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.
Purpose/Objective(s): Recurrent high-grade gliomas (HGG) have limited treatment options. Both re-irradiation (reRT) and bevacizumab have been used as salvage treatment with limited success. Our institutional practice is to reserve reRT for bevacizumab failure to minimize the risk of radiation toxicity. This report summarizes efficacy of reRT, post-bevacizumab salvage chemotherapy (PBSC) with or without subsequent reRT, or best supportive care (BSC) for high-grade gliomas that progressed on salvage bevacizumab. Materials/Methods: A total of 86 patients were treated for recurrent highgrade gliomas between 2012 and 2016. Patients with prior pathological diagnosis of glioma, prior course of RT, and pathological or radiographic evidence of progressive high-grade disease after salvage bevacizumab were included in this retrospective study. A total of 71 patients received a median of 2 (range 1-5) salvage systemic chemotherapy agents prior to bevacizumab. Prognostic factors and outcomes were abstracted from our institution's electronic medical record. Results: Initial histologic grade was II in 16 patients, III in 18 patients, and 4 in 52 patients. Median age at initial diagnosis was 55 years. Chemotherapeutic agents used prior to bevicizumab included temozolomide, procarbazine, carboplatin, lomustine, carmustine, PCV, and imatinib. Thirteen of 21 BSC patients received a median of 1 chemotherapy agent prior to bevacizumab (range 1-3). Twenty-nine of 36 PBSC patients received a median of 2 chemotherapy agents prior to bevacizumab (range 1-5). Twenty-seven of 28 reRT patients received a median of 2 chemotherapy agents prior to bevacizumab (range 1-4). Median PFS after bevacizumab failure was 2.6 months (1.5 months BSC, 3.0 months for those receiving PBSC with or without subsequent reRT, and 3.1 months for immediate post-bevacizumab reRT (pZ0.0001)). All PBSC patients went on to receive a median of 2 chemotherapy agents (range 1-3) after first progression. Eighteen of 36 also eventually received reRT after PBSC. After reRT, 27 of 28 patients received a median of 1 chemotherapy agent (range 1-2) and 4 patients were treated with an Optune device. Median overall survival from bevacizumab failure was 2.0 months BSC, 6.4 months PBSC, 8.6 months PBSC followed by reRT, and 5.7 months reRT (p<0.0001). Conclusion: Compared to reports in which reRT is used earlier in the course of disease progression, progression-free survival in this cohort of heavily pre-treated high-grade glioma patients is limited. However, reirradiation as well as post-bevacizumab salvage chemotherapy may be associated with improved patient survival when compared to best supportive care even late in the course of disease progression in high-grade glioma.
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