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Role of fecal diversion in colorectal anastomotic failure: Where are we now?
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2014 Category: Gastroenterology Authors: Bikash Devaraj, Kyle G. Cologne Source Type: research

Influence of trauma, peritonitis, and obstruction on restoring intestinal continuity—To connect or not to connect?
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2014 Category: Gastroenterology Authors: Jason R. Bingham, Scott R. Steele Source Type: research

Effect of chemotherapy, radiation, or immunosuppression on the integrity of the intestinal anastomosis
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2014 Category: Gastroenterology Authors: Erica B. Sneider, Jennifer S. Davids Source Type: research

Introduction
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2014 Category: Gastroenterology Authors: Todd D. Francone Source Type: research

Stereotactic body radiation therapy (SBRT) for liver metastases: A clinical review
Abstract: For over half a century, conventionally fractionated whole-liver radiation has been used for the palliation of diffuse, symptomatic liver metastases. More recently, interest has grown in identifying subsets of patients with a limited disease burden where focal ablation of metastases may improve disease control and prolong survival. Although promising outcomes have been reached following resection of liver metastases, most patients are not resection candidates. Stereotactic body radiation therapy (SBRT) is a modern technique for the delivery of ablative, high-dose external beam radiation with subcentimeter accurac...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Chad G. Rusthoven, Christine F. Lauro, Brian D. Kavanagh, Tracey E. Schefter Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Intraoperative and stereotactic ablative radiation therapy in recurrent rectal cancer
Abstract: Despite significant advances in primary management of rectal cancer, local recurrence, although increasingly uncommon, presents a therapeutic challenge. Multimodality therapy, including surgery, radiation therapy, and chemotherapy, is often called for despite, in most cases, having been used in the primary setting. Technical advances in radiation planning and delivery have contributed to development of ways to deliver high-radiation doses to exactly where it is needed, preventing damage to surrounding normal structures. In combination with modern surgical and chemotherapeutic options, these specialized radiation ...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Arul Mahadevan Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Late effects of pelvic radiation for rectal cancer and implications for survivorship
Abstract: Improved treatment for colorectal cancer with better survival rates has heightened awareness of the potential late toxicities of pelvic radiation. Colorectal cancer (CRC) survivors experience inferior physical and mental quality of life (Denlinger and Barsevick, 2009 ). As a growing population of CRC survivors live long enough to experience normal tissue adverse effects induced or exacerbated from pelvic radiation, survivorship plans that address subsequent gastrointestinal and sexual dysfunctions are beginning to emerge. Early identification and referral for treatment interventions is important for reducing late...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Nikhil Rao, Ravi Shridhar, Sarah E. Hoffe Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Local management of the primary tumor in stage IV rectal cancer
Abstract: Over the past 2 decades, the survival of patients with metastatic colorectal cancer has improved considerably. With multidisciplinary treatment, a select group of stage IV patients can be treated with curative intent. The natural history and clinical course of stage IV rectal cancer varies considerably between individuals, and optimal management involves complex treatment decisions. The focus of this review is to explore the current issues and controversies surrounding the local management of the primary tumor in the setting of resectable as well as unresectable metastatic rectal cancer. The integration of system...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Brian R. Knab Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Preoperative endorectal brachytherapy in the treatment of locally advanced rectal cancer: Rethinking neoadjuvant treatment
Abstract: Prior to the introduction of preoperative treatment and modern surgical technique, recurrence rates for locally advanced rectal cancer ranged from 30% to 50%. Since the widespread adoption of total mesorectal excision and preoperative chemoradiation therapy (CRT), local recurrence rates have reduced considerably to only 5–10%. However, preoperative treatment comes at a cost with significant acute and late toxicity. Additionally, 2 standards of care have emerged—1 week of radiation alone vs 5 weeks of concurrent chemoradiation. In this review, we evaluate toxicity associated with preoperative treatment as well...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Matthew C. Biagioli, Joseph M. Herman Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Non-operative management of locally advanced rectal cancer
Abstract: A combination of chemoradiation therapy (CRT) and total mesorectal excision (TME) provides excellent locoregional control in locally advanced rectal cancer; however, this regimen may be associated with significant morbidity. Researchers have assessed the safety of omitting rectal resection in patients who achieve a clinical complete response to CRT. Preliminary results have been promising. However, the accurate identification of patients who have responded completely to CRT is a challenge to non-operative management. Other areas warranting further investigation include techniques to increase response rates and to...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Sarah A. Milgrom, Karyn A. Goodman Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Preoperative therapy for rectal cancer: Short-course radiation vs. long-course chemoradiation
Abstract: Preoperative radiation therapy for rectal cancer is delivered by two techniques: short-course radiation and long-course chemoradiation. These two approaches cannot be directly compared since patients selected for treatment with short-course radiation commonly included those with cT1–3 disease, whereas chemoradiation is used for cT3 and/or N+ disease. Recent trials of short-course radiation have included patients with cT3 and/or N+ disease as well as delivered sequential or postoperative chemotherapy. This review will evaluate the results of the two preoperative approaches. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Bruce D. Minsky, Claus Rödel, Vincenzo Valentini Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Rectal cancer genomics
Abstract: Cellular signaling abnormalities play an important role in the oncogenesis of rectal cancer. These signaling changes are frequently driven by genomic changes. This review describes five commonly altered cell signaling pathways in rectal cancer: WNT, RAS, TGF-β, p53, and PI3K. For these pathways, both physiologic (non-altered) function and common mutations that contribute to abnormal signaling are described. As rectal cancer is driven by genomic changes, a discussion of the prognostic value of pathway signaling mutations is included. Lastly, the use of genomic changes as predictive markers for response to preoper...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Aaron D. Falchook, Joel E. Tepper Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Patient selection for neoadjuvant therapy of rectal adenocarcinoma
Abstract: Rectal adenocarcinomas are typically treated with a combination of radiotherapy, chemotherapy, and surgical resection. Risk factors for local recurrence include tumor stage, nodal stage, tumor location, circumferential resection margin status, and surgical technique. Most patients receive pre-operative therapy based on staging evaluations using endorectal ultrasound and/or pelvic MRI. Pre-operative therapy is recommended for any patient with T3–4 disease or nodal involvement. Subgroups of patients defined by combinations of stage and tumor location are at very low risk for local recurrence after surgery alone a...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Stephen L. Harris Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Preface
The past decade has witnessed an explosion in radiation treatment planning and delivery capabilities. Combined with advancements in genetic tumor profiling, systemic disease control, volumetric definition of normal tissue toxicity profiles, and patient survivorship, these new technical capabilities have revolutionized the practice of radiation oncology in the treatment of colorectal cancer. Innovative concepts of re-irradiation, stereotactic ablative radiation therapy (SABR) to pelvic recurrences and oligometastatic disease sites, and de-intensification strategies to improve quality-of-life metrics have replaced the dogma ...
Source: Seminars in Colon and Rectal Surgery - February 22, 2014 Category: Gastroenterology Authors: Andrea McKee Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research

Preface
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 18, 2014 Category: Gastroenterology Authors: Andrea McKee Tags: Innovative Radiotherapy Options for the Patient with Colon and Rectal Cancer Source Type: research