Rectal Cancer: Neoadjuvant Therapy [sounds like]
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Rectal Cancer: Neoadjuvant Therapy- Key Concepts
- Utilization of Systemic Chemotherapy in the Neoadjuvant Setting
- Radiation Therapy With Systemic Chemo Therapy (Concurrent)
- Consolidation Versus Induction Chemotherapy
- Neoadjuvant Immunotherapy
- Conclusion
- References
- Introduction
- Rectal Cancer Staging
- History of (Neo)Adjuvant Therapy
- Adjuvant Radiation
- Neoadjuvant Radiation
- The Foundation Trials
- Short-course Versus Long-course Radiation
- Total Neoadjuvant Chemoradiation Therapy (TNT)
Malignancy- A 67-year-old man who has never had colonoscopy presented to the emergency room reporting abdominal pain, distention, constipation, and blood per rectum for the past 2 days. He says his bowel movements are thin in caliber. Computed tomography (CT) of abdomen and pelvis shows a large mass in the mid rectum with proximal colonic distention. Magnetic resonance imaging (MRI) of the pelvis with rectal cancer protocol shows a mid-rectal T4N2M0 lesion. The mass is not amendable to endoscopic placement of stent due to angulation. The best next step is
- A 56-year-old obese man with locally advanced distal rectal cancer is treated with total neoadjuvant chemoradiation therapy. His is a 45-pack-per-year smoker. Restaging reveals no sign of metastasis. Magnetic resonance imaging (MRI) rectal protocol reveals partial clinical response and flexible sigmoidsociopy that shows a 3-cm tumor involving the sphincteric complex. What is the best surgical approach in his care?
- A healthy 65-year-old male patient is diagnosed with a moderately differentiated rectal adenocarcinoma, microsatellite stable. Staging was negative for metastatic disease. Pelvic magnetic resonance imaging (MRI) shows possible involvement of the prostate with mesorectal lymph nodes suspicious for metastasis. What is the current recommended course of treatment for this patient, given these findings?
- A 48-year-old man with T3N1 rectal adenocarcinoma is treated with total neoadjuvant therapy. He undergoes repeat clinical staging with computed tomography (CT) of his chest, abdomen, and pelvis, and magnetic resonance imaging (MRI) of his pelvis. He is found to have flexible sigmoidoscopy revealing a complete clinical response. Which of the following is an accurate prognosis?
- A 61-year-old man is found to have a 2-cm mass in the mid-rectum (8 cm from the anal verge) on diagnostic colonoscopy. Biopsy reveals moderately differentiated adenocarcinoma. Computed tomography (CT) reveals no evidence of metastatic disease, and magnetic resonance imaging (MRI) demonstrates a cT3, node-negative cancer. After presentation at a multidisciplinary tumor board, the patient agrees to total neoadjuvant therapy. The patient has a complete clinical response to treatment and opts for close radiologic and endoscopic surveillance in an effort to avoid surgery. On a surveillance proctoscopy 6 months after treatment, the patient is found to have a 7-mm recurrence at the original cancer site. Which of the following is the best next step in management?
- A 57-year-old man undergoes total neoadjuvant therapy (TNT) for management of a cT3N1M0 rectal cancer. After completion of both chemotherapy/radiotherapy and consolidation chemotherapy, the presence of complete clinical response to treatment is assessed by
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
- A 55-year-old male patient presents to the clinic for evaluation of intermittent fecal incontinence and fecal urgency. The patient has a history of stage III rectal cancer for which he completed total neoadjuvant therapy (TNT) and low anterior resection (LAR) with diverting loop ileostomy. He is now 3 months status post ileostomy reversal. Despite fiber supplementation and intermittent antidiarrheal medication use, he experiences stool stacking and incomplete evacuation 3 days per week. The patient’s symptoms are consistent with
Indications for Neoadjuvant Therapy
Benign Disease- Perioperative
- Rectal Cancer: Nonoperative Management
- Proctectomy for Rectal Cancer
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Adjuvant Therapy for Rectal Adenocarcinoma
- Locally Recurrent Rectal Cancer
Management of Rectal Cancer (2020)- ASCRS Annual Meeting 2021
- Rationale for Multimodality Therapy
- Management of Rectal Cancer 2023 Supplement (2023)
- Colorectal Cancer: Preoperative Evaluation and Staging
- Rectal Cancer: Local Excision
- Malignancy
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- A 64-year-old man received neoadjuvant chemoradiotherapy followed by a low anterior resection 3 years ago for the treatment of rectal cancer. He complains of persistent fecal urgency, occasional fecal incontinence, clustered stools, and incomplete evacuation, which has persisted since the time of surgery. What is the most likely cause of these symptoms?
- A 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Miscellaneous
- Fundamentals of Rectal Cancer Surgery
- ASCRS Annual Meeting 2022
- Preoperative Staging
- Benign Disease
- A 55-year-old man with a history of ulcerative colitis (UC) diagnosed in his early 20s presents with a new diagnosis of distal rectal moderately differentiated adenocarcinoma. Mismatch repair (MMR) protein expression is intact; routine surveillance endoscopy showed a mass starting ~2 cm from the anal verge with all other biopsies negative for dysplasia. Laboratory results reveal unremarkable levels of carcinoembryonic antigen (CEA), comprehensive metabolic panel (CMP), and complete blood count (CBC). Systemic staging is negative for metastatic disease. Local staging with magnetic resonance imaging (MRI) reveals a T3N1 lesion. Based on a multidisciplinary tumor board discussion, the patient is planned for total neoadjuvant chemotherapy with upfront chemoradiation followed by consolidation chemotherapy. After this therapy is completed, what is the optimal surgical course for this patient?
- A 55-year-old man with obesity has completed neoadjuvant chemoradiation therapy for CT3 N2 M0 distal rectal cancer. During his posttreatment evaluation, he is found to have a partial clinical response and is offered a low anterior resection. His total mesorectal excision is completed uneventfully; however, the mesentery to his terminal ileum is thickened and foreshortened causing difficulty in getting the bowel to reach the abdominal wall in the ideal location. The best option for fecal diversion in this patient is
- Rectal Cancer Pathology Assessment
- Surveillance After Rectal Cancer Treatment
- Indications for Extended Resection
- Management of Local Recurrences
- About ASCRS Textbook of Colon and Rectal Surgery
- Large Bowel Obstruction
Surgical and Non-Surgical Approaches to the Management of Rectal Cancer- Tailored Mesorectal Excision