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Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?

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World Journal of Gastroenterology 2011年第7期17卷 848-854页

作者： Sarah Popek Vassiliki Liana Tsikitis Department of Surgery University of Arizona Tucson AZ 85724 United States

The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.

关键词： locally advanced rectal cancer Neoadjuvant radiation Adjuvant radiation rectal neoplasm Chemoradiotherapy Neoadjuvant chemoradiotherapy

Nomogram for predicting pathological complete response and tumor downstaging in patients with locally advanced rectal cancer on the basis of a randomized clinical trial

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Gastroenterology Report 2020年第3期8卷 234-241,I0002页

作者： Jian-Wei Zhang Yue Cai Xiao-Yu Xie Hua-Bin Hu Jia-Yu Ling Ze-Hua Wu Ping Lan Xiao-Jian Wu Mei-Jin Huang Hui Wang Liang Kang Zhi-Yang Zhou Jian-Ping Wang Yan-Hong Deng Department of Medical Oncology The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases GuangzhouGuangdongP.R.China Department of Colorectal Surgery The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China Department of Radiology The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background:Preoperative fluoropyrimidine with radiotherapy was regarded as the standard of care for locally advanced rectal cancer(LARC).The model for predicting pCR in LARC patients was based on standard treatment *** study aimed to establish a nomogramwith pretherapeutic parameters and different neoadjuvant regimens for predicting pathologic complete response(pCR)and tumor downstaging or good response(ypT0-2N0M0)after receiving neoadjuvant treatment in patients with LARC based on a randomized clinical ***:Between January 2011 and February 2015,309 patients with rectal cancer were enrolled from a prospective randomized study(NCT01211210).All pretreatment clinical parameters were collected to build a nomogram for predicting pCR and tumor *** model was subjected to bootstrap internal *** predictive performance of the model was assessed with concordance index(C-index)and calibration ***:Of the 309 patients,53(17.2%)achieved pCR and 132(42.7%)patients were classified as tumor downstaging with *** on the logistic-regression analysis and clinical consideration,tumor length(P=0.005),tumor circumferential extent(P=0.036),distance from the anal verge(P=0.019),and neoadjuvant treatment regimen(Prectal *** model might help physicians

关键词： nomogram pathological complete response tumor downstaging locally advanced rectal cancer

Total neoadjuvant therapy vs standard therapy of locally advanced rectal cancer with high-risk factors for failure

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World Journal of Gastrointestinal Oncology 2021年第2期13卷 119-130页

作者： Mojca Tuta Nina Boc Erik Brecelj Monika Peternel Vaneja Velenik Division of Radiology Institute of OncologyLjubljana 1000Slovenia Faculty of Medicine University of LjubljanaLjubljana 1000Slovenia Division of Surgery Institute of OncologyLjubljana 1000Slovenia Division of Radiotherapy Institute of OncologyLjubljana 1000Slovenia

BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local ***,survival is still poor due to distant metastases,which remains the leading cause of death among these *** recent years,the concept of total neoadjuvant treatment(TNT)has been developed,whereby all systemic ChT-mainly affecting micrometastases-is applied prior to *** To compare standard therapy and total neoadjuvant therapy for LARC patients with high-risk factors for *** In a retrospective study,we compared LARC patients with high-risk factors for failure who were treated with standard therapy or with ***-risk for failure was defined according to the presence of at least one of the following factors:T4 stage;N2 stage;positive mesorectal fascia;extramural vascular invasion;positive lateral lymph *** consisted of 12 wk of induction ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin,CRT with capecitabine,and 6-8 wk of consolidation ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin prior to *** primary endpoint was pathological complete response(pCR).In total,72 patients treated with standard therapy and 89 patients treated with TNT were included in the *** Compared to standard therapy,TNT showed a higher proportion of pCR(23%vs 7%;P=0.01),a lower neoadjuvant rectal score(median:8.43 vs 14.98;P<0.05),higher T-and N-downstaging(70%and 94%vs 51%and 86%),equivalent R0 resection(95%vs 93%),shorter time to stoma closure(mean:20 vs 33 wk;P<0.05),higher compliance during systemic ChT(completed all cycles 87%vs 76%;P<0.05),lower proportion of acute toxicity grade≥3 during ChT(3%vs 14%,P<0.05),and equivalent acute toxicity and compliance during CRT and in the postoperative *** pCR rate in patients treated with TNT was significantly higher in patients

关键词： locally advanced rectal cancer Total neoadjuvant therapy Pathological complete response Neoadjuvant rectal cancer score

Prediction of pathological complete response and prognosis in locally advanced rectal cancer

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2520-2530页

作者： Yi-Jun Xu Dan Tao Song-Bing Qin Xiao-Yan Xu Kai-Wen Yang Zhong-Xu Xing Ju-Ying Zhou Yang Jiao Li-Li Wang Department of Radiation Oncology The First Affiliated Hospital of Soochow UniversitySuzhou 215006Jiangsu ProvinceChina Department of Radiation Oncology The Fourth Affiliated Hospital of Soochow UniversitySuzhou 215006Jiangsu ProvinceChina School of Radiation Medicine and Protection Medical College of Soochow UniversitySuzhou 215123Jiangsu ProvinceChina

BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death *** chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before *** date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient *** To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with *** Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively *** were categorized into pCR and non-pCR *** analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting *** 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank *** Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with *** results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for *** analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR *** deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC *** pCR demonstrates longer DFS and *** correlate with poor pr

关键词： locally advanced rectal cancer Neoadjuvant chemoradiotherapy Pathological complete response Carcinoembryonic antigen Inflammation-related markers Tumor deposit Prognosis

Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer

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World Journal of Gastroenterology 2022年第23期28卷 2609-2624页

作者： Mayra Evelia Jiménez de los Santos Juan Armando Reyes-Pérez Victor Domínguez Osorio Yolanda Villaseñor-Navarro Liliana Moreno-Astudillo Itzel Vela-Sarmiento Isabel Sollozo-Dupont Department of Radiology National Cancer InstituteMexico 14080Mexico Department of Gastrointestinal Surgery National Cancer InstituteMexico 14080Mexico

BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with *** This is a single-center,retrospective study,which included 48 patients with *** patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response *** sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after *** all data were compared between R and non-R using the Mann-Whitney U *** measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%***,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass corr

关键词： Apparent diffusion coefficient Diffusion-weighted imaging Histogram analysis Magnetic resonance imaging locally advanced rectal cancer

Bevacizumab in the pre-operative treatment of locally advanced rectal cancer: A systematic review

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World Journal of Gastroenterology 2014年第20期20卷 6081-6091页

作者： Lorenzo Fornaro Chiara Caparello Caterina Vivaldi Virginia Rotella Gianna Musettini Alfredo Falcone Editta Baldini Gianluca Masi Division of Medical Oncology Azienda USL2 Lucca 55100 Lucca Italy Division of Medical Oncology 2 Azienda Ospedaliero-Universitaria Pisana 56126 Pisa Italy

Despite advances in the management of patients with locally advanced, non-metastatic rectal adenocarcinoma (LARC), prognosis remains largely unsatisfactory due to a high rate of distant relapse. In fact, currently available neoadjuvant protocols, represented by fluoropyrimidine-based chemo-radiotherapy (CT-RT) or short-course RT, together with improved surgical techniques, have largely reduced the risk of local relapse, with limited impact on distant recurrence. Available results of phase III trials with additional cytotoxic agents combined with standard CT-RT are disappointing, as no significant reduction in the risk of recurrence has been demonstrated. In order to improve the control of micrometastatic disease, integrating targeted agents into neoadjuvant treatment protocols thus offers a rational approach. In particular, the antiangiogenic agent bevacizumab has demonstrated synergistic activity with both CT and RT in pre-clinical and clinical models, and thus may represent a suitable companion in the neoadjuvant treatment of LARC. Preliminary results of phase I-II clinical studies are promising and suggest potential clinical parameters and molecular predictive biomarkers useful for patient selection: treatment personalization is indeed the key in order to maximize the benefit while reducing the risk of more complex neoadjuvant treatment schedules.

关键词： Bevacizumab Chemotherapy locally advanced rectal cancer Neoadjuvant treatment Radiotherapy

Neoadjuvant oxaliplatin and capecitabine combined with bevacizumab plus radiotherapy for locally advanced rectal cancer: results of a single-institute phase II study

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cancer Communications 2018年第1期38卷 263-271页

作者： Xin Yu Qiao-xuan Wang Wei-wei Xiao Hui Chang Zhi-fan Zeng Zhen-hai Lu Xiao-jun Wu Gong Chen Zhi-zhong Pan De-sen Wan Pei-rong Ding Yuan-hong Gao Sun Yat-sen University cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuang-zhouP.R.China Department of Radiation Oncology Sun Yat-sen University Cancer Center651 Dongfeng Rd EastGuangzhou 510060P.R.China Department of Colorectal Surgery Sun Yat-sen University Cancer Center651 Dongfeng Rd EastGuangzhou 510060P.R.China

Background:Neoadjuvant chemoradiotherapy followed by surgery is recommended as the standard of care for locally advanced rectal cancer,reducing local recurrence but not distant *** systemic therapy is warranted to reduce the risk of distant *** present study aimed to evaluate the safety and efficacy of neo-adjuvant oxaliplatin and capecitabine(XELOX)combined with bevacizumab plus radiotherapy for locally advanced rectal ***:Patients with stages II to III rectal cancer received one cycle of induction chemotherapy and concurrent chemoradiotherapy with XELOX plus *** was performed 6-8 weeks after completion of radiotherapy,and postoperative chemotherapy with three cycles of XELOX and two cycles of capecitabine were *** primary endpoints were pathologic complete response(pCR)rate and safety,and the secondary endpoints were 3-year overall survival and progression-free ***:Forty-five patients were enrolled between February 2013 and April *** completed the neoadjuvant *** patients(15.6%)refused subsequent surgical therapy for personal reasons,and the other 38 patients received radical resection,with a sphincter preservation rate of 84.2%and a pCR rate of 39.5%.Toxicity was acceptable,with grades 3-4 hematological toxicity and diarrhea observed in six and two patients,*** of anastomotic leak that required surgical intervention was 13.3%.After a median follow-up period of 37 months,five patients developed disease progression and two died of *** 3-year overall survival rate and 3-year progres-sion-free survival rate were 95.3%and 88.6%,***:The addition of bevacizumab to neoadjuvant chemoradiotherapy resulted in a satisfying pCR rate and 3-year survival,but also may increase the risk of anastomotic leak,thus this regimen is not suitable to be considered for regular recommendation for locally advanced rectal cancer.

关键词： Bevacizumab Neoadjuvant chemoradiotherapy locally advanced rectal cancer Safety Efficacy

Retrospective research of neoadjuvant therapy on tumordownstaging,post-operative complications,and prognosis in locally advanced rectal cancer

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World Journal of Gastrointestinal Surgery 2021年第3期13卷 267-278页

作者： Wen-Chang Li Jing-Kun Zhao Wen-Qing Feng Yi-Ming Miao Zi-Feng Xu Zhuo-Qing Xu Han Gao Jing Sun Min-Hua Zheng Ya-Ping Zong Ai-Guo Lu Department of General Surgery Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai 200025China

BACKGROUND Neoadjuvant therapy(NAT)is becoming increasingly important in locally advanced rectal ***,such research has become a *** To evaluate the downstaging effect of NAT,its impact on postoperative complications and its prognosis with different medical *** Seventy-seven cases from Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University School of Medicine were retrospectively collected and divided into the neoadjuvant radiochemotherapy(NRCT)group and the neoadjuvant chemotherapy(NCT)*** differences between the two groups in tumor regression,postoperative complications,rectal function,disease-free survival,and overall survival were compared using theχ2 test and Kaplan-Meier *** Baseline data showed no statistical differences between the two groups,whereas the NRCT group had a higher rate of T4(30/55 vs 5/22,P<0.05)than the NCT *** cases were evaluated as complete responders,and 15 cases were evaluated as tumor regression grade *** for the reduction rate of T stage(NRCT 37/55 vs NCT 9/22,P<0.05),there was no difference in effectiveness between the two *** radiation was not a risk factor for poor reaction or anastomotic *** significant difference in postoperative complications and disease-free survival between the two groups was observed,although the NRCT group might have better long-term overall *** NAT can cause tumor downstaging preoperatively or even complete remission of the primary *** could lead to better T downstaging and promising overall survival without more complications.

关键词： locally advanced rectal cancer Neoadjuvant therapy Tumor downstaging Postoperative complications Prognosis

Predictive significance of cancer related-inflammatory markers in locally advanced rectal cancer

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World Journal of Gastrointestinal Surgery 2020年第9期12卷 390-396页

作者： Kitinat Timudom Thawatchai Akaraviputh Vitoon Chinswangwatanakul Ananya Pongpaibul Pornpim Korpraphong Janjira Petsuksiri Suthinee Ithimakin Atthaphorn Trakarnsanga Department of Surgery Faculty of MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand Department of Pathology Faculty of MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand Department of Radiology Faculty of MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand Department of Medicine Faculty of MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand

BACKGROUND locally advanced rectal cancer is treated using neoadjuvant chemoradiation(nCRT),followed by total mesorectal excision(TME).Tumor regression and pathological post-treatment stage are prognostic for oncological *** is a significant correlation between markers representing cancer-related inflammation,including high neutrophil-to-lymphocyte ratio(NLR),monocyteto-lymphocyte ratio(MLR),and platelet-to-lymphocyte(MLR)and unfavorable oncological ***,the predictive role of these markers on the effect of chemoradiation is *** To evaluate the predictive roles of NLR,MLR,and PLR in patients with locally advanced rectal cancer receiving neoadjuvant *** Patients(n=111)with locally advanced rectal cancer who underwent nCRT followed by TME at the Minimally Invasive Surgery Unit,Siriraj Hospital between 2012 and 2018 were retrospectively *** associations between post-treatment pathological stages,neoadjuvant rectal(NAR)score and the pretreatment ratios of markers of inflammation(NLR,MLR,and PLR)were *** Clinical stages determined using computed tomography,magnetic resonance imaging,or both were T4(n=16),T3(n=94),and T2(n=1).The NAR scores were categorized as high(score>16)in 23.4%,intermediate(score 8-16)in 41.4%,and low(scoreadvanced pathological stage and high NAR scores,but not statistically *** In patients with locally advanced rectal cancer,pretreatment NLR,MLR and PLR are higher in those with advanced pathological stage but the differences are not significantly different.

关键词： locally advanced rectal cancer cancer-related inflammatory markers Neoadjuvant chemoradiation Neutrophil-to-lymphocyte ratio Monocyte-to-lymphocyte ratio Platelet-to-lymphocyte ratio