Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?

MacDermid

et al. 2019

ANZ Journal of Surgery

Background Positive circumferential resections are associated with local disease recurrence and reduced survival in rectal cancer. We studied a cohort of consecutive rectal cancer resections to assess for clinicopathological differences and survival in patients with positive and negative circumferential margins. Methods Rectal cancers were identified from a retrospective histopathology database of colorectal resections performed at five western Sydney hospitals from 2010 to 2016. Univariate and multivariate analysis with binary logistic regression were performed on histopathology data matched with survival times from the New South Wales Registry of Births Deaths and Marriages. Results A total of 502 rectal cancer patients were identified including 66 (13.1%) with involved circumferential margins. Patients with positive and negative circumferential margins had a similar distribution of age, gender and use of neoadjuvant radiotherapy. Tumours with involved circumferential margin comprised 98.5% T3 and T4 disease of which 51.5% received neoadjuvant radiotherapy. These were significantly associated with metastatic disease, increasing tumour size, circumferential and perforated tumours on univariate analysis. Multivariate analysis identified abdomino‐perineal resection (odds ratio (OR) 3.35; P = 0.003), en‐bloc multivisceral resection (OR 2.56; P = 0.032), T4 stage (OR 6.99; P < 0.001), perineural (OR 5.61; P < 0.001) and vascular invasion (OR 2.46; P = 0.022) as independent risk factors. Five‐year survival was significantly worse for patients with involved circumferential margins (26% versus 69%; P < 0.001). Conclusion Circumferential margin status reflects not only technical success but also aggressive disease phenotypes which require adjuvant therapy. Further work is needed to determine whether omission of radiotherapy has had an effect on long‐term outcomes in some of our at‐risk patients.

Section: Discussionmentioning

confidence: 87%

Clinicopathological factors associated with positive circumferential margins in rectal cancers

MacDermid

et al. 2019

ANZ Journal of Surgery

“…Seventeen studies met the inclusion and exclusion criteria, with an overall patient number of 4785, in which 15.9% had a pCR and 84.1% a non‐pCR (shown in Table ) . There were 12 retrospective studies , four prospective observational studies and one randomized controlled trial comparing preoperative CRT with postoperative CRT.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 579 titles and abstracts were screened, with 58 studies selected for full text review, and a further nine were added after scanning the associated reference lists. Seventeen studies met the inclusion and exclusion criteria, with an overall patient number of 4785, in which 15.9% had a pCR and 84.1% a non-pCR (shown in Table 1) [4][5][6][11][12][13]15,16,20,[22][23][24][25][26][27][28][29]. There were 12 retrospective studies [4,[11][12][13]16,20,22,[24][25][26][27][28], four prospective observational studies [5,6,15,29] and one randomized controlled trial [23] comparing preoperative CRT with postoperative CRT.…”

Section: Resultsmentioning

confidence: 99%

“…Prognostic markers such as ypN, LVI and PNI are commonly used to assess patient's risk of recurrence and therefore negate recommendation for adjuvant chemotherapy. However inconsistent reports on the significance of these markers to predict patient's prognosis is a concern [11- 13,15,22,23,29]. By comparing the pooled HR results for each covariate, no response has the highest HR of 2.97, compared with the LVI HR of 1.4, the ypN HR of 2.2 and the PNI HR of 2.3.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta‐analysis

et al. 2018

“…Topalian 15,16 . For this reason, a new standard sampling and histopathological classification system for peritoneal malignancies of Solas et al was used in our study.…”

mentioning

confidence: 99%

Effects of nivolumab in peritoneal carcinamatosis of malign melanoma in mouse model

et al. 2017

Effects of nivolumab in peritoneal carcinamatosis of malign melanoma in mouse model 1 AbstractPurpose: To evaluate the efficacy of nivolumab and comparison with dacarbazine (DTIC) on peritoneal carcinomatosis of malignant melanoma in mouse model. Methods: Mouse skin melanoma cells was injected under the capsule of the peritoneal surface in the left side of the abdomen. On postoperative day ten, mouses randomised into three groups. Group 1: Control, Group 2: HIPEC (Hyperthermic intraperitoneal chemotherapy) with DTIC and Group 3: HIPEC with Nivolumab. After the sacrification on postoperative day fifteen, peritoneum evaluated macroscopically and histopathologically by using peritoneal regression grading score (PRGS). Results: In the 15th day exploration, all animals developed extensive intraperitoneal tumor growth in Group 1. In Group 2 and Group 3 median tumor size was 0.7±0.3cm and 0.3±0.2cm respectively (p: 0.023). Peritoneal carcinomatosis index (PCI) were significantly lower in Group 3 than other groups (p: 0.019). The lowest total tumor nodules in group 3 was 4 ± 2. The PGRS score was found significantly lower in Group 3 than other groups (p: 0.03). Lymphocytic response rate was found higher in the Group 3. Conclusions: It has been found that nivolumab significantly better than DTIC on peritoneal metastases of malign melanoma in mouse models. Nivolumab treatment gives promising results with pathological evidence in the treatment of metastatic disease of malignant melanoma.