Clinical Case: Patient with Locally Rectal Cancer in Watch and Wait Program with Perianal Tumor Fistula (original) (raw)
Related papers
Medicina Moderna - Modern Medicine, 2020
Anorectal adenocarcinoma is a very rare complication which can occur during the long-lasting evolution of perianal fi stulas (PAF), chronic inflammation being the main predisposing factor incriminated for malignant evolution. Moreover, in rare cases (only 28 being published until now), adenocarcinoma developing at the level of a perianal fi stula may occur by migration of tumoral cells originating from a rectal cancer into the granulation tissue of the fi stula. We present the case of a patient with a rectal adenocarcinoma that has metastasized to a perianal fi stula, in evolution for 7 years. Clinical suspicion of malignant seeding at the site of the fi stula has been confi rmed by immunohistochemical studies.
International Journal of Radiation Oncology*Biology*Physics, 1989
Between 1976 and 1984, 139 patients with rectal cancer were treated with complete surgical resection and postoperative adjnvant pelvic radiation therapy with or without chemotherapy. In this group, tumor extended beyond the bowel wall or involved lymph nodes or both. Irradiation was begun between 15 and 182 days postoperatively (median delay, 42 days). The radiation was delivered with 4-, 6-, or lo-MV photons given 5 days per week at 1.8 to 2.0 Gy per fraction. Total doses ranged from 3.8 to 64.4 Gy (median, 50 Gy). The fields were APPA in 49 and AP:PA plus laterals in 90. Forty-four received concurrent chemotherapy: Wluorouracil and semustlne in 37, and 5fluorouracil alone in seven. Follow-up in survivors ranged from 2 to 10 years (medii, 4.2 years). This analysis includes all failures, both initial and subsequent sites of failure. Local failure occurred in 30 (22%) of the 139 patients overall, 6 (18%) of 33 in Stage B-2, 1 of 3 in Stage B-3, 2 (10%) of 20 in Stage C-l, 20 (26%) of 76 in Stage C-2, and 1 (14%) of 7 in Stage C-3. Five-year actuarial survival was 59% overall, 82% in Stage B-2,79% in Stages B-2 and B-3,89% in Stage C-l, 41% in Stage C-2, and 42% in Stages C-2 and C-3. The following prognostic factors were independently associated with poorer survival and increasing distant failure: lymph node involvement, tumor extension beyond the bowel wall, and high histologic grade. Use of chemotherapy was associated with a significant improvement in survival and decrease in distant failure. No single factor was significantly associated with local failure. Adequate perineal coverage after combined abdominoperineal resection yielded significantly fewer perineal failures. Overall, serious complications developed in 71, but none was fatal. Treatment recommendations and optimal treatment techniques are discussed. Adjuvant chemotherapy, Adjuvant radiotherapy, Rectal cancer. INTRODUmION
Arquivos de gastroenterologia
The approach of locally advanced extra-peritoneal rectal adenocarcinoma implies a treatment with neoadjuvant chemoradiotherapy associated with total mesorectal excision surgery. However, the tumors respond variably to this neoadjuvant therapy, and the mechanisms for response are not completely understood. Evaluate the variables related to the complete tumor response and the outcomes of patients who underwent surgery, comparing those with partial tumor regression and those with total remission of rectal lesion, at the pathological examination. Retrospective analysis of medical records of 212 patients operated between 2000 and 2010, in which 182 (85.9%) obtained partial remission at neoadjuvant therapy (Group 1) and 30 (14.1%), total remission (Group 2). No difference was found between the groups in relation to gender, ethnicity, age, tumor distance from the anal verge, occurrence of metastases and synchronous lesions on preoperative staging, dose of radiotherapy and performed surgery...
Nonoperative Management of Rectal Cancer With Complete Clinical Response After Neoadjuvant Therapy
Annals of Surgery, 2012
Introduction: Nonoperative management (NOM) of rectal cancer after a complete clinical response (cCR) to neoadjuvant therapy is controversial. In this article, we retrospectively reviewed the outcomes of patients managed with selective NOM after a cCR to neoadjuvant treatment and compared these with patients who underwent standard rectal resection with a pathological complete response (pCR). Methods: Patients completing neoadjuvant chemoradiotherapy (CRT) for stage I to III rectal cancer between January 2006 and August 2010 were retrospectively reviewed. Median follow-up was calculated in months after completion of CRT. Results: Thirty-two patients (median follow-up 28 months) were treated by NOM after a cCR. Among 265 treated by CRT and rectal resection, 57 patients (22%) had a pCR and formed the control group (median follow-up 43 months). Factors associated with selective use of NOM included lower pretreatment stage, older age, and distal tumor location (P < 0.05). In the NOM group, 6 recurred locally (median 11 months, range 7-14), 3 of whom also had concurrent distant recurrence. All 6 local failures were controlled by salvage rectal resection with no further local recurrence of disease (median follow-up 17 months). In the rectal resection/pCR group, there were no local failures. The 2-year distant disease-free survival (88% vs 98%, P = 0.27) and overall survival (96% vs 100%, P = 0.56) were similar for NOM and rectal resection/pCR groups. Conclusions: Rectal resection was successfully avoided in 81% of patients selected for NOM. When combined with salvage surgery, NOM appears to achieve similar local and distant disease control compared with patients with a pCR treated by rectal resection. Longer follow-up and prospective trials are warranted to evaluate this promising treatment option.
Diagnostics, 2021
Multimodal treatments for rectal cancer, along with significant research on predictors to response to therapy, have led to more conservative surgical strategies. We describe our experience of the rectal sparing approach in rectal cancer patients with clinical complete response (cCR) after neoadjuvant treatment. We also specifically highlight our clinical and imaging criteria to select patients for the watch and wait strategy (w&w). Data came from 39 out of 670 patients treated for locally advanced rectal cancer between January 2016 until February 2020. The selection criteria were a clinical complete response after neoadjuvant chemotherapy managed with a watch and wait (w&w) strategy. A strict follow-up period was adopted in these selected patients and follow-ups were performed every three months during the first two years and every six months after that. The median follow-up time was 28 months. Six patients had a local recurrence (15.3%); all were salvageable by total mesorectal exc...
Introduction: the standard treatment for locally advanced extra-peritoneal rectal adenocarcinoma, consists of neoadjuvant treatment with radiotherapy and chemotherapy followed by total mesorectal excision. Objective: evaluate, retrospectively, the patients submitted to neoadjuvant therapy and surgery that presents with total remission of the lesion in the anatomopathological examination. Methods: between 2000 and 2010, 212 patients underwent surgery at the Coloproctology Unit at DMAD at FCM-UNICAMP. They were grouped as: rectosigmoidectomy and colorectal anastomosis (n = 54), rectosigmoidectomy with coloanal anastomosis (n = 41), 114 abdominoperineal resection of the rectum (n = 114) and other (n = 3). Results: thirty (14.2%) patients (mean age 57.6 years; 60% males) showed complete remission of the rectal lesion. 4 (13.3%) had compromised lymph nodes and/or lymphatic invasion At follow-up (mean 51.9 months), 4 (13.3%) presented with local recurrence (one patient) or distant metastases (two patients had liver metastasis, one had liver and lung, and one had bone metastasis). The mean survival was 86.7%. Conclusion: patients with a complete tumor response show ed an increased survival rate, however, the same patients without evidence of residual tumors could develop local recurrence or distant metastases on a later follow-up.
Continued progress of preoperative therapy for rectal cancer
Clinical & Translational Oncology - CLIN TRANSL ONCOL, 2001
The indications for adjuvant therapy for rectal cancer are based on the patterns of failure after surgery. Despite radical surgery, local-regional failure occurs frequently in patients with transmural or node-positive rectal cancers. The incidence of local failure in the pelvis increases from less than 10% in stages T1-2N0M0 to 15% to 30% in stages T3N0M0 and T1-2N1M0, and is as high as 40% to 60% in stages T3-4N1-2M0 1 . Much of the recent debate in adjuvant therapy of rectal cancer has centered on the merits of preoperative versus postoperative adjuvant therapy. In some clinical situations, more than one approach may be acceptable. Their selection depends on factors such as tumor histology, size, location, mobility, anatomic constraints, intercurrent medical disease, and the technical expertise of the surgeon and radiation oncologist. Since the National Cancer Institute Consensus Conference in 1990 2 , postoperative combined modality therapy has been considered, at least in the Un...
Neoadjuvant Treatment in Rectal Cancer: Actual Status
Chemotherapy Research and Practice, 2011
Neoadjuvant (preoperative) concomitant chemoradiotherapy (CRT) has become a standard treatment of locally advanced rectal adenocarcinomas. The clinical stages II (cT3-4, N0, M0) and III (cT1-4, N+, M0) according to International Union Against Cancer (IUCC) are concerned. It can reduce tumor volume and subsequently lead to an increase in complete resections (R0 resections), shows less toxicity, and improves local control rate. The aim of this review is to summarize actual approaches, main problems, and discrepancies in the treatment of locally advanced rectal adenocarcinomas.