News Update on Rectal Cancer Research: April – 2019

Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis

Background: the aim of this meta-analysis is to judge the proof on the market on the security similarly as effectiveness of robotic surgery as compared to traditional laparoscopic surgery for body part cancer.

Material and methods: A comparison of laparoscopic and robotic surgical treatments for body part cancer was collected. Eligible trials that analyzed probabilistic hazard ratios (HR) for endpoints of interest (including perioperative morbidity) and surgical  complications were enclosed in our review.

Results: a complete of six studies were enclosed supported this inclusion criteria. The pooled information showed that R-TME gave the impression to have association with outstanding reduction within the surgical  morbidity rate as compared to L-TME. Moreover, R-TME was conjointly coupled to lower conversion, small node variety, and longer operation time compared with L-TME. However, there was no distinction in hospital keep, positive vary of circumferential surgery and blood loss between the 2 study teams.

Conclusions: Robotic body part cancer surgery provides favorable outcomes and is taken into account as a secure surgical technique in terms of surgical  oncologic safety. Like laparoscopic TME surgery, robotic surgery could also be a legitimate various and complementary approach with helpful effects on minimally-invasive surgery. [1]

Serial circulating tumour DNA analysis during multimodality treatment of locally advanced rectal cancer: a prospective biomarker study

Objective For patients with regionally advanced body part cancer (LARC), adjuvant therapy choice following surgery remains a serious clinical quandary. Here, we have a tendency to investigated the power of current tumor desoxyribonucleic acid (ctDNA) to enhance risk stratification in patients with LARC.

Design we have a tendency to listed patients with LARC (T3/T4 and/or N+) planned for neoadjuvant chemoradiotherapy. Plasma samples were collected pretreatment, postchemoradiotherapy and 4–10 weeks when surgery. physical mutations in individual patient’s tumor were known via massively parallel sequencing of fifteen genes unremarkably mutated in body part cancer. we have a tendency to then designed personalized assays to quantify ctDNA in plasma samples. Patients received adjuvant medical care at practitioner discretion, unsighted to the ctDNA results.

Results we have a tendency to analysed 462 serial plasma samples from 159 patients. ctDNA was detectable in seventy seven, 8.3% and 12-tone music of pretreatment, postchemoradiotherapy and postsurgery plasma samples. considerably worse recurrence-free survival was seen if ctDNA was detectable when chemoradiotherapy (HR half-dozen.6; P [2]

Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy

The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy

Objective: To demonstrate the distinction in organ-preservation rates and turning away of definitive surgery among cT2N0 body part cancer patients undergoing two totally different chemoradiation (CRT) regimens.

Background: Patients with cT2N0 body part cancer are additional seemingly to develop complete response to neoadjuvant cathode-ray tube. Organ preservation has been thought of another treatment strategy for designated patients. Radiation dose-escalation and consolidation therapy are related to enhanced rates of response and should improve possibilities of organ preservation among these patients.

Methods: Patients with distal and nonmetastatic cT2N0 body part cancer managed by neoadjuvant cathode-ray tube were retrospectively reviewed. Patients undergoing normal cathode-ray tube (50.4 Gy and a couple of cycles of 5-FU-based chemotherapy) were compared with those undergoing extended cathode-ray tube (54 Gy and vi cycles of 5-FU-based chemotherapy). Patients were assessed for tumour response at eight to ten weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy (“Watch and Wait”). Patients were mentioned salvage surgery within the event of native return throughout follow-up.

Results: xxxv patients underwent normal and forty six patients extended cathode-ray tube. Patients endureing extended cathode-ray tube were additional seemingly to undergo organ preservation and avoid definitive surgical surgical operation at 5years (67% vs 30%; P = zero.001). when development of a cCR, surgery-free survival is analogous between extended and normal cathode-ray tube teams at five years (78% vs 56%; P = zero.12).

Conclusions: Dose-escalation and consolidation therapy results in enhanced long organ-preservation rates among cT2N0 body part cancer. when action of a cCR, the chance for native return and wish for salvage surgery is analogous, no matter the cathode-ray tube plan. [3] 

Predictive Value of [18F]FDG PET/CT for Lymph Node Metastasis in Rectal Cancer

[18F]Fluorodeoxyglucose ([18F]FDG) antilepton emission picturing/computed tomography (PET/CT) is often used for body part cancer staging, however improved diagnostic strategies for nodal metastases are required. we tend to aimed to judge whether or not the mix model of the metabolic tumour volume of primary tumor (T_MTV) and most standardized uptake worth of lymphatic tissue (N_SUVmax) on pretreatment [18F]FDG PET/CT may improve nodal metastases prediction in body part cancer. we tend to listed a complete of 166 body part cancer patients UN agency underwent pretreatment [18F]FDG PET/CT and surgical operation while not neoadjuvant treatment between Gregorian calendar month 2009 and August 2016. Visual and semiquantitative PET/CT parameters were obtained. Associations between clinicopathological, PET/CT-derived variables and nodal metastases were evaluated by logistical multivariate analysis. Nodal metastases.

were confirmed histologically in sixty eight of the 166 patients (41%). Uni- and variable analyses incontestible T_MTV and N_SUVmax were freelance prophetical factors for nodal metastases. The c-statistics of the mix model was zero.806 (Standard Error, 0.034; ninety five Confidence Interval, 0.737–0.863), that showed vital improvement compared to T_MTV (0.698, P = 0.0002) or N_SUVmax (0.720, P = 0.0008) alone. T_MTV and N_SUVmax are severally correlative with nodal metastases. moreover, the mix model showed improved performance for risk prediction; therefore, [18F]FDG PET/CT might need a task in body part cancer staging and treatment designing. [4]

MicroRNA-21 as a Potential Biomarker for Colorectal Cancer Diagnosis: A Meta-analysis

Aims: body part cancer (CRC) occupies a vital position within the morbidity and mortality constitution of malignancies. In recent years, mounting literature has reportable concerning the upregulating expression of microRNA-21 in blood and stool of CRC patients, that advised that microRNA-21 might become a unique potential biomarker for CRC. Consequently, this meta-analysis was designed to consistently review the values of microRNA-21 in CRC identification.

Methodology: Databases, together with Cochrane library, PubMed, EMbase, Google Scholar, and Chinese National information Infrastructure, were scanned to retrieve relevant articles that specialize in microRNA-21 in CRC identification. Articles were then filtered in line with the PRISMA statement and assessed by quality assessment of identification accuracy studies-2. Sensitivity (SEN), specificity (SPE), positive chance quantitative relation, negative chance quantitative relation, and diagnostic odds quantitative relation (DOR) were pooled exploitation fixed-effects model or random-effects model. outline receiver operational characteristic (SROC) curve and space beneath the curve (AUC) were accustomed estimate the general diagnostic performance.

Results: a complete of fifteen studies, comprising 1268 CRC patients and 910 healthy controls, were registered during this meta-analysis. For bodily fluid miR-21, the pooled DOR, SEN, and SPE were thirteen.97 (95% CI: eight.44–23.11), 0.73 (95% CI: zero.69–0.77), and 0.83 (95% CI: zero.76–0.89), severally; for plasma miR-21, the pooled DOR, SEN, and SPE were eight.03 (95% CI: three.30–19.52), 0.67 (95% CI: zero.60–0.73), and 0.76 (95% CI: zero.69–0.81), severally; and for feculent miR-21, the pooled DOR, SEN, and SPE were seven.06 (95% CI: a pair of.17–22.95), 0.33 (95% CI: zero.28–0.37), and 0.91 (95% CI: zero.88–0.93), respectively. Moreover, the United Self-Defense Group of Colombia values of bodily fluid, plasma, and feculent miR-21 in CRC identification were zero.8701, 0.8295, and 0.6742, respectively.

Conclusion: Blood miR-21 demonstrates sensible diagnostic performance, and bodily fluid samples are higher than plasma samples in CRC identification. For feculent miR-21, the sensitivity is disappointing, however the specificity is favorable in predicting CRC patients. [5]

Reference

[1] Sun, X.Y., Xu, L., Lu, J.Y. and Zhang, G.N., 2019. Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis. Minimally Invasive Therapy & Allied Technologies, pp.1-8. (Web Link)

[2] Tie, J., Cohen, J.D., Wang, Y., Li, L., Christie, M., Simons, K., Elsaleh, H., Kosmider, S., Wong, R., Yip, D. and Lee, M., 2019. Serial circulating tumour DNA analysis during multimodality treatment of locally advanced rectal cancer: a prospective biomarker study. Gut, 68(4), pp.663-671. (Web Link)

[3] Habr-Gama, A., São Julião, G.P., Vailati, B.B., Sabbaga, J., Aguilar, P.B., Fernandez, L.M., Araújo, S.E.A. and Perez, R.O., 2019. Organ preservation in cT2N0 rectal cancer after neoadjuvant chemoradiation therapy: the impact

of radiation therapy dose-escalation and consolidation chemotherapy. Annals of surgery, 269(1), pp.102-107. (Web Link)

[4] Predictive Value of [18F]FDG PET/CT for Lymph Node Metastasis in Rectal Cancer
Sung Hoon Kim, Bong-Il Song, Beong Woo Kim, Hae Won Kim, Kyoung Sook Won, Sung Uk Bae, Woon Kyung Jeong & Seong Kyu Baek
Scientific Reportsvolume 9, Article number: 4979 (2019) (Web Link)

 

[5] Zhen, C.-H., Yao, G.-J., Tan, Y., Yang, L., Yu, X.-F. and Li, F.-R. (2016) “MicroRNA-21 as a Potential Biomarker for Colorectal Cancer Diagnosis: A Meta-analysis”, Journal of Advances in Medicine and Medical Research, 17(8), pp. 1-13. doi: 10.9734/BJMMR/2016/27261. (Web Link)

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