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11. Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Author

Taku, Nicolette, Yi-Qian, Y. Nancy, Chang, George J., Ludmir, Ethan B., Raghav, Kanwal Pratap Singh, Rodriguez-Bigas, Miguel A., Holliday, Emma Brey, Smith, Grace L., Minsky, Bruce D., Overman, Michael J., Messick, Craig, Boyce-Fappiano, David, Koong, Albert C., Skibber, John Michael, Koay, Eugene Jon, Dasari, Arvind, Taniguchi, Cullen M., Bednarski, Brian K., Morris, Van K., Kopetz, Scott, and Das, Prajnan

Published
2022
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16. Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study

Author

Kroon, Hidde M., Malakorn, Songphol, Dudi-Venkata, Nagendra N., Bedrikovetski, Sergei, Liu, Jianliang, Kenyon-Smith, Tim, Bednarski, Brian K., Ogura, Atsushi, van de Velde, Cornelis J.H., Rutten, Harm J.T., Beets, Geerard L., Thomas, Michelle L., Kusters, Miranda, Chang, George J., and Sammour, Tarik

Published
2021
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18. The prognostic impact of tumor deposits in colorectal cancer: More than just N1c.

Author

Bhutiani, Neal, Peacock, Oliver, Uppal, Abhineet, Hu, Chung‐Yuan, Bednarski, Brian K., Taggart, Melissa W., Dasari, Arvind, Morris, Van K., Kaur, Harmeet, Kopetz, Scott, Holliday, Emma B., Das, Prajnan, You, Y. Nancy, and Chang, George J.

Abstract

Background: The identification of tumor deposits (TD) currently plays a limited role in staging for colorectal cancer (CRC) aside from N1c lymph node designation. The objective of this study was to determine the prognostic impact, beyond American Joint Committee on Cancer N1c designation, of TDs among patients with primary CRC. Methods: Patients who had resected stage I–III primary CRC diagnosed between 2010 and 2019 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Cancer‐specific survival (CSS) stratified by TD status and lymph node (N) status was calculated using the Kaplan–Meier method and multivariable Cox proportional hazards regression analyses. Results: In total, 147,783 patients with primary CRC were identified. TDs were present in 15,444 patients (10.5%). The presence of TDs was significantly associated with adverse tumor characteristics, including advanced pathologic stage, nodal status, and metastasis status. The presence of TDs was associated with worse CSS (hazard ratio [HR], 3.12; 95% confidence interval [CI], 3.02–3.22), as it was for each given N category (e.g., N2a and TD‐negative [HR, 2.50; 95% CI, 2.37–2.64] vs. N2a and TD‐positive [HR, 3.75; 95% CI, 3.49–4.03]). The presence of multiple TDs was also associated with decreased CSS for each given N category compared with a single TD (e.g. N2a with one TD [HR, 3.09; 95% CI, 2.65–3.61] vs. N2a with two or more TDs [HR, 4.32; 95% CI, 3.87–4.82]). Conclusions: TDs were identified as an independent predictor of a worse outcome in patients with CRC. The presence of TDs confers distinctly different CSS and provides important prognostic information among patients with CRC and warrants further investigation as a unique variable in future iterations of CRC staging. The presence of tumor deposits confers distinctly different cancer‐specific survival beyond lymph node categories and provides important added prognostic information among patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

Author

Ochiai, Kentaro, Bhutiani, Neal, Ikeda, Atsushi, Uppal, Abhineet, White, Michael G., Peacock, Oliver, Messick, Craig A., Bednarski, Brian K., You, Yi-Qian Nancy, Skibber, John M., Chang, George J., and Konishi, Tsuyoshi

Subjects
PATIENT compliance, RADIOTHERAPY, CHEMORADIOTHERAPY, TREATMENT effectiveness, DISEASE remission, PRESERVATION of organs, tissues, etc., DECISION making in clinical medicine, RECTUM tumors, CANCER chemotherapy, COMBINED modality therapy, QUALITY assurance
Abstract

Simple Summary: Total neoadjuvant therapy (TNT) for rectal cancer is expected to improve oncologic outcomes and organ preservation. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews the updated evidence on TNT and addresses tailor-made use of TNT regimens based on tumor location and local and systemic risk. Total neoadjuvant therapy (TNT) is a novel strategy for rectal cancer that administers both (chemo)radiotherapy and systemic chemotherapy before surgery. TNT is expected to improve treatment compliance, tumor regression, organ preservation, and oncologic outcomes. Multiple TNT regimens are currently available with various combinations of the treatments including induction or consolidation chemotherapy, triplet or doublet chemotherapy, and long-course chemoradiotherapy or short-course radiotherapy. Evidence on TNT is rapidly evolving with new data on clinical trials, and no definitive consensus has been established on which regimens to use for improving outcomes. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews currently available evidence on TNT for rectal cancer. A decision making flow chart is provided for tailor-made use of TNT regimens based on tumor location and local and systemic risk. [ABSTRACT FROM AUTHOR]

Published
2024
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24. The current multidisciplinary management of rectal cancer.

Author

Bhutiani, Neal, Peacock, Oliver, Uppal, Abhineet, You, Y. Nancy, Bednarski, Brian K., Skibber, John M., Messick, Craig, White, Michael G., Chang, George J., and Konishi, Tsuyoshi

Subjects
RECTAL cancer, PRESERVATION of organs, tissues, etc., NEOADJUVANT chemotherapy, LYMPH nodes
Abstract

Multidisciplinary management of rectal cancer has rapidly evolved over the last several years. This review describes recent data surrounding total neoadjuvant therapy, organ preservation, and management of lateral pelvic lymph nodes. It then presents our treatment algorithm for management of rectal cancer at The University of Texas MD Anderson Cancer Center in the context of this and other existing literature. As part of this discussion, the review describes how we tailor management based upon both patient and tumor‐related factors in an effort to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Perioperative and oncological outcomes following robotic en bloc multivisceral resection for colorectal cancer.

Author

DiBrito, Sandra R., Manisundaram, Naveen, Kim, Youngwan, Peacock, Oliver, Hu, Chung‐Yuan, Bednarski, Brian, You, Y. Nancy, Uppal, Abhineet, Tillman, Matthew, Konishi, Tsuyoshi, Kaur, Harmeet, Palmquist, Sarah, Holliday, Emma, Dasari, Arvind, and Chang, George J.

Subjects
COLORECTAL cancer, RECTAL surgery, ONCOLOGIC surgery, VAS deferens, MINIMALLY invasive procedures, SEMINAL vesicles
Abstract

Aim: As multidisciplinary treatment strategies for colorectal cancer have improved, aggressive surgical resection has become commonplace. Multivisceral and extended resections offer curative‐intent resection with significant survival benefit. However, limited data exist regarding the feasibility and oncological efficacy of performing extended resection via a minimally invasive approach. The aim of this study was to determine the perioperative and long‐term outcomes following robotic extended resection for colorectal cancer. Method: We describe the population of patients undergoing robotic multivisceral resection for colorectal cancer at our single institution. We evaluated perioperative details and investigated short‐ and long‐term outcomes, using the Kaplan–Meier method to analyse overall and recurrence‐free survival. Results: Among the 86 patients most tumours were T3 (47%) or T4 (47%) lesions in the rectum (78%). Most resections involved the anterior compartment (72%): bladder (n = 13), seminal vesicle/vas deferens (n = 27), ureter (n = 6), prostate (n = 15) and uterus/vagina/adnexa (n = 27). Three cases required conversion to open surgery; 10 patients had grade 3 complications. The median hospital stay was 4 days. Resections were R0 (>1 mm) in 78 and R1 (0 to ≤1 mm) in 8, with none being R2. The average nodal yield was 26 and 48 (55.8%) were pN0. Three‐year overall survival was 88% and median progression‐free survival was 19.4 months. Local recurrence was 6.1% and distant recurrence was 26.1% at 3 years. Conclusion: Performance of multivisceral and extended resection on the robotic platform allows patients the benefit of minimally invasive surgery while achieving oncologically sound resection of colorectal cancer. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Association of pathologic nodal status with minimal residual disease after neoadjuvant treatment and resection of locally advanced rectal cancer.

Author

Uppal, Abhineet, Bhutiani, Neal, Shen, John Paul Y.C., Alfaro, Kristin, Kell, Robert J., Yousef, Mahmoud M.G., Yousef, Abdelrahman M.G., Konishi, Tsuyoshi, Holliday, Emma, Morris, Van K., Dasari, Arvind, Willis, Jason, Newhook, Timothy E., Bednarski, Brian K., You, Y. Nancy, Peacock, Oliver, Messick, Craig, Das, Prajnan, Chang, George J., and Kopetz, Scott

Published
2024
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38. Rectal Adenocarcinoma Presenting as a Cervical Mass: A Case Report.

Author

Stanietzky, Nir, Bednarski, Brian, Shafer, Aaron, Taggart, Melissa W., Peacock, Oliver, and Vikram, Raghunandan

Subjects
*ADENOCARCINOMA, *CROSS-sectional imaging, *UTERINE hemorrhage, *GYNECOLOGIC oncology, *INVASIVE diagnosis, *OVERALL survival, *RECTAL cancer
Abstract

Objective: Challenging differential diagnosis Background: Invasive cervical tumors are often seen in clinical practice. However, there are multiple structures within the pelvis, and invasion of the cervix from another site must be included in the differential diagnosis. In such cases, a multidisciplinary approach is needed to define the organ of tumor origin. Ensuring proper staging and histologic analysis are critical for optimal management. Case Report: We present a case of a 68-year-old woman who presented to her gynecologist with painless post-menopausal vaginal bleeding. She was diagnosed with a locally aggressive cervical adenocarcinoma, which was histologically confirmed by an in-office biopsy. She was referred to the gynecologic oncology service at a tertiary care hospital for definitive management, where a thorough clinical workup was performed. Physical exam revealed that the mass had invaded the anterior rectal wall. Through a multidisciplinary approach and a repeat biopsy, she was correctly diagnosed with an invasive rectal adenocarcinoma. She was treated with neoadjuvant chemoradiotherapy and underwent curative surgery. Had she been incorrectly treated as having a primary cervical adenocarcinoma, there would have been no role for surgery. The change in the organ of primary drastically altered the patient’s management and outcome. She is currently undergoing surveillance with cross-sectional imaging. Conclusions: Cervical masses originating from non-gynecologic organs can be difficult to differentiate on physical exam and histologic analysis. When a mass involves the rectum, an invasive primary rectal adenocarcinoma must be included in the differential. This will have a significant impact on patient management and ultimately on patient survival. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Differential Spatial Gene and Protein Expression Associated with Recurrence Following Chemoradiation for Localized Anal Squamous Cell Cancer.

Author

Hernandez, Sharia, Das, Prajnan, Holliday, Emma B., Shen, Li, Lu, Wei, Johnson, Benny, Messick, Craig A., Taniguchi, Cullen M., Skibber, John, Ludmir, Ethan B., You, Y. Nancy, Smith, Grace Li, Bednarski, Brian, Kostousov, Larisa, Koay, Eugene J., Minsky, Bruce D., Tillman, Matthew, Portier, Shaelynn, Eng, Cathy, and Koong, Albert C.

Subjects
EPITHELIAL cell tumors, IMMUNE checkpoint proteins, CANCER relapse, ANAL tumors, CHEMORADIOTHERAPY, GENE expression, TREATMENT effectiveness, GENE expression profiling, RESEARCH funding, TUMOR markers
Abstract

Simple Summary: While anti-PD1 antibodies have demonstrated efficacy in some patients with metastatic anal cancer, these agents have no proven benefit for those with localized disease treated with chemoradiation. Difficulty procuring fresh tumor tissue required for RNA and protein expression analysis has limited extensive molecular profiling for this rare cancer. Our team utilized a novel digital spatial profiling technology on pretreatment anal cancer specimens to identify biomarkers associated with recurrence after chemoradiation. We observed that recurrent tumors had higher baseline expression of immune checkpoint biomarkers, higher MAPK signaling activation and higher PI3K/Akt signaling activation. These findings provide a rationale that supports future clinical trials with immunotherapy that seek to improve survival beyond chemoradiation for patients with localized squamous cell cancer of the anus. The identification of transcriptomic and protein biomarkers prognosticating recurrence risk after chemoradiation of localized squamous cell carcinoma of the anus (SCCA) has been limited by a lack of available fresh tissue at initial presentation. We analyzed archival FFPE SCCA specimens from pretreatment biopsies prior to chemoradiation for protein and RNA biomarkers from patients with localized SCCA who recurred (N = 23) and who did not recur (N = 25). Tumor cells and the tumor microenvironment (TME) were analyzed separately to identify biomarkers with significantly different expression between the recurrent and non-recurrent groups. Recurrent patients had higher mean protein expression of FoxP3, MAPK-activation markers (BRAF, p38-MAPK) and PI3K/Akt activation (phospho-Akt) within the tumor regions. The TME was characterized by the higher protein expression of immune checkpoint biomarkers such as PD-1, OX40L and LAG3. For patients with recurrent SCCA, the higher mean protein expression of fibronectin was observed in the tumor and TME compartments. No significant differences in RNA expression were observed. The higher baseline expression of immune checkpoint biomarkers, together with markers of MAPK and PI3K/Akt signaling, are associated with recurrence following chemoradiation for patients with localized SCCA. These data provide a rationale towards the application of immune-based therapeutic strategies to improve curative-intent outcomes beyond conventional therapies for patients with SCCA. [ABSTRACT FROM AUTHOR]

Published
2023
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