Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer

Liu, Xiaoliang; Wang, Junjie; Hu, Ke; Zhang, Fuquan; Hou, Xiaorong; Xiao, Yi; Lian, Xin; Sun, Shibin; Liu, Zhikai; Yan, Jun; Zheng, Min

doi:10.7150/jca.41950

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Because the exact relationship between PLR and the OS and DFS of patients receiving NAC is yet unknown, we conducted a meta-analysis to determine the relevant relationships. In some cases, the addition of NAC resulted in greater tumor downsizing and increasing the rate of complete resection, improved the pCR rate, and demonstrated local control, but the relative effects are controversial [38–45] . To the best of our knowledge, meta-analyses are a more comprehensive update that systematically and quantitatively evaluates this topic.…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, the addition of NAC resulted in greater tumor downsizing and increasing the rate of complete resection, improved the pCR rate, and demonstrated local control, but the relative effects are controversial. [38][39][40][41][42][43][44][45] To the best of our knowledge, meta-analyses are a more comprehensive update that systematically and quantitatively evaluates this topic. In the present meta-analysis of 18 studies including 3653 cases, we evaluated the prognostic role of PLR in solid tumors following NAC or nCRT.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

Long

Zhang²,

Ni³

et al. 2021

Medicine

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Introduction: Previous research indicates that the platelet-to-lymphocyte ratio (PLR) may be an indicator of poor prognosis in many tumor types. However, the PLR is rarely described in patients undergoing neoadjuvant chemotherapy (NAC) for solid tumors. Thus, we performed a meta-analysis to investigate the prognostic value of this ratio for patients with solid tumors treated by NAC.Methods: A comprehensive search of the literature was conducted using the PubMed, EMBASE, Cochrane Library, and Web of Science databases, followed by a manual search of references from the retrieved articles. Pooled hazard ratios (HRs) with 95% confidence interval (CIs) were used to evaluate the association between PLR and 3 outcomes, namely, overall survival, disease-free survival, and pathological complete response rate after NAC.Results: Eighteen studies published no earlier than 2014 were included in our study. A lower PLR was associated with better overall survival (HR = 1.46, 95% CI, 1.11-1.92) and favorable disease-free survival (HR = 1.81, 95% CI, 1.27-2.59). A PLR that was higher than a certain cutoff was associated with a lower pathological complete response rate in patients with cancer who received NAC (Odds ratio = 1.93, 95% CI, 1.40-2.87).Conclusion: Elevated PLR is associated with poor prognosis in various solid tumors. PLR may be a useful biomarker in delineating those patients with poorer prognoses who may benefit from neoadjuvant therapies.Abbreviations: CI = confidence interval, DFS = disease-free survival, HR = hazard ratio, NOS = Newcastle-Ottawa Scale, OR = odds ratio, OS = overall survival, PFS = progression-free survival, PLR = platelet-to-lymphocyte ratio, NAC = neoadjuvant chemotherapy, nCRT = neoadjuvant chemoradiotherapy, pCR = pathological complete response, ROC = receiver operating characteristic curve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

Long

Zhang²,

Ni³

et al. 2021

Medicine

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A prospective phase II clinical trial of total neoadjuvant therapy for locally advanced gastric cancer and gastroesophageal junction adenocarcinoma

Shi,

Li,

Jiang

et al. 2024

Sci Rep

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To investigate the safety and efficacy of the neoadjuvant chemoradiotherapy (NCRT) followed by neoadjuvant consolidation chemotherapy (NCCT) and surgery for locally advanced gastric cancer (GC) or gastroesophageal junction (GEJ) adenocarcinoma. Patients diagnosed as locally advanced GC or Siewert II/III GEJ adenocarcinoma with clinical stage T3-4 and/or N positive were prospectively enrolled. Patients underwent NCRT (45 Gy/25 fractions) with concurrent S-1, followed by NCCT (4 to 6 cycles of the SOX regimen) 2 to 4 weeks after NCRT. Gastric cancer radical resection with D2 lymph node dissection was performed 4 to 6 weeks after the total neoadjuvant therapy. The study was conducted from November 2019 to January 2023, enrolling a total of 46 patients. During the NCRT, all patients completed the treatment without dose reduction or delay. During the NCCT, 32 patients (69.6%) completed at least 4 cycles of chemotherapy. Grade 3 or higher adverse events in NCRT (5 cases) were non-hematological. During the course of NCCT, a notable occurrence of hematological toxicities was observed, with grade 3 or higher leukopenia (9.7%) and thrombocytopenia (12.2%) being experienced. A total of 28 patients (60.9%) underwent surgery, achieving R0 resection in all cases. A significant proportion of cases (71.4%) exhibited pathological downstaging to ypT0-2, while 10 patients (35.7%) demonstrated a pathologic complete response (pCR). The total neoadjuvant therapy comprising NCRT followed by NCCT and surgery demonstrates a low severe adverse reactions and promising efficacy, which could be considered as a viable treatment for locally advanced GC or GEJ adenocarcinoma.Trial registration: Clinicaltrials.gov (registration number: NCT04062058); the full date of first trial registration was 20/08/2019.

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Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature

Delishaj

Fumagalli

Ursino

et al. 2021

WJCC

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BACKGROUND The standard treatment of locally advanced rectal cancers (LARC) consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision. Different data in literature showed a benefit on tumor downstaging and pathological complete response (pCR) rate using radiotherapy dose escalation, however there is shortage of studies regarding dose escalation using the innovative techniques for LARC (T3-4 or N1-2). AIM To analyze the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques. METHODS In December 2020, we conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane library. The limit period of research included articles published from January 2009 to December 2020. Screening by title and abstract was carried out to identify only studies using radiation doses equivalent dose 2 Gy fraction (EQD2) ≥ 54 Gy and Volumetric Modulated Arc Therapy (VMAT), intensity-modulated radiotherapy or image-guided radiotherapy (IGRT) techniques. The authors’ searches generated a total of 2287 results and, according to PRISMA Group (2009) screening process, 21 publications fulfil selection criteria and were included for the review. RESULTS The main radiotherapy technique used consisted in VMAT and IGRT modality. The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with simultaneous integrated boosts technique (42.85%). The mean pCR was 28.2% with no correlation between dose prescribed and response rates ( P value ≥ 0.5). The R0 margins and sphincter preservation rates were 98.88% and 76.03%, respectively. After a mean follow-up of 35 months local control was 92.29%. G3 or higher toxicity was 11.06% with no correlation between dose prescription and toxicities. Patients receiving EQD2 dose > 58.9 Gy and BED > 70.7 Gy had higher surgical complications rates compared to other group ( P value = 0.047). CONCLUSION Dose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC achieving higher rates of pCR. EQD2 doses > 58.9 Gy is associated with higher rate of surgical complications.

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Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer

Cited by 3 publications

References 32 publications

Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

A prospective phase II clinical trial of total neoadjuvant therapy for locally advanced gastric cancer and gastroesophageal junction adenocarcinoma

Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature

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