Clinical impact of tumor volume reduction in rectal cancer following preoperative chemoradiation

Han, Yo; Oh, Soon Nam; Choi, Min‐Kyung; Lee, S.H.; Jang, Hong-Seok; Lee, M.A.; Kim, J.-G.

doi:10.1016/j.diii.2016.05.004

Cited by 22 publications

(22 citation statements)

References 37 publications

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“…This evaluation can be performed within days to weeks of the start of the intervention and prior to surgery by assessing volume effects using RECIST criteria with CT or MRI [4,5], MRI based tumour regression grading [6], and mapping macroscopic and microscopic details about tumour architecture [7,8]. Results of prospective trials showed clinical complete response (cCR) or TNM down-staging after CRT is a biomarker of more favourable oncological outcomes in LARC [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Nagtegaal

Glynne‐Jones

2020

Cancer Treatment Reviews

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Various methods categorize tumour response after neoadjuvant therapy, including down-staging and tumour regression grading. Response categories allow comparison of different treatments within clinical trials and predict outcome. A reproducible response categorization could identify subgroups with high or low risk for the most appropriate subsequent treatments, like watch and wait. Lack of standardization and interpretation difficulties currently limit the usability of these approaches. In this review we describe these difficulties for the evaluation of chemoradiation in rectal cancer. An alternative approach of tumour response is based on patterns of residual disease, including fragmentation. We summarise the evidence behind this alternative method of response categorisation, which explains a number of very relevant clinical discrepancies. These issues include differences between downstaging and tumour regression, high local regrowth in advanced tumours during watchful waiting procedures, the importance of resection margins, the limited value of post-treatment biopsies and the relatively poor outcome of patients with a near complete pathological response. Recognition of these patterns of response can allow meaningful development of novel biomarkers in the future.

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Section: Introductionmentioning

confidence: 99%

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Nagtegaal

Glynne‐Jones

2020

Cancer Treatment Reviews

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“…Survival outcomes can be predicted from tumor volume reductions after preoperative CRT [12,16,17]. MRI-based assessments of response to CRT are associated with survival outcomes, including RFS and OS.…”

Section: Discussionmentioning

confidence: 99%

“…The TVRR was defined as 100 × [(volume baseline − volume post NAC)/volume baseline]. We classified the patients into two groups according to previously established criteria: good responders (those having a TVRR ≥60) and poor responders (those having a TVRR <60) [12,13]. The sizes of primary lesions and the presence of mrEMVI and ymrEMVI were evaluated by two experienced colorectal surgeons, and incongruent results were reviewed and finalized by consensus.…”

Section: Clinical Tnm Classifications Clinical Crm Mremvi Ymremvimentioning

confidence: 99%

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

Shiraishi

Sasaki²,

Ikeda

et al. 2019

Preprint

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Background: Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy. Methods: We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated. Results: The cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p =0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p =0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate <60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36–5.50, p =0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57–7.72, p =0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0% and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4% and 50.0%, respectively). Conclusions: Reductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.

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“…The TVRR was defined as 100×[(Volume baseline − Volume post NAC)/Volume baseline]. We classified the patients into two groups according to previously established criteria: good responders (those having a TVRR ≥60) and poor responders (those having a TVRR <60) [12,13]. The sizes of primary lesions and the presence of mrEMVI were evaluated by two experienced colorectal surgeons and incongruent results were reviewed and finalized by consensus.…”

Section: Methodsmentioning

confidence: 99%

“…Survival outcomes can be predicted from tumor volume reductions after preoperative CRT[12, 16, 17]. MRI-based assessments of response to CRT are associated with survival outcomes, including RFS and OS.…”

mentioning

confidence: 99%

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

Shiraishi

Sasaki²,

Ikeda

et al. 2019

Preprint

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Background: Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer although some of these cases are systemic, and local control may be inadequate. We aimed to stratify patients into prognostic groups based on preoperative factors, including response to neoadjuvant chemotherapy. Methods: We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy followed by curative resection between 2010 and 2017 and those, who did not receive neoadjuvant chemoradiotherapy. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging. Recurrence and overall survival were also evaluated.Results: The cohort was composed of 105 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 83.3%, poor responders: 50.9%; p=0.001) and 5-year overall survival (good responders: 95.8%, poor responders: 82.5%; p=0.04). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging before neoadjuvant chemotherapy was significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.57, 95% confidence interval: 1.32–5.03, p=0.006). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.7% and 94.9%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (26.7% and 60.0%, respectively).Conclusions: Reductions in tumor volume after neoadjuvant chemotherapy were associated with better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.

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Clinical impact of tumor volume reduction in rectal cancer following preoperative chemoradiation

Abstract: MR volumetric measurement of rectal cancer helps predict disease-free survival in patients with rectal cancer who underwent preoperative CRT.

Cited by 22 publications

References 37 publications

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

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