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Point/Counterpoint #2: Current Clinical Considerations With Nonoperative Management of Rectal Cancer. 观点/反方观点 2：直肠癌非手术治疗的当前临床考虑因素。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000732
Greeshma Rajeev-Kumar, Rohan R Katipally, Shen Li, Benjamin D Shogan, Kinga S Olortegui, Janet Chin, Blase N Polite, Stanley L Liauw
{"title":"Point/Counterpoint #2: Current Clinical Considerations With Nonoperative Management of Rectal Cancer.","authors":"Greeshma Rajeev-Kumar, Rohan R Katipally, Shen Li, Benjamin D Shogan, Kinga S Olortegui, Janet Chin, Blase N Polite, Stanley L Liauw","doi":"10.1097/PPO.0000000000000732","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000732","url":null,"abstract":"<p><strong>Abstract: </strong>Locally advanced rectal cancer has historically been treated with multimodal therapy consisting of radiation therapy, chemotherapy, and total mesorectal excision. However, recent prospective trials and registry studies have demonstrated similar disease outcomes with nonoperative management for patients who experience an excellent clinical response to radiation and chemotherapy. This article reviews data regarding nonoperative management for rectal cancer, and highlights current challenges and limitations in a point-counterpoint format, in the context of two clinical cases.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"256-263"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rectal Cancer-The Only Constant Is Change. 直肠癌--唯一不变的是变化。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000733
Daniel T Chang
{"title":"Rectal Cancer-The Only Constant Is Change.","authors":"Daniel T Chang","doi":"10.1097/PPO.0000000000000733","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000733","url":null,"abstract":"","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"225-226"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
T3N0 Rectal Cancer: Radiation for All, None, or Some? T3N0 直肠癌：全部放疗、不放疗还是部分放疗？
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000726
Zachary R Chalmers, Hannah J Roberts, Jennifer Y Wo
{"title":"T3N0 Rectal Cancer: Radiation for All, None, or Some?","authors":"Zachary R Chalmers, Hannah J Roberts, Jennifer Y Wo","doi":"10.1097/PPO.0000000000000726","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000726","url":null,"abstract":"<p><strong>Abstract: </strong>The optimal management of T3N0 rectal cancer is an area of active debate that has withstood multiple decades of research. In this comprehensive review, we delve into the many nuances that come with treating T3N0 rectal cancer, particularly examining the role and evolution of radiation therapy. We review both the historical paradigms and latest advances in treatment and highlight the significance of precise preoperative staging. As the field continues to evolve, this review highlights a shift toward more tailored treatments, considering both patient goals and the desire for optimal oncologic outcomes. In the current era, clinical decision-making for T3N0 rectal cancer requires a patient-centric approach that balances effective therapy while minimizing undue side effects.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"232-237"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current State of Neoadjuvant Therapy for Locally Advanced Rectal Cancer. 局部晚期直肠癌新辅助疗法的现状。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000725
Sonal S Noticewala, Prajnan Das
{"title":"Current State of Neoadjuvant Therapy for Locally Advanced Rectal Cancer.","authors":"Sonal S Noticewala, Prajnan Das","doi":"10.1097/PPO.0000000000000725","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000725","url":null,"abstract":"<p><strong>Abstract: </strong>In locally advanced rectal cancer, neoadjuvant treatment has evolved from no preoperative treatment to the addition of radiation and systemic therapy and ultimately total neoadjuvant therapy. Total neoadjuvant therapy is the completion of preoperative radiation or chemoradiation and chemotherapy before surgery in order to maximize tumor response and improve survival outcomes. This review summarizes the literature of the neoadjuvant approaches related to locally advanced rectal cancer and highlights the nuances of selecting the appropriate treatment.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"227-231"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Point/Counterpoint #1: Chemotherapy Alone Is a Sufficient Preoperative Treatment for Rectal cancer. 观点/反方观点 1：化疗是直肠癌术前治疗的充分手段。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000735
Abhishek Kumar, Manisha Palta, Jingquan Jia
{"title":"Point/Counterpoint #1: Chemotherapy Alone Is a Sufficient Preoperative Treatment for Rectal cancer.","authors":"Abhishek Kumar, Manisha Palta, Jingquan Jia","doi":"10.1097/PPO.0000000000000735","DOIUrl":"10.1097/PPO.0000000000000735","url":null,"abstract":"<p><strong>Abstract: </strong>For decades, the standard neoadjuvant therapy regimen for locally advanced rectal cancer consisted of chemoradiation, surgical resection, and consideration of adjuvant systemic therapy. Additional data have emerged suggesting neoadjuvant systemic therapy as a reasonable alternative to chemoradiation in selected patients. In addition, a total neoadjuvant therapy approach integrating both chemotherapy and chemoradiation results in superior cancer outcomes and the potential for consideration of nonoperative management in patients with a clinical complete response. Despite a multitude of therapeutic pathways for the management of rectal cancer, what is clear, however, is the importance of a multidisciplinary approach with shared patient and provider decision-making.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"251-255"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nonoperative Management for Rectal Cancer. 直肠癌的非手术疗法
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000727
Erqi L Pollom, Vipul R Sheth, Aaron J Dawes, Thomas Holden
{"title":"Nonoperative Management for Rectal Cancer.","authors":"Erqi L Pollom, Vipul R Sheth, Aaron J Dawes, Thomas Holden","doi":"10.1097/PPO.0000000000000727","DOIUrl":"10.1097/PPO.0000000000000727","url":null,"abstract":"<p><strong>Abstract: </strong>The treatment paradigm for rectal cancer has been shifting toward de-escalated approaches to preserve patient quality of life. Historically, the standard treatment in the United States for locally advanced rectal cancer has standardly comprised preoperative chemoradiotherapy coupled with total mesorectal excision. Recent data challenge this \"one-size-fits-all\" strategy, supporting the possibility of omitting surgery for certain patients who achieve a clinical complete response to neoadjuvant therapy. Consequently, patients and their physicians must navigate diverse neoadjuvant options, often in the context of pursuing organ preservation. Total neoadjuvant therapy, involving the administration of all chemotherapy and radiation before total mesorectal excision, is associated with the highest rates of clinical complete response. However, questions persist regarding the optimal sequencing of radiation and chemotherapy and the choice between short-course and long-course radiation. Additionally, meticulous response assessment and surveillance are critical for selecting patients for nonoperative management without compromising the excellent cure rates associated with trimodality therapy. As nonoperative management becomes increasingly recognized as a standard-of-care treatment option for patients with rectal cancer, ongoing research in patient selection and monitoring as well as patient-reported outcomes is critical to guide personalized rectal cancer management within a patient-centered framework.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"238-244"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local Excision for Early-Stage Rectal Adenocarcinomas. 早期直肠腺癌的局部切除术
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000734
Kristen Donohue, Alexander Rossi, Matthew P Deek, Daniel Feingold, Nell Maloney Patel, Salma K Jabbour
{"title":"Local Excision for Early-Stage Rectal Adenocarcinomas.","authors":"Kristen Donohue, Alexander Rossi, Matthew P Deek, Daniel Feingold, Nell Maloney Patel, Salma K Jabbour","doi":"10.1097/PPO.0000000000000734","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000734","url":null,"abstract":"<p><strong>Abstract: </strong>Although total mesorectal excision (TME) remains the standard of care for rectal cancer, including early-stage T1/T2 rectal adenocarcinoma, local excision may be warranted for these early-stage tumors in a select group of patients who may decline surgery or may be nonoptimal surgical candidates. Operative approaches for transanal local excision include transanal endoscopic microsurgery or transanal minimally invasive surgery for tumors <4 cm, occupying <40% of the rectal circumference and <10 cm from the dentate line. The use of preoperative chemoradiation therapy may help to downstage tumors and allow for more limited resections, and chemoradiation may also be employed postoperatively. Local excision approaches appear to result in improved quality of life compared with TME, but limited resections may also compromise survival rates compared with TME. Multidisciplinary management and shared decision-making can allow for the desired patient outcomes.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"245-250"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local Therapy for Metastatic Colorectal Cancer: A Case-Based Review. 转移性结直肠癌的局部治疗：基于病例的综述。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000730
Michael P Dykstra, Smith Apisarnthanarax, George Poultsides, Katelyn M Atkins, David Binder, Jeffrey Olsen, Dayssy Alexandra Diaz, Daniel T Chang
{"title":"Local Therapy for Metastatic Colorectal Cancer: A Case-Based Review.","authors":"Michael P Dykstra, Smith Apisarnthanarax, George Poultsides, Katelyn M Atkins, David Binder, Jeffrey Olsen, Dayssy Alexandra Diaz, Daniel T Chang","doi":"10.1097/PPO.0000000000000730","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000730","url":null,"abstract":"<p><strong>Abstract: </strong>The oligometastatic disease state, defined as a cancer with 5 or fewer sites of metastasis, is a therapeutic opportunity to improve oncologic outcomes. Colorectal cancer (CRC) was among the first for which oligometastatic treatment was used in routine clinical practice, and recent studies have shown potential for improved overall survival with metastasis-directed therapies. As CRC is the third most common cause of cancer death in men and women, improving oncologic outcomes in this population is of paramount importance. The relatively recent identification of this treatment paradigm and paucity of high-quality data have led to heterogeneity in clinical practice. This review will explore perspectives of a panel of surgical and radiation oncologists for complex or controversial cases of metastatic CRC.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"280-289"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local-Regional Therapy for Oligometastatic Colorectal Cancer. 治疗寡转移性结直肠癌的局部区域疗法
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000729
Sean R Miller, Daniel T Chang
{"title":"Local-Regional Therapy for Oligometastatic Colorectal Cancer.","authors":"Sean R Miller, Daniel T Chang","doi":"10.1097/PPO.0000000000000729","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000729","url":null,"abstract":"<p><strong>Abstract: </strong>Colorectal cancer is one of the most common malignancies in the United States as well as a leading cause of cancer-related death. Upward of 30% of patients ultimately develop metastatic disease, most commonly to the liver and lung. Untreated, patients have poor survival. Historically, patients with oligometastatic disease were treated with resection leading to long-term survival; however, there are many patients who are not surgical candidates. Innovations in thermal ablation, hepatic artery infusions, chemoembolization and radioembolization, and stereotactic ablative radiation have led to an expansion of patients eligible for local therapy. This review examines the evidence behind each modality for the most common locations of oligometastatic colorectal cancer.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"272-279"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of Locally Recurrent Rectal Cancer: A Review. 局部复发直肠癌的治疗：综述。
IF 2.6 4区 医学
Cancer journal Pub Date : 2024-07-01 DOI: 10.1097/PPO.0000000000000728
Samuel N Regan, Samantha Hendren, John C Krauss, Oxana V Crysler, Kyle C Cuneo
{"title":"Treatment of Locally Recurrent Rectal Cancer: A Review.","authors":"Samuel N Regan, Samantha Hendren, John C Krauss, Oxana V Crysler, Kyle C Cuneo","doi":"10.1097/PPO.0000000000000728","DOIUrl":"https://doi.org/10.1097/PPO.0000000000000728","url":null,"abstract":"<p><strong>Abstract: </strong>Up to 10% of patients with locally advanced rectal cancer will experience locoregional recurrence. In the setting of prior surgery and often radiation and chemotherapy, these represent uniquely challenging cases. When feasible, surgical resection offers the best chance for oncologic control yet risks significant morbidity. Studies have consistently indicated that a negative surgical resection margin is the strongest predictor of oncologic outcomes. Chemoradiation is often recommended to increase the chance of an R0 resection, and in cases of close/positive margins, intraoperative radiation/brachytherapy can be utilized. In patients who are not surgical candidates, radiation can provide symptomatic relief. Ongoing phase III trials are aiming to address questions regarding the role of reirradiation and induction multiagent chemotherapy regimens in this population.</p>","PeriodicalId":9655,"journal":{"name":"Cancer journal","volume":"30 4","pages":"264-271"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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