Advances in the treatment of locally advanced rectal cancer

Ali, Fadwa; Keshinro, Ajaratu; Weiser, Martin R.

doi:10.1002/ags3.12389

Cited by 21 publications

(33 citation statements)

References 41 publications

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“…Locally advanced rectal cancer (LARC) was established based on the tumor classification parameters cT3-T4, N -/+, and M0, which have a 5-years survival rate of 50-65%, with a local recurrence rate of around 30-40%, and a high incidence of metastases. 13 Locally Advanced Rectal Cancer (LARC) can also be defined as a tumor that invades or spreads close (< 2 mm) to the mesorectal fascia. In addition, because LARC is cancer of the rectum that reaches T3 and T4, which means that the tumor is adjacent to adjacent organs such as the pelvic bone, proximity of the sphincter or peritoneum, vagina, prostate and also the autonomic nerves, making surgical resection an option challenging because it can cause patient morbidity.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

Branko¹,

Lesmana²

2022

Bali Med J.

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Background: Several serum inflammatory markers have been investigated as prognostic biomarkers for rectal cancer patients, including C-Reactive Protein (CRP)/Albumin Ratio (CAR). We aimed to examine the association between the CAR pre-therapy value and radiological response after neoadjuvant chemotherapyMethods: We recruited locally advanced rectal cancer patients who underwent FOLFOX first-line neoadjuvant chemotherapy (NAC) at Dr. Soetomo General Hospital (Surabaya, Indonesia) from January 2015 to December 2020. Before neoadjuvant chemotherapy treatment, the C-reactive protein (CRP) and albumin were measured. The chemotherapy response was performed by evaluating the CT scan result before and after the NAC was given. We used RESIST criteria to assess the radiological response after NAC treatment. Data were analyzed using SPSS version 23 for Windows.Results: We included a total of 102 patients, with the female being the predominant gender with LARC (52%.0). The well-differentiated adenocarcinoma was the most common adenocarcinoma type found in this study (59.8%). We found 57 patients with positive responses and 45 patients with negative responses. Patients with well-differentiated status who had adenocarcinoma had a higher chance to have a positive response to NAC. Patients with low CAR values had a 2.13 times higher chance of having a positive chemotherapy response than patients with high CAR values (95% CI = 1.30-3.30). Conclusion: There was a significant relationship between high CAR values and poor radiological response after neoadjuvant chemotherapy in locally advanced rectal cancer patients. The CAR value may be a potential biomarker to predict the radiologic response after NAC treatment.

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Section: Discussionmentioning

confidence: 99%

C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

Branko¹,

Lesmana²

2022

Bali Med J.

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“…Author details 1 Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038 Lisbon, Portugal. 2 Nova Medical School, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.…”

Section: Fundingmentioning

confidence: 99%

“…The concept of “locally-advanced rectal cancer” is intrinsically linked with a clinical indication for neoadjuvant therapy (NAT). It traditionally applies to all clinically staged T3/T4 and/or N+ tumours, although in the UK and other centres across Europe criteria may be more strict [ 1 , 2 ]. NAT regimens were initially designed with the sole purpose of downsizing/downstaging tumours in order to increase the likelihood of an R0 resection and diminish the risk of local recurrence [ 3 ], but the 10–25% pathologic complete response (pCR) rates have led clinicians to question the utility of radical surgery itself in such cases [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

et al. 2021

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In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template.

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“…Moreover, neoadjuvant chemotherapy has been introduced to manage unresectable colorectal carcinoma (CRC) with oligo-metastasis [ 2 ]. This patient group is highly heterogeneous and each patient has a different prognosis [ 2 , 3 ]. To achieve better clinical outcomes, it is necessary to select those who respond well to neoadjuvant treatment.…”

Section: Introductionmentioning

confidence: 99%

Intratumoral Budding in Pretreatment Biopsies, among Tumor Microenvironmental Components, Can Predict Prognosis and Neoadjuvant Therapy Response in Colorectal Adenocarcinoma

et al. 2022

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Background and Objectives: The prediction of the prognosis and effect of neoadjuvant therapy is vital for patients with advanced or unresectable colorectal carcinoma (CRC). Materials and Methods: We investigated several tumor microenvironment factors, such as intratumoral budding (ITB), desmoplastic reaction (DR), and Klintrup–Mäkinen (KM) inflammation grade, and the tumor–stroma ratio (TSR) in pretreatment biopsy samples (PBSs) collected from patients with advanced or unresectable CRC. A total of 85 patients with 74 rectal carcinomas and 11 colon cancers treated at our hospital were enrolled; 66 patients had curative surgery and 19 patients received palliative treatment. Results: High-grade ITB was associated with recurrence (p = 0.002), death (p = 0.034), and cancer-specific death (p = 0.034). Immature DR was associated with a higher grade of clinical tumor-node-metastasis stage (cTNM) (p = 0.045), cN category (p = 0.045), and cM category (p = 0.046). The KM grade and TSR were not related to any clinicopathological factors. High-grade ITB had a significant relationship with tumor regression in patients who received curative surgery (p = 0.049). Conclusions: High-grade ITB in PBSs is a potential unfavorable prognostic factor for patients with advanced CRC. Immature DR, TSR, and KM grade could not predict prognosis or therapy response in PBSs.

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Advances in the treatment of locally advanced rectal cancer

Cited by 21 publications

References 41 publications

C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

Intratumoral Budding in Pretreatment Biopsies, among Tumor Microenvironmental Components, Can Predict Prognosis and Neoadjuvant Therapy Response in Colorectal Adenocarcinoma

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