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Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (25 June 2023) | Viewed by 12204

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Special Issue Editors

Dr. Vincenza Granata

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Guest Editor

Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Campania, Italy
Interests: oncology; screening; diagnosis; monitoring; precision medicine; radiomics
Special Issues, Collections and Topics in MDPI journals

Dr. Daniela Rega

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Guest Editor

Colorectal Surgical Oncology, Department of Abdominal Oncology, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
Interests: colorectal surgery; colorectal oncology; rectal sparing; neoadjuvant treatment

Special Issue Information

Dear Colleagues,

Despite intended curative surgery, colorectal cancer will recur in ~ 45% of the patients and frequent follow-up does not lead to early detection of recurrence. The present literature shows that several factors play important roles in development of recurrence. From pathology studies it has been shown that tumours behave differently depending on their location and recur more often when micrometastases are present in lymph nodes and around vessels and nerves. K-ras mutations, microsatellite instability, and mismatch repair genes have also been shown to be important in relation with recurrences, and tumours appear to have different mutations depending on their location. Therefore, further research is urgently needed to verify which of the well-known parameters, as well as new parameters, must be added to the current follow-up programs to identify patients at risk of recurrence.

Multimodality treatment, as a combination of chemotherapy, radiotherapy and surgery, appears essential in order to obtain better results.

This topic encloses all oncological clinical branches: diagnostics (endoscopy, pathology and radiology with essential need of accurate evaluation that manages the clinicians to proper patient’s tailored therapy) and therapeutics branches (oncological treatment, surgical treatment, radiotherapy treatment, novel strategies of cure and palliative treatment).

We are inviting you to contribute with relevant original research, systematic reviews, meta-analyses, and short communications covering the above-mentioned topics.

Dr. Vincenza Granata
Dr. Daniela Rega
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

colonic cancer recurrence
rectal cancer recurrence
metastatic colonic cancer
metastatic rectal cancer
diagnosis pelvic recurrence
diagnosis distance metastasis
treatment pelvic recurrence
treatment distance recurrence
palliative treatment
radiotherapy treatment

Published Papers (5 papers)

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Research

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12 pages, 367 KiB

Open AccessArticle

Radiomic Features from Post-Operative ¹⁸F-FDG PET/CT and CT Imaging Associated with Locally Recurrent Rectal Cancer: Preliminary Findings

by Dajana Cuicchi, Margherita Mottola, Paolo Castellucci, Alessandro Bevilacqua, Arrigo Cattabriga, Maria Adriana Cocozza, Stefano Cardelli, Gerti Dajti, Susanna Mattoni, Rita Golfieri, Stefano Fanti, Alberta Cappelli, Francesca Coppola and Gilberto Poggioli

J. Clin. Med. 2023, 12(5), 2058; https://doi.org/10.3390/jcm12052058 - 6 Mar 2023

Cited by 1 | Viewed by 1438

Abstract

Locally Recurrent Rectal Cancer (LRRC) remains a major clinical concern; it rapidly invades pelvic organs and nerve roots, causing severe symptoms. Curative-intent salvage therapy offers the only potential for cure but it has a higher chance of success when LRRC is diagnosed at an early stage. Imaging diagnosis of LRRC is very challenging due to fibrosis and inflammatory pelvic tissue, which can mislead even the most expert reader. This study exploited a radiomic analysis to enrich, through quantitative features, the characterization of tissue properties, thus favoring an accurate detection of LRRC by Computed Tomography (CT) and

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F-FDG-Positron Emission Tomography/CT (PET/CT). Of 563 eligible patients undergoing radical resection (R0) of primary RC, 57 patients with suspected LRRC were included, 33 of which were histologically confirmed. After manually segmenting suspected LRRC in CT and PET/CT, 144 Radiomic Features (RFs) were generated, and RFs were investigated for univariate significant discriminations (Wilcoxon rank-sum test, p < 0.050) of LRRC from NO LRRC. Five RFs in PET/CT (p < 0.017) and two in CT (p < 0.022) enabled, individually, a clear distinction of the groups, and one RF was shared by PET/CT and CT. As well as confirming the potential role of radiomics to advance LRRC diagnosis, the aforementioned shared RF describes LRRC as tissues having high local inhomogeneity due to the evolving tissue’s properties. Full article

(This article belongs to the Special Issue Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management)

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17 pages, 1553 KiB

Open AccessArticle

Safety, Feasibility and Technical Considerations from a Prospective, Observational Study—CIREL: Irinotecan-TACE for CRLM in 152 Patients

by Thomas Helmberger, Pierleone Lucatelli, Philippe L. Pereira, Aleksandar Gjoreski, Ivona Jovanoska, Zoltan Bansaghi, Stavros Spiliopoulos, Francesca Carchesio, Dirk Arnold, Andreas Baierl, Bleranda Zeka, Nathalie C. Kaufmann, Julien Taieb and Roberto Iezzi

J. Clin. Med. 2022, 11(20), 6178; https://doi.org/10.3390/jcm11206178 - 19 Oct 2022

Cited by 5 | Viewed by 1651

Abstract

CIREL, a prospective, Europe-wide, observational study aimed to assess the real-world feasibility and tolerability of irinotecan-based transarterial chemoembolization (LP-irinotecan TACE) for unresectable colorectal cancer liver metastases with regard to the treatment plan and adverse events (AEs). CIREL enrolled 152 eligible patients (≥18 years) with liver-only or dominant metastases treated with LP-irinotecan TACE following a multidisciplinary tumor board decision. Data were prospectively collected for baseline, the number of planned and performed sessions, and technical information and safety according to CTCAE 4.03/5.0. Results from 351 analyzed treatment sessions showed technical success for 99% of sessions, and 121 patients (79%) completed all planned sessions. Further, 60% of sessions were performed using opioids, 4% intra-arterial anesthetics, and 25% both. Additionally, 60% of patients experienced at least one peri-interventional AE of any grade; 8% of grade 3–4. Occurrence of AEs was related to larger liver-involvement (p < 0.001), bi-lobar disease (p = 0.002), and larger beads (p < 0.001). Using corticosteroids together with antiemetics showed reduced and lower grade vomiting (p = 0.01). LP-irinotecan TACE was tolerated well and had a high proportion of completed treatment plans. This minimally invasive locoregional treatment can be used together with concomitant systemic therapy or ablation. Full article

(This article belongs to the Special Issue Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management)

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17 pages, 4871 KiB

Open AccessArticle

Histopathological and Haemogram Features Correlate with Prognosis in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation without Pathological Complete Response

by Yu-Ming Huang, Hsi-Hsien Hsu, Chien-Kuo Liu, Ching-Kuo Yang, Po-Li Tsai, Tzu-Yin Tang, Shih-Ming Hsu and Yu-Jen Chen

J. Clin. Med. 2022, 11(17), 4947; https://doi.org/10.3390/jcm11174947 - 23 Aug 2022

Cited by 2 | Viewed by 1902

Abstract

Background: Neoadjuvant chemoradiation therapy (NCRT) followed by surgery is the standard treatment for locally advanced rectal cancer (LARC); approximately 80% of patients do not achieve complete response. Identifying prognostic factors predictive of survival in these patients to guide further management is needed. The intratumoural lymphocytic response (ILR), peritumoural lymphocytic reaction (PLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PtLR) are correlated with the tumour microenvironment and cancer-related systemic inflammation. This study aimed to explore the ability of the ILR, PLR, NLR, and PtLR to predict survival in LARC patients without a complete response to NCRT. Methods: Sixty-nine patients who underwent NCRT and surgery were retrospectively reviewed. The ILR and PLR were assessed in surgical specimens, and the NLR and PtLR were calculated using pre- and post-NCRT blood count data. The Kaplan–Meier method and Cox regression analyses were performed for survival analysis. Results: A high PLR and high post-NCRT NLR and PtLR were significantly associated with better prognosis. Lymphovascular invasion (LVI), post-NCRT neutrophil count, and lymphocyte count were significant predictors of overall survival. LVI and the PLR were independent predictors of disease-free survival. Conclusions: NCRT-induced local and systemic immune responses are favourable prognostic predictors in LARC patients without complete response to NCRT. Full article

(This article belongs to the Special Issue Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management)

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9 pages, 757 KiB

Open AccessArticle

High Yield of Chest X-ray in the Follow-Up of Colorectal Cancer

by Eline G. M. Steenhuis, Ivonne J. H. Schoenaker, Jan Willem B. De Groot, Jos A. Stigt, Onne Reerink, Wouter H. De Vos tot Nederveen Cappel, Henderik L. Van Westreenen and Richard M. Brohet

J. Clin. Med. 2022, 11(13), 3828; https://doi.org/10.3390/jcm11133828 - 1 Jul 2022

Viewed by 1315

Abstract

Purpose: Worldwide, colorectal carcinoma (CRC) has a high incidence and a substantial cancer-related mortality. The recurrence risk is 30–50% and lung metastases are common. Treatment of lung metastases with stereotactic ablative radiotherapy (SABR) or metastasectomy may increase survival. The best modality for thoracic screening in the follow-up, however, remains controversial. In this study, we aimed to unravel the additional value of routine chest X-ray (CXR) for detecting lung metastases during the follow-up of CRC patients treated with curative surgery. Methods: Between 2013 and 2017, 668 CRC patients were treated with curative intent, of whom 633 patients were included in follow-up, which consisted of CXR, serum Carcino-Embryonic Antigen (CEA) and ultrasound of the liver. Patients who developed lung metastases, diagnosed with CXR and characterised by a normal concomitant serum CEA level, were identified. Number, size and treatment of lung metastases were described. Results: Thirty-four (5.4%) patients developed lung metastases. Seventeen (50%) were detected by CXR without pathological CEA levels. Eleven (65%) of these patients were treated with curative intent, whereas 21% of patients with lung metastases and elevated CEA levels were treated with curative intent (p = 0.049). Higher numbers of lung metastases were associated with a lower chance of curative treatment. Conclusions: More than 50% of patients with lung metastases on CXR in the follow-up would not have been detected with CEA-triggered imaging only. In addition, patients with colorectal lung metastases without elevated CEA levels were often suitable for curative treatment and, therefore, CXR seems to have additional value within the follow-up of CRC. Full article

(This article belongs to the Special Issue Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management)

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Review

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26 pages, 3584 KiB

Open AccessReview

Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective

by Alessandra Borgheresi, Federica De Muzio, Andrea Agostini, Letizia Ottaviani, Alessandra Bruno, Vincenza Granata, Roberta Fusco, Ginevra Danti, Federica Flammia, Roberta Grassi, Francesca Grassi, Federico Bruno, Pierpaolo Palumbo, Antonio Barile, Vittorio Miele and Andrea Giovagnoni

J. Clin. Med. 2022, 11(9), 2599; https://doi.org/10.3390/jcm11092599 - 5 May 2022

Cited by 21 | Viewed by 4680

Abstract

The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting. Full article

(This article belongs to the Special Issue Colorectal Cancer Recurrence and Metastasis: Advance in Clinical Diagnosis and Management)

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