were collected. The patients were classified by gender and tumor position, and randomly assigned to the training group (300 cases) and the validation group (50 cases) at a ratio of 6:1 by computer random number method. The CRM positive region was identified on the T2WI image using the LabelImg software. The identified training group images were used to iteratively train and optimize parameters of the Faster R-CNN model until the network converged to obtain the best deep learning model. The test set data were used to evaluate the recognition performance of the artificial intelligence platform. The selected indicators included accuracy, sensitivity, positive predictive value, receiver operating characteristic (ROC) curves, areas under the ROC curves (AUC), and the time taken to identify a single image. Results: The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CRM status determined by the trained Faster R-CNN artificial intelligence approach were 0.884, 0.857, 0.898, 0.807, and 0.926, respectively; the AUC was 0.934 (95% CI: 91.3% to 95.4%). The Faster R-CNN model's automatic recognition time for a single image was 0.2 s. Conclusion: The artificial intelligence model based on Faster R-CNN for the identification and segmentation of CRM-positive MRI images of rectal cancer is established, which can complete the risk assessment of CRM-positive areas caused by in-situ tumor invasion and has the application value of preliminary screening.


Assuntos
Imagem por Ressonância Magnética/métodos , Margens de Excisão , Redes Neurais de Computação , Neoplasias Retais/diagnóstico por imagem , Simulação por Computador , Estudos de Viabilidade , Humanos , Modelos Biológicos , Terapia Neoadjuvante , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Medição de Risco
18.
Medicine (Baltimore) ; 99(22): e20336, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481410

RESUMO

INTRODUCTION: Synchronous colorectal and prostate malignancies are uncommon, with standard treatment guidelines not yet established. Chemoradiation therapy is involved in both colorectal and prostate cancers. However, differing dosage regimens and effects of irradiation field on anatomical planes for surgery makes management of the synchronous cancers challenging. We report the first case of synchronous prostate and rectal cancer being treated with a combination of treatment modalities with a unique addition of high dose rate prostate brachytherapy boost. PATIENT CONCERNS: The patient, a 69-year-old Chinese gentleman, presented with per-rectal bleeding with alternating bowel habits and a hemoglobin drop. He also had a history of urinary urge incontinence. DIAGNOSIS: Following diagnostic workup, he was diagnosed with synchronous rectal adenocarcinoma (T3N1M0) and prostate malignancy (T2bN0M0). INTERVENTIONS: The management consisted of neoadjuvant androgen deprivation therapy (ADT) and pelvic chemoradiation, followed by high dose rate prostate brachytherapy boost and subsequently anterior resection. OUTCOMES: Following therapy, the patient has no evidence of local recurrence or distant metastasis. CONCLUSION: We suggest a new feasible treatment strategy for the management of synchronous colorectal and prostate cancers.


Assuntos
Neoplasias da Próstata/complicações , Neoplasias da Próstata/terapia , Neoplasias Retais/complicações , Neoplasias Retais/terapia , Idoso , Antagonistas de Androgênios/uso terapêutico , Quimiorradioterapia/métodos , Humanos , Masculino
19.
Zhonghua Zhong Liu Za Zhi ; 42(5): 376-382, 2020 May 23.
Artigo em Chinês | MEDLINE | ID: mdl-32482026

RESUMO

Objective: To investigate the associations between the genetic variations of apoptosis genes and the adverse events of postoperative concurrent chemoradiotherapy in patients with rectal cancer. Methods: We enrolled 362 patients with stage Ⅱ to Ⅲ rectal cancer who received concurrent chemoradiotherapy. Whole blood sample (2 ml) was collected from patient at the time of enrollment before therapy. Sequenom MassARRAY was used to detect the genotypes of 29 haplotype-tagging single nucleotide polymorphisms (htSNPs) in eight apoptosis genes, including Fas cell surface death receptor(FAS), Fas ligand(FASL), apoptotic peptidase activating factor 1(APAF1), BCL2 associated X(BAX), TNF-related apoptosis-inducing ligand(TRAIL), TNF-related apoptosis-inducing ligand receptor 1(TRAILR1), TNF-related apoptosis-inducing ligand receptor 2(TRAILR2) and caspase-7(CASP7). The associations between genotypes and adverse events of chemoradiotherapy were measured by unconditional logistic regression model. Results: Three hundred and sixty two patients were treated with total mesorectal excision surgery followed by a total radiation dose of 50 Gy applied in 25 fractions over a period of 5 weeks concurrently with daily administration of capecitabine (1 600 mg/m(2) per day, continuously for 2 weeks and taking a week off every 21-day cycle). One hundred and six patients (29.3%) had grade≥2 myelosuppression. Three SNPs associated with the risk of grade ≥2 myelosuppression included FAS rs1468063 (OR=1.51, 95% CI: 1.07-2.15, P=0.020), APAF1 rs11296996 (OR=0.69, 95% CI: 0.49-0.98, P=0.039) and BAX rs4645904 (OR=0.69, 95% CI: 0.50-0.97, P=0.030). One hundred and sixty one patients (44.5%) developed grade≥2 diarrhea. Five SNPs that significantly associated with risk of grade≥2 diarrhea included APAF1 rs11296996 (OR=1.42, 95% CI: 1.02-2.00, P=0.040), rs74619561 (OR=2.16, 95% CI: 1.27-3.68, P=0.005), CASP7 rs12263370 (OR=1.67, 95% CI: 1.05-2.66, P=0.029), rs12247479 (OR=1.85, 95% CI: 1.12-3.08, P=0.017) and TRAIL rs112822654 (OR=0.68, 95% CI: 0.48-0.96, P=0.027). The remaining SNPs were not related to the adverse events of chemoradiotherapy (all P>0.05). Grade≥2 myelosuppression occurred less frequently in male than in female (P=0.046); Surgical treatment and tumor location had great impact on the occurrence of grade≥2 diarrhea (all P<0.001) and dermatitis (all P<0.05). Conclusions: The genetic variations of FAS, APAF1, BAX, TRAIL and CASP7 are related to the adverse events of concurrent chemoradiotherapy in patients with rectal cancer, which may be potential genetic biomarkers for individualized treatment of rectal cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Gastrectomia/efeitos adversos , Terapia Neoadjuvante , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Apoptose , Feminino , Humanos , Masculino , Terapia Neoadjuvante/efeitos adversos , Estadiamento de Neoplasias , Período Pós-Operatório , Resultado do Tratamento
20.
PLoS One ; 15(6): e0234310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520954

RESUMO

The aim of this study is to investigate the influencing factors associated with no/low response to preoperative concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer (LARC) patients. A total of 79 patients were included in this prospective study. Fifteen factors that might affect the resistance to CCRT were included in this logistic regression analysis, these factors include the general clinical data of patients, the expression status of tumor stem cell marker CD44v6 and the volumetric imaging parameters of primary tumor lesions. We found that the no/low response status to preoperative CCRT was positively correlated with the real tumor volume (RTV), the total surface area of tumor (TSA), and CD44v6 expression, whereas negatively correlated with the tumor compactness (TC). According to the results of logistic regression analysis, two formulas that could predict whether or not no/low response to preoperative CCRT were established. The Area Under Curve (AUC) of the two formulas and those significant measurement data (RTV, TC, TSA) were 0.900, 0.858, 0.771, 0.754, 0.859, the sensitivity were 95.8%, 79.17%, 62.50%, 95.83%, 62.5%, the specificity were 70.9%, 74.55%, 83.64%,47.27%, 96.36%, the positive predictive values were 58.96%, 57.58%, 62.51%,44.23%, 88.23%, the negative predictive values were 97.48%, 89.13%, 83.64%, 96.29%, and 85.48%, respectively.


Assuntos
Biomarcadores Farmacológicos/análise , Quimiorradioterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Terapia Combinada/métodos , Tratamento Conservador/métodos , Tratamento Conservador/mortalidade , Feminino , Fragilidade/fisiopatologia , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Segunda Neoplasia Primária/tratamento farmacológico , Curva ROC , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/patologia , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/mortalidade , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Carga Tumoral
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