Muthusamy, V.R. and Chang, K.J. (2007). Optimal methods for staging rectal cancer. Clin. Cancer Res. 13: 6877s–6884s.
53 53 Allen, S.D., Padhani, A.R., Dzik‐Jurasz, A.S., and Glynne‐Jones, R. (2007). Rectal carcinoma: MRI with histologic correlation before and after chemoradiation therapy. Am. J. Roentgenol. 188: 442–451.
54 54 Maretto, I., Pomerri, F., Pucciarelli, S. et al. (2007). The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann. Surg. Oncol. 14: 455–461.
55 55 Del Vescovo, R., Trodella, L.E., Sansoni, I. et al. (2012). MR imaging of rectal cancer before and after chemoradiation therapy. Radiol. Med. 117: 1125–1138.
56 56 Gagliardi, G., Hawley, P.R., Hershman, M.J., and Arnott, S.J. (1995). Prognostic factors in surgery for local recurrence of rectal cancer. Br. J. Surg. 82: 1401–1405.
57 57 Potter, K.C., Husband, J.E., Houghton, S.L. et al. (2009). Diagnostic accuracy of serial CT/magnetic resonance imaging review vs. positron emission tomography/CT in colorectal cancer patients with suspected and known recurrence. Dis. Colon Rectum 52: 253–259.
58 58 Sammour, T. and Skibber, J.M. (2018). Evaluation of treatment of locally recurrent rectal cancer. In: Rectal Cancer: Modern Approaches to Treatment (ed. G.J. Chang), 231–245. Cham: Springer International Publishing.
59 59 Watson, A.J., Lolohea, S., Robertson, G.M., and Frizelle, F.A. (2007). The role of positron emission tomography in the management of recurrent colorectal cancer: a review. Dis. Colon Rectum 50: 102–114.
60 60 Selvaggi, F., Fucini, C., Pellino, G. et al. (2015). Outcome and prognostic factors of local recurrent rectal cancer: a pooled analysis of 150 patients. Tech. Coloproctol. 19: 135–144.
61 61 Floriani, I., Torri, V., Rulli, E. et al. (2010). Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta‐analysis. J. Magn. Reson. Imaging 31: 19–31.
62 62 Bellomi, M., Rizzo, S., Travaini, L.L. et al. (2007). Role of multidetector CT and FDG‐PET/CT in the diagnosis of local and distant recurrence of resected rectal cancer. Radiol. Med. 112: 681–690.
63 63 Agarwal, A., Marcus, C., Xiao, J. et al. (2014). FDG PET/CT in the management of colorectal and anal cancers. Am. J. Roentgenol. 203: 1109–1119.
64 64 Zhang, C., Chen, Y., Xue, H. et al. (2009). Diagnostic value of FDG‐PET in recurrent colorectal carcinoma: a meta‐analysis. Int. J. Cancer 124: 167–173.
65 65 Sugarbaker, P.H. and Jablonski, K.A. (1995). Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann. Surg. 221: 124–132.
66 66 Portilla, A.G., Sugarbaker, P.H., and Chang, D. (1999). Second‐look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. World J. Surg. 23: 23–29.
67 67 Sugarbaker, P.H. (1999). Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother. Pharmacol. 43: S15–S25.
68 68 Elias, D., Blot, F., El Otmany, A. et al. (2001). Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92: 71–76.
69 69 Glehen, O. and Gilly, F.N. (2003). Quantitative prognostic indicators of peritoneal surface malignancy: carcinomatosis, sarcomatosis, and peritoneal mesothelioma. Surg. Oncol. Clin. North Am. 12: 649–671.
70 70 Tentes, A.A., Tripsiannis, G., Markakidis, S.K. et al. (2003). Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur. J. Surg. Oncol. 29: 69–73.
71 71 Harmon, R.L. and Sugarbaker, P.H. (2005). Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int. Semin. Surg. Oncol. 2: 3.
72 72 Low, R.N., Barone, R.M., and Lucero, J. (2015). Comparison of MRI and CT for predicting the peritoneal cancer index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures. Ann. Surg. Oncol. 22: 1708–1715.
73 73 Koh, J.L., Yan, T.D., Glenn, D., and Morris, D.L. (2009). Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann. Surg. Oncol. 16: 327–333.
74 74 Chua, T.C., Al‐Zahrani, A., Saxena, A. et al. (2011). Determining the association between preoperative computed tomography findings and postoperative outcomes after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann. Surg. Oncol. 18: 1582–1589.
75 75 Fujii, S., Matsusue, E., Kanasaki, Y. et al. (2008). Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion‐weighted MR imaging. Eur. Radiol. 18: 18–23.
4 Neoadjuvant Therapy Options for Advanced Rectal Cancer
Alexandra Zaborowski1, Paul Kelly2, and Brian Bird3
1 Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland
2 Department of Radiation Oncology, Bon Secours, Cork, Ireland
3 Department of Medical Oncology, Bon Secours, Cork, Ireland
Background
Combined‐modality therapy was a paradigm shift in managing locally advanced rectal cancer (LARC) in the latter part of the twentieth century. Neoadjuvant chemoradiotherapy (nCRT; long‐course radiotherapy with concomitant fluoropyrimidine‐based chemotherapy) then interval total mesorectal excision (TME) is the standard of care for patients with bulky cT3/4 tumors or predicted node‐positive disease in most countries. Short‐course radiotherapy (five fractions without chemotherapy) is also an evidence‐based standard and was pioneered in Scandinavia, the Netherlands, and the UK. Several large studies have demonstrated superior disease‐related outcomes with neoadjuvant therapy over surgery alone [1–4]. Following systematically taught TME and widespread adoption of tri‐modality therapy, five‐year local recurrence rates decreased to 5% or less [5]. However, long‐term overall survival (OS) did not improve in parallel and the leading cause of rectal‐cancer‐related death is now distant disease failure, with approximately 20–30% of patients developing distant metastases despite receiving postoperative chemotherapy in some countries [6]. Increasing emphasis has been placed on optimized systemic therapy to improve long‐term OS.
In the USA and some European countries adjuvant chemotherapy has been recommended in the management of LARC. This is largely based on extrapolation from the results of trials in colonic cancer demonstrating improved disease‐free survival (DFS) and OS. Oncologists generally estimate that adjuvant fluoropyrimidine‐based chemotherapy reduces the relative risk of systemic recurrence of colon cancer by one‐third, with oxaliplatin adding another 5–6% benefit [7, 8]. Early trials in rectal cancer observed similar survival advantages; however, these trials were conducted prior to the introduction of neoadjuvant therapy [9, 10]. The role of adjuvant chemotherapy in the modern era of nCRT is less defined. ADORE—a large phase II Korean trial—randomized patients post nCRT to four cycles of adjuvant 5‐fluorouracil (5‐FU) or FOLFOX (5‐FU, leucovorin, and oxaliplatin) and demonstrated improvement in DFS [11]. Four randomized European trials have failed to demonstrate a significant survival benefit [12–15]. Notably, these trials demonstrated that compliance with adjuvant chemotherapy is poor following rectal cancer surgery. In the largest of these studies, the European Organization for Research and Treatment of Cancer (EORTC) 22921 trial, over half of patients did not complete the intended four cycles [15]. Any apparent absence of survival advantage with adjuvant chemotherapy may be related, in part, to poor tolerance of postoperative treatment. Furthermore, a meta‐analysis evaluating the impact of time from surgery to adjuvant therapy on survival in colorectal cancers demonstrated that a four‐week increase in time