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Radiographics : a Review Publication of... 2019Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of... (Review)
Review
Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." RSNA, 2019.
Topics: Chemoradiotherapy; Humans; Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms; Rectum
PubMed: 30768361
DOI: 10.1148/rg.2019180114 -
Surgical Oncology Aug 2022Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal... (Review)
Review
Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying "high" and "low" risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and "watch-and-wait", MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.
Topics: Humans; Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms; Rectum
PubMed: 35339339
DOI: 10.1016/j.suronc.2022.101739 -
Clinical Colorectal Cancer Mar 2022Rectal cancer is a relatively common malignancy in the United States. Magnetic resonance imaging (MRI) of rectal cancer has evolved tremendously in recent years, and has... (Review)
Review
Rectal cancer is a relatively common malignancy in the United States. Magnetic resonance imaging (MRI) of rectal cancer has evolved tremendously in recent years, and has become a key component of baseline staging and treatment planning. In addition to assessing the primary tumor and locoregional lymph nodes, rectal MRI can be used to help with risk stratification by identifying high-risk features such as extramural vascular invasion and can assess treatment response for patients receiving neoadjuvant therapy. As the practice of rectal MRI continues to expand further into academic centers and private practices, standard MRI protocols, and reporting are critical. In addition, it is imperative that the radiologists reading these cases work closely with surgeons, medical oncologists, radiation oncologists, and pathologists to ensure we are providing the best possible care to patients. This review aims to provide a broad overview of the role of MRI for rectal cancer.
Topics: Humans; Lymph Nodes; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Staging; Rectal Neoplasms; Retrospective Studies
PubMed: 34895835
DOI: 10.1016/j.clcc.2021.10.007 -
Annals of Oncology : Official Journal... Jul 2017
Topics: Follow-Up Studies; Humans; Medical Oncology; Neoplasm Grading; Neoplasm Staging; Rectal Neoplasms
PubMed: 28881920
DOI: 10.1093/annonc/mdx224 -
International Journal of Biological... 2016Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and... (Review)
Review
Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and recurrence, but also increase the tumor resection rate and anus retention rate with very slight side effect. Comparing with preoperative chemotherapy, preoperative chemoradiotherapy can further reduce the local recurrence rate and downstage. Middle and low rectal cancers can benefit more from neoadjuvant chemradiotherapy than high rectal cancer. It needs to refine the selection of appropriate patients and irradiation modes for neoadjuvant chemoradiotherapy. Different therapeutic reactions to neoadjuvant chemoradiotherapy affect the type of surgical techniques, hence calling for the need of much attention. Furthermore, many problems such as accurate staging before surgery, selection of suitable neoadjuvant chemoradiotherapy method, and sensitivity prediction to preoperative radiotherapy need to be well settled.
Topics: Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy; Female; Humans; Male; Neoadjuvant Therapy; Neoplasm Staging; Rectal Neoplasms
PubMed: 27489505
DOI: 10.7150/ijbs.15438 -
Internal Medicine (Tokyo, Japan) Jan 2019A 57-year-old woman was admitted with lower abdominal pain and bloody bowel discharge. She was diagnosed with rectal tumor by colonoscopy, and a biopsy was performed.... (Review)
Review
A 57-year-old woman was admitted with lower abdominal pain and bloody bowel discharge. She was diagnosed with rectal tumor by colonoscopy, and a biopsy was performed. Surgery was performed, resulting in a diagnosis of rectal paraganglioma. Since recurrence was confirmed three years later, reoperation was done, and chemotherapy with cyclophosphamide, vincristine and dacarbazine (CVD) was subsequently carried out for further recurrence. After the administration of up to 15 courses of CVD, we delivered best supportive care due to disease progression. She died a year and a half after starting chemotherapy. We herein report this rare disease with a review of the relevant literature.
Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Colonoscopy; Combined Modality Therapy; Cyclophosphamide; Dacarbazine; Disease Progression; Fatal Outcome; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Paraganglioma; Rectal Neoplasms; Reoperation; Vincristine
PubMed: 30146582
DOI: 10.2169/internalmedicine.1218-18 -
Diagnostic and Interventional Radiology... May 2019MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with... (Review)
Review
MRI has a pivotal role in both pretreatment staging and posttreatment evaluation of rectal cancer. The accuracy of MRI in pretreatment staging is higher compared with posttreatment evaluation. This occurs due to similar signal intensities of tumoral and posttreatment fibrotic, necrotic, and inflamed tissue. This limitation occurs with conventional MRI of the rectum with morphologic sequences. There is a need towards increasing the accuracy of MRI, especially for posttreatment evaluation. The term multiparametric MRI implies addition of functional sequences, namely, diffusion and perfusion to the routine protocol. This review summarizes the technique, potential implications and previously published studies about multiparametric MRI of rectal cancer.
Topics: Humans; Multiparametric Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Staging; Rectal Neoplasms; Treatment Outcome
PubMed: 31063142
DOI: 10.5152/dir.2019.18189 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021The aim: To evaluate and analyze early and late results of treatment of patients with rectal cancer after chemotherapy.
OBJECTIVE
The aim: To evaluate and analyze early and late results of treatment of patients with rectal cancer after chemotherapy.
PATIENTS AND METHODS
Materials and methods: The study is based on the results of observation of 779 patients with stage II, III and IV rectal cancer (RC) who were divided into groups according to the chemotherapy treatment.
RESULTS
Results: In the course of chemotherapy treatment of RC patients, most of them received the FOLFOX regimen treatment - 87 patients (43.5%). 40 people (20%) received Mayo regimen. 36 patients (18%) underwent FOLFIRI regimen. Another 33 patients received the XELOX regimen chemotherapy (16.5%). In four cases, patients underwent Tegafur monotherapy (2%).
CONCLUSION
Conclusions: The obtained data for patients with stage III RC showed that at all studied time intervals, the highest percentage of surviving patients was recorded in those who received chemotherapeutic treatment according to the FOLFOX regimen. In patients with stage II RC, the most ef f ective was Mejo regimen - 30.7% (survived patients for the 5 year observation).
Topics: Disease-Free Survival; Fluorouracil; Humans; Neoplasm Staging; Rectal Neoplasms
PubMed: 34537726
DOI: No ID Found -
Current Problems in Cancer Apr 2023Colon and rectal cancer imaging has traditionally been performed to assess for distant disease (typically lung and liver metastases) and to assess the resectability of...
Colon and rectal cancer imaging has traditionally been performed to assess for distant disease (typically lung and liver metastases) and to assess the resectability of the primary tumor. With technological and scientific advances in imaging and the evolution of treatment options, the role of imaging has expanded. Radiologists are now expected to provide a precise description of primary tumor invasion extent, including adjacent organ invasion, involvement of the surgical resection plane, extramural vascular invasion, lymphadenopathy, and response to neoadjuvant treatment, and to monitor for recurrence after clinical complete response.
Topics: Humans; Neoplasm Staging; Rectal Neoplasms; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Neoadjuvant Therapy; Colon
PubMed: 37330400
DOI: 10.1016/j.currproblcancer.2023.100970 -
Hematology/oncology Clinics of North... Jun 2022The treatment algorithm for locally advanced rectal cancer (LARC) has increased in complexity over the past 10 years. Nonoperative management (NOM) for rectal cancer in... (Review)
Review
The treatment algorithm for locally advanced rectal cancer (LARC) has increased in complexity over the past 10 years. Nonoperative management (NOM) for rectal cancer in patients with clinical complete response (cCR) after neoadjuvant therapy has been gaining acceptance as a potential treatment option for selected LARC patients. The current challenge is to accurately select the patients with an apparent cCR, thereby correctly identifying those would-be appropriate candidates for a NOM strategy. NOM should be part of the treatment discussion of LARC, considering increasing rates of cCR, patient preference, potential quality of life gains, and the potential avoidance of surgical morbidity.
Topics: Chemoradiotherapy; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Quality of Life; Rectal Neoplasms; Treatment Outcome
PubMed: 35562257
DOI: 10.1016/j.hoc.2022.03.003