Complete Pathologic Response after Combined Modality Treatment for Rectal Cancer and Long-Term Survival: A Meta-Analysis

Zorcolo, Luigi; Rosman, Alan S.; Restivo, Angelo; Pisano, Michele; Nigri, Giuseppe; Fancellu, Alessandro; Melis, Marcovalerio

doi:10.1245/s10434-011-2209-y

Cited by 208 publications

(186 citation statements)

References 69 publications

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“…e rate of complete responses (11.1%) was similar with the reported 10.4-25.6% in studies including several stages [13], although on the lower end of the range, probably due to a large number of advanced cases (cT3N2 35/81 or 43.2%; cT4b 19/81 or 23.5%).…”

Section: Discussionsupporting

confidence: 85%

Neoadjuvant Conformal Chemoradiation with Induction Chemotherapy for Rectal Adenocarcinoma. A Prospective Observational Study

Fekete

Muntean

Hica

et al. 2014

JGLD

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Background & Aims: The purpose of this prospective observational study was to evaluate the rate andthe prognostic factors for down-staging and complete response for rectal adenocarcinoma after inductionchemotherapy and neoadjuvant chemoradiation followed by surgery, and to analyze the rate of sphinctersaving surgery.Methods: We included from March 2011 to October 2013 a number of 88 patients hospitalized with locally advanced rectal adenocarcinoma in the Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj. The treatment schedule included 2-4 cycles of Oxaliplatin plus a fluoropyrimidine followed by concomitant chemoradiation with a dose of 50 Gy in 25 fractions combined with a fluoropyrimidine monotherapy.Results:The rate of T down-staging was 49.4% (40/81 evaluable patients). Independent prognostic factors for T down-staging were: age >57 years (p<0.01), cN0 (p<0.01), distance from anal verge >5 cm (p<0.01), initial CEA <6.2 ng/ml (p<0.01), higher number of chemotherapy cycles with Oxaliplatin (pROC=0.05) and protraction of radiotherapy of >35 days (p<0.01). Nine patients from 81 (11.1%) presented complete response (7 pathological and 2 clinical); the independent prognostic factors were stage cT2 versus cT3-4 (p<0.01), initial tumor size ≤3.5 cm and distance from anal verge >5 cm (p=0.03). Sixty-eight patients (79.1%) underwent radical surgery and among them 35 patients (51.5 %) had a sphincter saving procedure.Conclusions: Induction chemotherapy with neoadjuvant chemoradiation produced important down-staging in rectal adenocarcinoma. Independent prognostic factors for T down-staging were: age, cN0, distance from anal verge, initial CEA, the number of Oxaliplatin cycles and duration of radiotherapy; for complete response: cT2, initial tumor size and distance from the anal verge. Abbreviations: 5FU: 5-fluorouracil; AJCC: American Joint Committee on Cancer; AV: anal verge; CAPOX: Capecitabine plus Oxaliplatin; CCR: clinical complete response; CRT: chemoradiation; CTC4.0: Common Terminology Criteria for Adverse Events, version 4.0; ECOG: Eastern Collaborative Oncology Group; EUS: endorectal ultrasound; FOLFOX: 5-fluorouracil plus Oxaliplatin; LARC: locally advanced rectal cancer; PCR: pathological complete response; PS: performance status; PTV: planning target volume; R0: Resection, 0 (microscopically clear resection margin); ROC curve: receiver operating characteristic curve; TME: total mesorectal excision; TRG: tumor regression grade.

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Section: Discussionsupporting

confidence: 85%

Neoadjuvant Conformal Chemoradiation with Induction Chemotherapy for Rectal Adenocarcinoma. A Prospective Observational Study

Fekete

Muntean

Hica

et al. 2014

JGLD

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“…Neoadjuvant chemoradiation-such as preoperative infusional 5fu and radiotherapy, capecitabine and radiotherapy, or 5fu-leucovorin and radiotherapy-is the preferred standard-of-care approach 9 . Pathologic complete response rates for standard regimens of neoadjuvant chemoradiation fall in the 8% -26% range [25][26][27][28] . Patients with T3/4 or node-positive disease who underwent preoperative chemoradiation had a 5-year overall survival of approximately 76% 27 .…”

Section: Discussionmentioning

confidence: 99%

Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma

et al. 2016

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Synchronous cancers of different primary origin are rare. Here, we describe the case of a patient with concomitant diagnoses of rectal adenocarcinoma and splenic marginal zone lymphoma (smzl).A 57-year-old woman initially presented with abdominal pain. Physical examination and computed tomography demonstrated massive splenomegaly, and a complete blood count revealed microcytic anemia and lymphopenia. During the subsequent evaluation, she presented with hematochezia, melena, and constipation, which prompted gastroenterology referral. Subsequent endoscopic rectal ultrasonography revealed a T3N1 moderately differentiated rectal adenocarcinoma, with computed tomography imaging of chest, abdomen, and pelvis confirming no metastasis. Thus, the cancer was classified as clinical stage T3N1M0, stage iii. Bone marrow biopsy confirmed co-existing marginal zone lymphoma, and with the clinical presentation of massive splenomegaly, a diagnosis of smzl was made.The patient's management was individually tailored for simultaneous optimal treatment of both conditions. Concurrent treatment with neoadjuvant rituximab and 5-fluorouracil chemotherapy, with external-beam radiation therapy to the pelvis, was administered, followed by surgery consisting of en bloc splenectomy and distal pancreatectomy, and low anterior resection. The patient completed a standard course of adjuvant folfox (fluorouracil-leucovorin-oxaliplatin) chemotherapy and has remained disease-free for 7 years.To our knowledge, this report is the first to specifically describe simultaneous diagnoses of locally advanced rectal cancer and smzl. We also describe the successful combined neoadjuvant treatment combination of 5-fluorouracil, rituximab, and pelvic radiation.

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“…After neoadjuvant treatment, rectal cancer patients may show T and N down-staging to some degree, and even about 10 to 20% patients may get tumor complete regression [4]. It is well known that the patients who achieved pathological complete response have very good prognosis so as postoperative adjuvant chemotherapy may be unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…Most trials failed to prove that neoadjuvant chemoradiotherapy and radiotherapy can improve overall survival. However, neoadjuvant radiotherapy may lead to some survival benefit for the patients who are sensitive to it (especially pathological complete response) [4].…”

mentioning

confidence: 99%

Rectal cancer patients after neoadjuvant radiotherapy (30Gy/10f) with negative lymph node may not benefit from postoperative adjuvant chemotherapy: a retrospective study

Chen

Yao

2015

Int J Colorectal Dis

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Complete Pathologic Response after Combined Modality Treatment for Rectal Cancer and Long-Term Survival: A Meta-Analysis

Abstract: CPR after CMT for rectal cancer is associated with improved local and distal control as well as better OS and DFS.

Cited by 208 publications

References 69 publications

Neoadjuvant Conformal Chemoradiation with Induction Chemotherapy for Rectal Adenocarcinoma. A Prospective Observational Study

Neoadjuvant Conformal Chemoradiation with Induction Chemotherapy for Rectal Adenocarcinoma. A Prospective Observational Study

Synchronous Rectal Adenocarcinoma and Splenic Marginal Zone Lymphoma

Rectal cancer patients after neoadjuvant radiotherapy (30Gy/10f) with negative lymph node may not benefit from postoperative adjuvant chemotherapy: a retrospective study

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