An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer

Yeo, Seung‐Gu; Kim, Dae Yong

doi:10.3393/jksc.2012.28.4.179

Cited by 6 publications

(3 citation statements)

References 51 publications

(60 reference statements)

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“…Preoperative CRT allows downstaging of the primary tumor, sterilization of micrometastases in the pelvis, improved locoregional control, and decreased complication rates. Among these, significant tumor responses to preoperative CRT may lead to the use of LE even in patients at a high risk of disease recurrence because a pathologically complete response (ypCR) after CRT was suggested to have a favorable outcome [ 12 , 13 , 14 ]. The key rationale for this approach is the correlation between radiosensitivity and the inherent low aggressiveness of rectal cancer [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Lee

Kim

et al. 2014

Cancer Res Treat

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PurposeTo evaluate the treatment outcomes of local excision following preoperative chemoradiotherapy in patients with locally advanced rectal cancer who have not undergone radical surgery for any reason.Materials and MethodsThe data of 27 patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy followed by local excision were analyzed retrospectively. The primary endpoint was the 5-year relapse-free survival rate, and the secondary endpoint was the pattern of recurrence.ResultsThe median follow-up time was 81.8 months (range, 28.6 to 138.5 months). The 5-year local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS) were 88.9%, 81.1%, 77.8%, and 85.0%, respectively. Six (22%) patients developed treatment failure; one (4%) patient had local recurrence only, three (11%) patients had distant recurrence only, and two (7%) patients had both. The 5-year LRFS, DMFS, RFS, and OS for patients with ypT0-1 compared with ypT2-3 were 94.1% vs. 77.8% (p=0.244), 94.1% vs. 55.6% (p=0.016), 88.2% vs. 55.6% (p=0.051), and 94.1% vs. 66.7% (p=0.073), respectively.ConclusionLocal excision following preoperative chemoradiotherapy may be an alternative treatment for highly selected patients with locally advanced rectal cancer who have achieved ypT0-1 after preoperative chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Lee

Kim

et al. 2014

Cancer Res Treat

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“…Clinicopathological factors associated with the CRT response to rectal cancer include the levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, and fibrinogen; the histological grade and mucinous histology; tumor size, volume, circumference, and movability; the hemoglobin level and blood lymphocyte counts; the clinical T or N stage; and the distance from the tumor to the anal verge [21,[45][46][47][48][49][50][51][52][53][54][55][56][57]. Of these factors, the serum CEA level has been the most relevant [48][49][50].…”

Section: Predictive Markers Clinicopathological Factorsmentioning

confidence: 99%

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organsparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

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“…For locally advanced rectal cancer [LARC; also referred to as stage T3-4 or N+ rectal cancer, according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual] (5), chemoradiotherapy (CRT) has been established as a standard preoperative treatment, rather than a postoperative treatment (6,7). Preoperative CRT leads to significant improvement in the local disease control of LARC (8). In addition, preoperative CRT and a 6-8-week interval prior to the surgical procedure result in a decrease in the stage and size of the primary mural tumors, along with a lower risk of regional lymphadenopathy (9).…”

Section: Introductionmentioning

confidence: 99%

Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report

Yeo

2016

Experimental and Therapeutic Medicine

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Local excision (LE) for rectal cancer is currently indicated for selected T1 stage tumors. However, preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer not only improves local disease control, but also leads to a decrease in the stage and size of the primary mural tumor, along with a decrease in the risk of regional lymphadenopathy. The present study reports the outcome of a patient with T3N0M0 rectal cancer who was treated with LE following preoperative CRT. The distal pole of the tumor was located 2 cm from the anal verge. Preoperative pelvic radiotherapy of 50.4 Gy was administered in 28 fractions. Chemotherapy using 5-fluorouracil and leucovorin was administered during the first and last weeks of radiotherapy. The tumor response to CRT, was found to be marked at 7 weeks after CRT completion, and a complete response was presumed clinically. Transanal full-thickness LE was performed, and pathological examination revealed the absence of residual cancer cells. After 30 months of close follow-up, the patient was alive with no evidence of disease, and treatment-associated severe toxicities were not observed. Although a longer follow-up period is required, this case report suggests that LE may also be a feasible alternative treatment for T3 rectal cancer, which exhibits a marked response to preoperative CRT, particularly in elderly and comorbid patients contraindicated for radical surgery, or patients who are reluctant to undergo sphincter-ablation surgery.

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An Update on Preoperative Radiotherapy for Locally Advanced Rectal Cancer

Cited by 6 publications

References 51 publications

Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report

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