Humans ; Rectal Neoplasms ; therapy

Humans ; Rectal Neoplasms ; diagnosis ; therapy

Rectal cancer is an emerging health issue in Korea because its incidence is rapidly increasing with changes in life styles and diets. The optimal treatment of rectal cancer is based on multimodality. Among them, surgical treatment is the corner-stone. In the past, local recurrence rate has been reported as high as 30-40%, but the concept of total mesorectal excision (TME) lowered the rate of local recurrence down to less than 10%. TME focuses on sharp pelvic dissection and complete removal of rectal cancer with surrounding mesorectum inside the rectal proper fascia. TME is now considered as a standard procedure for surgical treatment of mid and low rectal cancer. With the introduction of pelvic magnetic resonance imaging (MRI) for preoperative staging of rectal cancer, risk factors for local recurrence can be predicted before surgery to distinguish patients who are in high risk for recurrence that requires preoperative neoadjuvant chemoradiation therapy. Early rectal cancer was assessed by transrectal ultrasonography (TRUS) and endorectal MRI with coil. Transanal local excision can be applied with anal sphincter preservation safely. Neoadjuvant chemoradiation therapy was performed in patients with locally advanced rectal cancer, and this resulted in tumor size reductions and histopathologic downstaging effect. As far as the quality of life is concerned, sexual and voiding function are much improved by techniques preserving nerve. Many experts have dealt with challenging practical problems of managing rectal cancer from diagnosis to quality of life. This issue contains recent progresses in the diagnosis and treatment of rectal cancer which will serve as a comprehensive reference for those who manage rectal cancer in their medical practice.
Humans ; Rectal Neoplasms/diagnosis/*therapy

Combined Modality Therapy ; Humans ; Rectal Neoplasms ; therapy

No abstract available.
Chemoradiotherapy* ; Drug Therapy* ; Humans ; Rectal Neoplasms*

Combined Modality Therapy ; Evidence-Based Medicine ; Humans ; Rectal Neoplasms ; therapy

Rectal cancer is one of the most malignant tumors in gastrointestinal tract, while low rectal cancer with locally advanced stage is the most common type in China. The concept of neo-adjuvant therapy has challenged the traditional treatment strategy for rectal cancer, and has showed encouraging effects in local relapse control, radical resection and sphincter preservation. However, some important issues still remain controversial, including course and dose of radiotherapy, choice of chemotherapy regimen, long-term benefits. This article aims to review and discuss related issues of neo-adjuvant therapy.
China ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Rectal Neoplasms ; therapy

OBJECTIVETo analyze the association between the response of primary tumor to neoadjuvant chemoradiotherapy (CRT) and lymph node status in mid and low rectal cancer.

METHODSSeventy-one patients with locally advanced mid and low rectal cancer underwent preoperative CRT followed by surgery. Surgical specimens were examined by surgeons and pathologists to obtain more lymph nodes and the histological sections were examined. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to investigate the relationship between tumor regression and lymph node status.

RESULTSAll the patients completed the neoadjuvant CRT. Twelve patients achieved pathological complete response, of whom one was not operated and on surveillance. Pathological examination of the remaining 70 patients showed that the tumor was downstaged to T 0-2 group in 39 patients, among whom 5 patients (12.8%) had positive lymph nodes. Tumor was not downstaged in 31 patients, of whom 10 patients (32.3%) had positive nodes. The difference between the two groups was statistically significant (P=0.029).

CONCLUSIONTumor regression is consistent with the reduction of lymph node metastasis after preoperative CRT.

The current conventional treatment for locally advanced rectal cancer with stage II or III is surgery following or followed by chemoradiotherapy (CRT), which improved local control and overall survival when compared with surgery alone. Recently, a prospective randomized study with a large sample size and long-term follow-up reported that preoperative CRT resulted in improved local control and sphincter preservation, reduced toxicities, and comparative overall survival when compared with postoperative CRT. However, diagnostic imaging for accurate stage should be applied. In addition, chemotherapeutic regimen, schedule for radiation therapy, and timing of surgery should be also optimized in order to maximize the effect of preoperative CRT.
Combined Modality Therapy ; Humans ; Rectal Neoplasms/*drug therapy

Neoadjuvant chemoradiation combined with radical surgery has been established as the standard care for locally advanced rectal cancer(T3-T4 and/or N1-N2). Approximately 20% patients who achieve complete pathological response have an improved prognosis. Appropriate patient selection may help avoid over-treatment. Evaluation of treatment response mostly with imaging study and pathology after neoadjuvant chemoradiation and following surgery is essential for the subsequent selection of treatment strategy.
Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Patient Selection ; Prognosis ; Rectal Neoplasms ; therapy