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Guan TL, Kutzko JH, Lunn DP, Dunn NA, Burmeister BH, Dadwal P, Tran N, Holt TR. Utility of 30-day mortality as a quality metric for palliative radiation treatment: A population-based analysis from Queensland, Australia. J Med Imaging Radiat Oncol 2024; 68:316-324. [PMID: 38500454 DOI: 10.1111/1754-9485.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Palliative radiotherapy (PRT) is frequently used to treat symptoms of advanced cancer, however benefits are questionable when life expectancy is limited. The 30-day mortality rate after PRT is a potential quality indicator, and results from a recent meta-analysis suggest a benchmark of 16% as an upper limit. In this population-based study from Queensland, Australia, we examined 30-day mortality rates following PRT and factors associated with decreased life expectancy. METHODS Retrospective population data from Queensland Oncology Repository was used. Study population data included 22,501 patients diagnosed with an invasive cancer who died from any cause between 2008 and 2017 and had received PRT. Thirty-day mortality rates were determined from the date of last PRT fraction to date of death. Cox proportional hazards models were used to identify factors independently associated with risk of death within 30 days of PRT. RESULTS Overall 30-day mortality after PRT was 22.2% with decreasing trend in more recent years (P = 0.001). Male (HR = 1.20, 95% CI = 1.13-1.27); receiving 5 or less radiotherapy fractions (HR = 2.97, 95% CI = 2.74-3.22 and HR = 2.17, 95% CI = 2.03-2.32, respectively) and receiving PRT in a private compared to public facility (HR = 1.61, 95% CI = 1.51-1.71) was associated with decreased survival. CONCLUSION The 30-day mortality rate in Queensland following PRT is higher than expected and there is scope to reduce unnecessarily protracted treatment schedules. We encourage other Australian and New Zealand centres to examine and report their own 30-day mortality rate following PRT and would support collaboration for 30-day mortality to become a national and international quality metric for radiation oncology centres.
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Affiliation(s)
- Tracey L Guan
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Justin H Kutzko
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- William Osler Health System, Brampton, Ontario, Canada
- University of Queensland, Brisbane, Queensland, Australia
| | - Dominic P Lunn
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- ICON, Gold Coast University Hospital, Brisbane, Queensland, Australia
- ICON, Greenslopes Hospital, Brisbane, Queensland, Australia
| | - Nathan Am Dunn
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Bryan H Burmeister
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- GenesisCare, St Stephen's Hospital (Oncology), Hervey Bay, Queensland, Australia
- University of Queensland Rural Clinical School, Hervey Bay, Queensland, Australia
| | - Parvati Dadwal
- Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
| | - Nancy Tran
- Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Tanya R Holt
- Queensland Cancer Control Safety and Quality Partnership, Radiation Oncology Sub-Committee, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
- ICON, Greenslopes Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital - ROPART, Brisbane, Queensland, Australia
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Inci K, Nilsson B, Lindskog S, Giglio D. Palliative resection of the primary tumour improves survival in incurable metastatic colorectal cancer. ANZ J Surg 2023; 93:2680-2685. [PMID: 37489624 DOI: 10.1111/ans.18629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Studies show conflicting results on whether primary tumour resection (PTR) in metastatic colorectal cancer (mCRC) prolongs survival. The aim of this study was to analyse prognostic factors and the effects of PTR on overall survival (OS) in mCRC patients. METHODS In this population-based cohort study, factors associated with PTR and OS were assessed in 188 mCRC patients with mCRC treated with palliative chemotherapy between 2008 and 2019. The Chi-square test and Mann-Whitney U-test were used to assess factors associated with PTR. The log-rank test was used to compare Kaplan-Meier estimates for OS. Cox regression was used to identify factors predicting OS. RESULTS Patients undergoing PTR had significantly better performance status, fewer metastatic sites, lower CEA levels, and more often had left-sided CRC than patients not undergoing PTR. OS was longer in palliative mCRC patients undergoing PTR (P < 0.01) and PTR was an independent variable in the Cox regression analysis (P < 0.05). Median OS was 22.9 ± 1.9 months for the PTR group and 14.5 ± 1.5 months for the non-operated group. Poor performance status and liver metastases were significantly associated with poor prognosis. CONCLUSION This study shows that PTR had a positive effect on OS and may be considered in patients suitable for surgery. PTR was offered to palliative mCRC patients with prognostic factors associated with better prognosis.
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Affiliation(s)
- Kamuran Inci
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Halland, Varberg, Sweden
| | - Bengt Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Halland, Varberg, Sweden
| | - Stefan Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Giglio
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lupattelli M, Tenti MV, Nucciarelli S, Graziosi L, De Angelis V, Fulcheri C, Aristei C. Palliative short-course radiotherapy (RAPASH study) in patients with rectal cancer. Rep Pract Oncol Radiother 2023; 28:309-315. [PMID: 37795394 PMCID: PMC10547409 DOI: 10.5603/rpor.a2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background Palliative radiation therapy (RT) is used to treat symptomatic rectal cancer although clinical benefits and toxicities are poorly documented. There is no consensus about the optimal RT regimen and clinical practice undergoes significant changes. Our aim was to evaluate the efficacy and toxicity of short-course (SC) RT in this setting of patients. Materials and methods Charts from patients with locally advanced disease not candidates for standard treatment or with symptomatic metastatic rectal cancer treated with SCRT (25 Gy/5 fractions in 5 consecutive days) were retrospectively reviewed. Clinical outcome measures were symptomatic response rate and toxicity. Results From January 2007 to December 2017, 59 patients (median age 80 years) received SCRT; 53 were evaluable. The median follow-up was 8 months (range, 1-70). Clinical response to RT for bleeding, pain and tenesmus was 100%, 95% and 89%, respectively. The compliance with the treatment was 100% and no patient experienced acute severe (≥ grade 3) toxicities. Median time to symptoms recurrence was 11 months (range 3-69). Globally, the median overall survival was 12 months. Conclusions SCRT is a safe and effective regimen in symptomatic rectal cancer and may be considered the regimen of choice for standard treatment in unfit patients.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Section, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Luigina Graziosi
- General and Emergency Surgical Department, S. Maria della Misericordia Hospital and University, Perugia, Italy
| | - Verena De Angelis
- Medical Oncology Section, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Christian Fulcheri
- Medical Physics Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, S. Maria della Misericordia Hospital, Perugia, Italy
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4
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Kørner H, Guren MG, Larsen IK, Haugen DF, Søreide K, Kørner LR, Søreide JA. Characteristics and fate of patients with rectal cancer not entering a curative-intent treatment pathway: A complete nationwide registry cohort of 3,304 patients. Eur J Surg Oncol 2022; 48:1831-1839. [DOI: 10.1016/j.ejso.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
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Hedrick TL, Zaydfudim VM. Management of Synchronous Colorectal Cancer Metastases. Surg Oncol Clin N Am 2022; 31:265-278. [DOI: 10.1016/j.soc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Kutzko JH, Dadwal P, Holt T, Rahman MA, Zahir SF, Hickey B. Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: a meta-analysis. Radiother Oncol 2022. [DOI: 10.1016/j.radonc.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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Custers PA, Geubels BM, Huibregtse IL, Peters FP, Engelhardt EG, Beets GL, Marijnen CAM, van Leerdam ME, van Triest B. Contact X-ray Brachytherapy for Older or Inoperable Rectal Cancer Patients: Short-Term Oncological and Functional Follow-Up. Cancers (Basel) 2021; 13:cancers13246333. [PMID: 34944953 PMCID: PMC8699080 DOI: 10.3390/cancers13246333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Total mesorectal excision for rectal cancer is a major operation associated with morbidity and mortality. For older or inoperable patients, alternatives are necessary. This prospective study evaluated the oncological and functional outcome and quality of life of older or inoperable rectal cancer patients treated with a contact X-ray brachytherapy boost to avoid major surgery. During follow-up, tumor response and toxicity on endoscopy were scored. Functional outcome and quality of life were assessed with self-administered questionnaires. Additionally, in-depth interviews regarding patients' experiences were conducted. Nineteen patients were included with a median age of 80 years (range 72-91); nine patients achieved a clinical complete response and in another four local control of the tumor was established. The 12 month organ-preservation rate, progression-free survival, and overall survival were 88%, 78%, and 100%, respectively. A transient decrease in quality of life and bowel function was observed at 3 months, which was generally restored at 6 months. In-depth interviews revealed that patients' experience was positive despite the side-effects shortly after treatment. In older or inoperable rectal cancer patients, contact X-ray brachytherapy can be considered an option to avoid total mesorectal excision. Contact X-ray brachytherapy is well-tolerated and can provide good tumor control.
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Affiliation(s)
- Petra A. Custers
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Barbara M. Geubels
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Surgery, Catharina Hospital, Postbox 1350, 5602 ZA Eindhoven, The Netherlands
| | - Inge L. Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (I.L.H.); (M.E.v.L.)
| | - Femke P. Peters
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands;
| | - Geerard L. Beets
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (I.L.H.); (M.E.v.L.)
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Correspondence: ; Tel.: +31-(0)20-512-9111
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Gordeyev S, Ivanov V, Fedianin M, Chernikh M, Kozlov N, Petrov L, Erygin D, Gridasov I, Kaushanskiy V, Feoktistov D, Mamedli Z. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer with peritumoral abscesses and fistulas. Strahlenther Onkol 2021; 198:201-208. [PMID: 34825253 DOI: 10.1007/s00066-021-01878-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group. METHODS We performed a retrospective nested case-control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50-54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3-5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years. RESULTS A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4-5 toxicity. Grade 3-4 Clavien-Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively. CONCLUSION The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.
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Affiliation(s)
- Sergey Gordeyev
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.
| | - Valerii Ivanov
- "PET-technology" cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation
| | - Mikhail Fedianin
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.,Department of oncology and hematology at medical faculty of the Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Marina Chernikh
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.,"PET-technology" cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation.,I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nikolay Kozlov
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation
| | - Leonid Petrov
- A.F. Tsyb Medical Radiological Research Center, Zhukov st., 249031, Obninsk, Russian Federation
| | - Dmitriy Erygin
- Moscow city oncological hospital № 1, Baumanskaya 17/1, 105005, Moscow, Russian Federation
| | - Ivan Gridasov
- Stavropol regional oncological dispensary, 182A, Oktyabrskaya st., 355047, Stavropol, Russian Federation
| | - Valery Kaushanskiy
- Krasnodar regional oncological dispensary, 146, Dmitrova st., 350040, Krasnodar, Russian Federation
| | - Dmitry Feoktistov
- Bashkir regional oncological dispensary, 73/1, Prospekt Octyabrya, 450054, Ufa, Russian Federation
| | - Zaman Mamedli
- N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation
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Brown KGM, Solomon MJ. Managing the Primary Tumor in Patients With Incurable Metastatic Rectal Cancer. Dis Colon Rectum 2021; 64:5-6. [PMID: 33306523 DOI: 10.1097/DCR.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Oldenburger E, Oldenburger F, Coolbrandt A, Isebaert S, Neyens I, Sevenants A, Van Audenhove C, Haustermans K. The use of patient reported outcome measures (PROMs) in palliative radiotherapy: A topical review. Radiother Oncol 2020; 149:94-103. [DOI: 10.1016/j.radonc.2020.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
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Breugom A, Bastiaannet E, Guren M, Kørner H, Boelens P, Dekker F, Kapiteijn E, Gelderblom H, Larsen I, Liefers G, van de Velde C. Treatment strategies and overall survival for incurable metastatic colorectal cancer – A EURECCA international comparison including 21,196 patients from the Netherlands and Norway. Eur J Surg Oncol 2020; 46:1167-1173. [DOI: 10.1016/j.ejso.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/26/2022] Open
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Salari H, Afkhami-Poostchi A, Soleymanifard S, Nakhaei-Rad S, Merajifar E, Iranshahi M, Matin MM, Rassouli FB. Coadministration of auraptene and radiotherapy; a novel modality against colon carcinoma cells in vitro and in vivo. Int J Radiat Biol 2020; 96:1051-1059. [PMID: 32412318 DOI: 10.1080/09553002.2020.1770359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Use of ionizing radiation (IR) is a common therapeutic modality for patients with colon carcinoma, although resistance of cancer cells and unintended toxicity reduce clinical outcomes.Purpose: To enhance radioresponse of colon cancer cells, we designed a novel approach using auraptene (AUR) in combination with ionizing radiation (IR).Methods: For in vitro studies, CT26 cells were pretreated with AUR and irradiated at different doses. Then, cell viability was evaluated by alamarBlue assay, and the mechanism of cell death was elucidated using annexin V-PI. To determine efficacy of our combined therapeutic modality in vivo, AUR was injected intraperitoneally to murine models of colon carcinoma followed by IR, and then quantitative measurements and histopathological examinations were performed. For molecular analyses, real time PCR and Western blot were carried out.Results: Assessment of cell viability indicated significant enhancement of IR effects by AUR that was also confirmed by increased number of apoptotic cells. In vivo studies further demonstrated improved outcome in IR, since significant regression in tumor size was observed after administration of AUR + IR. Molecular analyses revealed down regulation of Cyclin D1 and CD44, along with involvement of PI3K-AKT-mTORC signaling pathway and Caspase-3 in observed combinatorial effects.Conclusion: Taken together, current findings support our previous reports on sensitizing effects of AUR and that AUR could be used as a promising adjunct to IR in cancer treatment.
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Affiliation(s)
- Hamide Salari
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Amin Afkhami-Poostchi
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Saeideh Nakhaei-Rad
- Stem Cell Biology and Regenerative Medicine Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Elahe Merajifar
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mehrdad Iranshahi
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam M Matin
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.,Novel Diagnostics and Therapeutics Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran.,Stem Cells and Regenerative Medicine Research Group, Iranian Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi, Mashhad, Iran
| | - Fatemeh B Rassouli
- Novel Diagnostics and Therapeutics Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
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Abstract
Radiotherapy (RT) has remained an important pillar in the multi-modality management of rectal cancer. Adjuvant RT with concurrent chemotherapy (chemo-RT) was once the standard of care for locally advanced rectal cancer, but with time, that has now changed and neoadjuvant chemo-RT followed by total mesorectal excision (TME) surgery is the new standard. Alternatively, neoadjuvant RT alone remains an option and clinicians are tasked to choose between the two. In an era of personalised oncological management, it is unsurprising that the treatment for rectal cancer is following suit and upcoming trials are studying ways to improve outcomes and minimise toxicity for patients while tailoring treatments specific to each patient's tumour. We review the evolution of the role of RT in rectal cancer and look forward to what the future holds.
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Affiliation(s)
- Michelle Tseng
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
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Yasuda T, Tanaka O, Hayashi S, Nakahata Y, Yasuda Y, Omatsu T, Obora A, Kojima T, Matsuo M, Yagi N. Successful treatment of unresectable advanced rectal cancer with liver metastases by hemostasis re-irradiation of the rectal cancer and palliative low-dose whole-liver radiation therapy: a case report. Clin J Gastroenterol 2019; 13:11-16. [PMID: 31321737 DOI: 10.1007/s12328-019-01023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
A 72-year-old man was admitted to the hospital with fatigue. Colonoscopy revealed a 50 × 50 mm rectal tumor with bleeding. Based on close inspection, he was diagnosed with unresectable advanced rectal cancer with multiple liver metastases. Chemotherapy was administered as 10 cycles of bevacizumab + mFOLFOX6 and 7 cycles of bevacizumab + FOLFIRI. Nine months later, he presented with hematochezia and progression of anemia. It was difficult to stop the bleeding via endoscopy. He underwent radiation therapy (39 Gy in 13 fractions), and hemostasis was confirmed. Then, further chemotherapy was performed with 3 cycles of bevacizumab + FOLFIRI and 2 cycles of TAS102. However 14 months after the initial visit, he presented with right hypochondralgia and abdominal fullness due to the progression of multiple liver metastases. Palliative low-dose whole-liver radiation therapy (WLRT) (30 Gy in 10 fractions) was performed. He developed Grade 2 nausea, but his right hypochondralgia reduced, liver dysfunction improved, and he successfully completed radiotherapy. At approximately the same time his anemia progressed, and colonoscopy revealed recurrent bleeding from the tumor. Re-irradiation (15 Gy in 5 fractions) of the rectal tumor was carried out and a blood transfusion was performed for the bleeding. He was discharged after confirmation the anemia had not progressed. Few reports have been published on the use of both palliative re-irradiation to stop bleeding from rectal cancer and palliative low-dose WLRT. Based on our experience with this case, we believe that palliative radiotherapy can be useful in treating patients with a poor prognosis.
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Affiliation(s)
- Takeshi Yasuda
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan.
| | - Osamu Tanaka
- Department of Radiation Oncology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Sadanari Hayashi
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Yuki Nakahata
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Yuriko Yasuda
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Tatsushi Omatsu
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Akihiro Obora
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Takao Kojima
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu, 501-1194, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan
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15
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Davis BR, Schlosser KA. Management of locally recurrent rectal cancer. Seminars in Colon and Rectal Surgery 2019. [DOI: 10.1053/j.scrs.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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Rohde G, Söderhamn U, Vistad I. Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study. BMJ Open 2019; 9:e023463. [PMID: 30850402 PMCID: PMC6429716 DOI: 10.1136/bmjopen-2018-023463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Patients with colorectal cancer undergoing palliative treatment receive extensive treatment-related information throughout their disease trajectory. We aimed to explore the experiences of patients with incurable colorectal cancer while in palliative care and their reflections on the information provided by physicians and nurses. Our main focus was the patients' thoughts about how information about disease status and life expectancy was communicated, from the first time that they were informed about the incurable nature of their disease through to postsurgery palliative treatment. SETTINGS Patients with colorectal cancer receiving palliative chemotherapy. RESEARCH DESIGN We used a qualitative approach, and the data were analysed by qualitative content analysis. PARTICIPANTS 20 patients (34-75 years of age) were included in the study; 12 received first-line chemotherapy and 8 received second-line chemotherapy. Eleven patients were treated by oncologists, and nine were treated by junior physicians. RESULTS Data-driven empirical analysis identified three themes: (1) inadequate information during the initial phase of the disease trajectory; (2) hope and information further into the disease trajectory and (3) personal, professional and organisational factors that influenced information and communication throughout the disease trajectory. CONCLUSION The participants' experience of being told for the first time that they had an incurable disease was perceived as inadequate, while postsurgery palliative chemotherapy, physicians and nurses offered hope. The participants preferred customised information about their treatment and likely future prospects and physicians and nurses who took a holistic and compassionate approach focusing on their lifeworld. To be a sensitive, holistic and compassionate physician or nurse requires knowledge and confidence. To achieve this requires training and guidance at universities and in hospitals.
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Affiliation(s)
- Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Ulrika Söderhamn
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Centre for Caring Research–Southern Norway, Grimstad, Norway
| | - Ingvild Vistad
- Department of Obstetric and Gynaecology, Sorlandet Hospital Kristiansand, Kristiansand, Norway
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17
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Tahover E, Bar-Shalom R, Sapir E, Pfeffer R, Nemirovsky I, Turner Y, Gips M, Ohana P, Corn BW, Wang AZ, Gabizon AA. Chemo-Radiotherapy of Oligometastases of Colorectal Cancer With Pegylated Liposomal Mitomycin-C Prodrug (Promitil): Mechanistic Basis and Preliminary Clinical Experience. Front Oncol 2018; 8:544. [PMID: 30534533 PMCID: PMC6275313 DOI: 10.3389/fonc.2018.00544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022] Open
Abstract
Hypo-fractionated radiotherapy and stereotactic body radiotherapy are viable options for treatment of oligometastases. A prodrug of mitomycin-C is under clinical testing as a pegylated liposomal formulation (Promitil) with an improved safety profile over mitomycin-C. Promitil was offered to two patients with oligometastases from colorectal cancer as radiosensitizer. Each derived durable clinical benefit from Promitil administered immediately prior to and following irradiation. Transient toxicity to normal tissues of moderate to severe degree was observed. Promitil appears to have potential clinical value in this setting. HIGHLIGHTS- Delivery of radio-sensitizing drugs with pegylated (long-circulating) liposomes is a pharmacologically rational approach which remains largely clinically untested. - A mitomycin-c prodrug delivered by pegylated liposomes (Promitil) is activated by thiol groups, which are produced in excess by radiation-damaged cells, thus potentiating the radio-sensitizing effect of Promitil. - Two durable clinical responses in patient with colorectal oligometastases to Promitil and radiotherapy suggest that this approach may be of value in cancer chemo-radiotherapy.
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Affiliation(s)
| | | | - Eli Sapir
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Igor Nemirovsky
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Maya Gips
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina-School of Medicine at Chapel Hill, Chapel Hill, NC, United States
| | - Alberto A Gabizon
- Shaare Zedek Medical Center, Jerusalem, Israel.,Lipomedix Pharmaceuticals Ltd., Jerusalem, Israel.,Department of Oncology, Hebrew University-School of Medicine, Jerusalem, Israel
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18
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Saito T, Toya R, Tomitaka E, Matsuyama T, Ninomura S, Watakabe T, Oya N. Improvement in pain interference after palliative radiotherapy for solid and hematologic painful tumors: a secondary analysis of a prospective observational study. Jpn J Clin Oncol 2018; 48:982-987. [PMID: 30239863 DOI: 10.1093/jjco/hyy130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/31/2018] [Indexed: 11/14/2022] Open
Abstract
Background We previously demonstrated that patients with painful hematologic tumors were more likely to experience pain response after palliative radiotherapy (RT) than those with painful solid tumors. However, it is unknown whether change in pain interference differs between these two tumor types. In the present study, we carried out a secondary analysis of our previous prospective observational study to investigate this matter. Methods From patients undergoing palliative RT to treat painful tumors, Brief Pain Inventory data were collected at the start of RT and at the 1-, 2-, and 3- month follow-ups. The Mann-Whitney U test was used to compare changes in pain interference score from baseline between the two groups. Results Of the 237 patients, 203 (86%) had solid and 34 (14%) had hematologic index tumors planned to receive RT. At baseline, the groups did not differ significantly in terms of pain score, analgesic use, or pain interference score. At the 1-, 2-, and 3-month follow-ups, the changes in pain interference score from baseline did not differ significantly between the two groups. In both groups, all seven pain interference items, other than sleep in patients with hematologic tumors at the 2-month follow-up, were significantly improved (P < 0.05). Conclusions The two groups showed comparable benefit from RT in terms of improvement in pain interference. Patients with tumor-related pain should be offered the option of palliative RT, irrespective of whether the painful tumor is solid or hematologic.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto.,Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Satoshi Ninomura
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Takahiro Watakabe
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto
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19
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Åsli LM, Myklebust TÅ, Kvaløy SO, Jetne V, Møller B, Levernes SG, Johannesen TB. Factors influencing access to palliative radiotherapy: a Norwegian population-based study. Acta Oncol 2018; 57:1250-1258. [PMID: 29706109 DOI: 10.1080/0284186x.2018.1468087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. We have described the use of PRT in Norway and aimed to identify and quantify the impact of factors associated with PRT utilization. MATERIAL AND METHODS Population-based data from the Cancer Registry of Norway identified 25,281 patients who died of cancer, 1 July 2009-31 December 2011. Additionally, individual-level data on socioeconomic status and community-level data on travel distance were collected. The proportion of patients who received PRT in the last two years of life (PRT2Y) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT2Y. Analyses of geographic variation in PRT use were also performed for the time period 2012-2016. RESULTS PRT2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter-county range; 21.8-36.6%). Female gender, increasing age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100-499 km, were also less likely to receive PRT. Patients with low household income (adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.56-0.72) and those diagnosed in hospitals without radiotherapy facility (OR = 0.70; 95% CI = 0.64-0.77) had especially low likelihood of receiving PRT. Significant inter-county variation in use of PRT remained during the time period 2012-2016. CONCLUSIONS Despite a publicly funded, universal healthcare system with equity as a stated health policy aim, utilization of PRT in Norway is significantly associated with factors such as household income and availability of radiotherapy facility at the diagnosing hospital. Even after adjustments for relevant factors, unexplained geographic variations in PRT utilization exist.
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Affiliation(s)
- Linn M. Åsli
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Tor Å. Myklebust
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Stein O. Kvaløy
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vidar Jetne
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | | | - Tom B. Johannesen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
| | - Rhona Parrish
- Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
| | - Rachael Barton
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Ann Henry
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
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Rijkmans E, van Triest B, Nout R, Kerkhof E, Buijsen J, Rozema T, Franssen J, Velema L, Laman M, Cats A, Marijnen C. Evaluation of clinical and endoscopic toxicity after external beam radiotherapy and endorectal brachytherapy in elderly patients with rectal cancer treated in the HERBERT study. Radiother Oncol 2018; 126:417-423. [DOI: 10.1016/j.radonc.2017.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics & Pathology, Uppsala University, SE 751 85 Uppsala, Sweden
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Abstract
Preoperative radiotherapy (RT) or chemoradiotherapy (CRT) is often required before rectal cancer surgery to obtain low local recurrence rates or, in locally advanced tumours, to radically remove the tumour. RT/CRT in tumours responding completely can allow an organ-preserving strategy. The time from the end of the RT/CRT to surgery or to the decision not to operate has been prolonged during recent years. After a brief review of the literature, the relevance of the time interval to surgery is discussed depending upon the indication for RT/CRT. In intermediate rectal cancers, where the aim is to decrease local recurrence rates without any need for down-sizing/-staging, short-course RT with immediate surgery is appropriate. In elderly patients at risk for surgical complications, surgery could be delayed 5-8 weeks. If CRT is used, surgery should be performed when the acute radiation reaction has subsided or after 5-6 weeks. In locally advanced tumours, where CRT is indicated, the optimal delay is 6-8 weeks. In patients not tolerating CRT, short-course RT with a 6-8-week delay is an alternative. If organ preservation is a goal, a first evaluation should preferably be carried out after about 6 weeks, with planned surgery for week 8 if the response is inadequate. In case the response is good, a new evaluation should be carried out after about 12 weeks, with a decision to start a 'watch-and-wait' programme or operate. Chemotherapy in the waiting period is an interesting option, and has been the subject of recent trials with promising results.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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24
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Glimelius B. What is most relevant in preoperative rectal cancer chemoradiotherapy - the chemotherapy, the radiation dose or the timing to surgery? Acta Oncol 2016; 55:1381-1385. [PMID: 27879164 DOI: 10.1080/0284186x.2016.1254817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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