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ABSTRACT: BACKGROUND: We investigated patterns of failure in patients with locally advanced rectal cancer (LARC) according to chemoradiotherapy (CRT) timing: pre-operative versus post-operative. Also, patterns of failure, particularly distant metastasis (DM), were analyzed according to tumor location within the rectum. METHODS: In total, 872 patients with LARC who had undergone concurrent CRT and radical surgery between 2001 and 2007 were analyzed retrospectively. Concurrent CRT was administered pre-operatively (cT3--4) or post-operatively (pT3--4 or pN+) in 550 (63.1%) and 322 (36.9%) patients, respectively. Median follow-up period was 86 (range, 12--133) months for 673 living patients. Local recurrence (LR) was defined as any disease recurrence within the pelvis, and any failure outside the pelvis was classified as a DM. Only the first site of recurrence was scored. RESULTS: In total, 226 (25.9%) patients developed disease recurrence. In the pre-operative CRT group, the incidences of isolated LR, combined LR and DM, and isolated DM were 17, 21, and 89 patients, respectively. In the post-operative CRT group, these incidences were 8, 15, and 76 patients, respectively. LR within 2 years constituted 44.7% and 60.9% of all LRs in the pre-operative and post-operative CRT groups, respectively. Late (> 5 years) LR comprised 13.2% and 4.3% of all LRs in the pre-operative and post-operative CRT groups, respectively. The lung was the most common DM site (108/249, 43.4%). Lung or para-aortic lymph node metastasis developed more commonly from low-to-mid rectal tumors while liver metastasis developed more commonly from upper rectal tumors. Lung metastasis occurred later than liver metastasis (n = 54; 22.6 +/- 15.6 vs. 17.4 +/- 12.1 months; P = 0.035). CONCLUSIONS: This study showed that LARC patients receiving pre-operative CRT tended to develop late LR more often than those receiving post-operative CRT. Further extended follow-up than is conventional may be necessary in LARC patients who are managed with optimized multimodal treatments, and the follow-up strategy may need to be individualized according to tumor location within the rectum.
Radiation Oncology 05/2013; 8(1):114. · 2.32 Impact Factor
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Seung-Gu Yeo,
Jae Hwan Oh,
Dae Yong Kim,
Ji Yeon Baek,
Sun Young Kim,
Ji Won Park, Min Ju Kim,
Hee Jin Chang,
Tae Hyun Kim,
Jong Hoon Lee,
Hong Seok Jang,
Jun-Gi Kim,
Myung Ah Lee,
Taek-Keun Nam
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ABSTRACT: PURPOSE: A prospective phase 2 multicenter trial was performed to investigate the efficacy and safety of preoperative short-course concurrent chemoradiation therapy (CRT) followed by delayed surgery for patients with locally advanced rectal cancer. METHODS AND MATERIALS: Seventy-three patients with cT3-4 rectal cancer were enrolled. Radiation therapy of 25 Gy in 5 fractions was delivered over 5 consecutive days using helical tomotherapy. Concurrent chemotherapy was administered on the same 5 days with intravenous bolus injection of 5-fluorouracil (400 mg/m(2)/day) and leucovorin (20 mg/m(2)/day). After 4 to 8 weeks, total mesorectal excision was performed. The primary endpoint was the pathologic downstaging (ypStage 0-I) rate, and secondary endpoints included tumor regression grade, tumor volume reduction rate, and toxicity. RESULTS: Seventy-one patients completed the planned preoperative CRT and surgery. Downstaging occurred in 20 (28.2%) patients, including 1 (1.4%) with a pathologic complete response. Favorable tumor regression (grade 4-3) was observed in 4 (5.6%) patients, and the mean tumor volume reduction rate was 62.5 ± 21.3%. Severe (grade ≥3) treatment toxicities were reported in 27 (38%) patients from CRT until 3 months after surgery. CONCLUSIONS: Preoperative short-course concurrent CRT followed by delayed surgery for patients with locally advanced rectal cancer demonstrated poor pathologic responses compared with conventional long-course CRT, and it yielded considerable toxicities despite the use of an advanced radiation therapy technique.
International journal of radiation oncology, biology, physics 12/2012; · 4.59 Impact Factor
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ABSTRACT: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique affording full-thickness resection of rectal tumors and can also be used as a platform for transrectal access to the peritoneal cavity for NOTES (natural orifice transluminal endoscopic surgery) procedures. The authors investigated the anatomical characteristics of the pelvis in Koreans to develop an ergonomically designed NOTES platform. A total of 256 patients (156 men and 100 women) who underwent pelvic magnetic resonance imaging for evaluating rectal neoplasms were enrolled for analysis. The authors retrospectively reviewed and calculated anatomical lengths and angles on pelvic magnetic resonance images and analyzed differences in pelvic anatomy in terms of patient gender, age, and body mass index. Various angulations were noted from the anal canal to the sacral promontory, attributable to the shape of the sacral bone. Minimal difference in pelvic anatomy was evident between men and women. In conclusions, the authors expect that their data will be useful in the development of ergonomic TEM-NOTES platforms.
Surgical Innovation 06/2012; · 2.13 Impact Factor
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ABSTRACT: Castleman’s disease is a benign lymphoid proliferative disorder, which most commonly presents as a solitary mass in the mediastinum,
although extrathoracic sites have been reported in the neck, axilla, pelvis, mesentery, pancreas, and retroperitoneum. We
report a case of asymptomatic, isolated Castleman’s disease in the mesorectum, which is extremely rare. The patient was a
34-year-old woman who underwent investigations for vaginal spotting. A presacral mass was located on the left side of the
rectum, 10 cm from the anal verge. Contrast-enhanced computed tomography showed a large, well-demarcated, strongly enhancing
mass with internal radiating septa in the mesorectum. The mass was well circumscribed and isointense to muscle on T1-weighted
magnetic resonance imaging, appearing as a slightly hyperintense mass on T2-weighted imaging. We performed laparoscopic mesorectal
mass excision, and histological examination revealed features typical of the hyaline-vascular type of Castleman’s disease.
Thus, when a mesorectal mass is being investigated, Castleman’s disease should be considered in the differential diagnosis.
Key wordsCastleman’s disease–Hyaline-vascular type–Mesorectal mass
Surgery Today 04/2012; 41(2):271-275. · 1.22 Impact Factor
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ABSTRACT: Although serum carcinoembryonic antigen (CEA) levels reflect tumor volume in rectal cancer patients intrapersonally, it is unclear interpersonally. We determined the correlation between pretreatment serum CEA levels and tumor volume.
A total of 489 patients with locally advanced primary rectal cancer who underwent preoperative chemoradiotherapy followed by surgery between October 2001 and April 2007 were retrospectively evaluated. CEA levels were measured by chemiluminescent microparticle immunoassay, and magnetic resonance (MR) volumetry was performed using MR data. The correlation between CEA levels and tumor volume was assessed using linear regression analysis and one-way analysis of variance. The prognostic values of CEA levels and tumor volume for survival were evaluated.
There was no significant correlation between CEA levels and tumor volume. The five-year overall survival and disease-free survival were 89.0%, 80.6% and 82.9%, and 72.0%, 70.0% and 60.3% in patients with CEA levels of ≤3 ng/ml, >3-10 ng/ml, and >10 ng/ml, respectively. Tumor volume had no prognostic value for either overall survival or disease-free survival
Pretreatment serum CEA levels were not correlated with tumor volume. While there was no correlation between tumor volume and survival, there was a positive correlation between CEA levels and survival.
Clinica chimica acta; international journal of clinical chemistry 11/2011; 413(3-4):511-5. · 2.54 Impact Factor
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ABSTRACT: To investigate the prognostic significance of tumor volume reduction rate (TVRR) after preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC).
In total, 430 primary LARC (cT3-4) patients who were treated with preoperative CRT and curative radical surgery between May 2002 and March 2008 were analyzed retrospectively. Pre- and post-CRT tumor volumes were measured using three-dimensional region-of-interest MR volumetry. Tumor volume reduction rate was determined using the equation TVRR (%) = (pre-CRT tumor volume--post-CRT tumor volume) × 100/pre-CRT tumor volume. The median follow-up period was 64 months (range, 27-99 months) for survivors. Endpoints were disease-free survival (DFS) and overall survival (OS).
The median TVRR was 70.2% (mean, 64.7% ± 22.6%; range, 0-100%). Downstaging (ypT0-2N0M0) occurred in 183 patients (42.6%). The 5-year DFS and OS rates were 77.7% and 86.3%, respectively. In the analysis that included pre-CRT and post-CRT tumor volumes and TVRR as continuous variables, only TVRR was an independent prognostic factor. Tumor volume reduction rate was categorized according to a cutoff value of 45% and included with clinicopathologic factors in the multivariate analysis; ypN status, circumferential resection margin, and TVRR were significant prognostic factors for both DFS and OS.
Tumor volume reduction rate was a significant prognostic factor in LARC patients receiving preoperative CRT. Tumor volume reduction rate data may be useful for tailoring surgery and postoperative adjuvant therapy after preoperative CRT.
International journal of radiation oncology, biology, physics 05/2011; 82(2):e193-9. · 4.59 Impact Factor
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ABSTRACT: Castleman's disease is a benign lymphoid proliferative disorder, which most commonly presents as a solitary mass in the mediastinum, although extrathoracic sites have been reported in the neck, axilla, pelvis, mesentery, pancreas, and retroperitoneum. We report a case of asymptomatic, isolated Castleman's disease in the mesorectum, which is extremely rare. The patient was a 34-year-old woman who underwent investigations for vaginal spotting. A presacral mass was located on the left side of the rectum, 10 cm from the anal verge. Contrast-enhanced computed tomography showed a large, well-demarcated, strongly enhancing mass with internal radiating septa in the mesorectum. The mass was well circumscribed and isointense to muscle on T1-weighted magnetic resonance imaging, appearing as a slightly hyperintense mass on T2-weighted imaging. We performed laparoscopic mesorectal mass excision, and histological examination revealed features typical of the hyaline-vascular type of Castleman's disease. Thus, when a mesorectal mass is being investigated, Castleman's disease should be considered in the differential diagnosis.
Surgery Today 02/2011; 41(2):271-5. · 1.22 Impact Factor
