Neoadjuvant-intensified treatment for rectal cancer: Time to change?

Musio, Daniela; Felice, Francesca De; Bulzonetti, Nadia; Guarnaccia, Roberta; Caiazzo, Rossella; Bangrazi, Caterina; Raffetto, Nicola; Tombolini, Vincenzo

doi:10.3748/wjg.v19.i20.3052

Cited by 42 publications

(36 citation statements)

References 33 publications

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“…This issue has achieved relevance to guide decision-making, because pCR has begun to be considered as surrogate of more conservative treatment approach, including a “wait and see” policy, in selected cases [1, 8]. …”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy (RT) was delivered with a 3D-conformational multiple field technique at a dose of 45 Gy (1,8 Gy/fraction) to the whole pelvis plus a 5,4–9 Gy (1,8 Gy/fraction) to the tumor volume. Chemotherapy (CHT) consisted of weekly OXP (50 mg/m 2 , day 1) and five daily continuous infusions of 5-FU (200 mg/m 2 /day) of each week of RT, based on promising results in high rate of pCR [7–8]. Surgery was planned 7–9 weeks after the end of nCRT and its type was left to surgeon's discretion.…”

Section: Methodsmentioning

confidence: 99%

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Clinical predictive factors of pathologic complete response in locally advanced rectal cancer

et al. 2016

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BackgroundPredictive factors of pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) are still not identified. The purpose of this study was to define them.Materials and MethodsData from consecutive LARC patients treated between January 2008 and June 2014 at our Institution were included in the analysis. All patients were treated with a long course of nCRT. Demographics, initial diagnosis and tumor extension details, as well as treatment modalities characteristics were included in the univariate and logistic regression analysis.ResultsIn total 99 patients received nCRT, of whom 23 patients (23.2%) achieved pCR. Patients with and without pCR were similar in term of age, sex, comobidities, BMI and tumor characteristics. Multivariate logistic regression indicated that pre-treatment tumor size ≤ 5 cm was a significant predictor for pCR (p = 0.035), whereas clinical N stage only showed a positive trend (p = 0.084).ConclusionsTumor size at diagnosis could be used to predict pCR, and thus to individualize therapy in LARC patients management. Validation in other studies is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical predictive factors of pathologic complete response in locally advanced rectal cancer

et al. 2016

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“…Based on better 5-year survival rates for patients in our cohort treated with adjuvant ctx after neoadjuvant longterm ccrt and surgery at all postoperative T0-3 stages and even in the N0 stage, our findings emphasize the further benefit and feasibility of adjuvant ctx even in patients with a good response to preoperative ccrt [38][39][40][41] .…”

Section: Discussionmentioning

confidence: 99%

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

et al. 2017

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“…In locally advanced rectal cancer, significant progress has been made over the past few decades for improving loco-regional control: total mesorectal excision standardization, radiotherapy dose fractionation, correct timing of treatment modalities, integration of diverse chemotherapy agent into the chemoradiotherapy regimes [1] . The German Rectal Cancer Study Group addressed the last of those controversies, and in a multicentre randomised phase Ⅲ study, the CAO/ARO/AIO-04 trial, compared oxaliplatin (OXP) and fluoropyrimidine (5-FU) in combination with radiation vs 5-FU with radiation as neoadjuvant long-course treatment [2] .…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues

Felice

Musio

Izzo

et al. 2014

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Rectal carcinoma represents the 30% of all colorectal cancers, with about 40000 new cases/years. In the past two decades, the management of rectal cancer has made important progress, highlighting the main role of a multimodality strategy approach, combining surgery, radiation therapy and chemotherapy. Nowadays, surgery remains the primary treatment and neoadjuvant chemoradiotherapy, based on fluoropyrimidine (5-FU) continuous infusion, is considered the standard in locally advanced rectal carcinoma. The aim is to reduce the incidence of local recurrence and to perform a conservative surgery. To improve these purposes different drugs combination have been tested in the neo-adjuvant setting. At American Society of Clinical Oncology 2014 an important abstract was presented focusing on the role of adding oxaliplatin to concomitant treatment, in patients with locally advanced rectal carcinoma. Rodel et al reported on the CAO/ARO/AIO-04 randomized phase Ⅲ trial that compared standard treatment with 5-FU and radiation therapy, to oxaliplatin plus 5-FU in association with radiation therapy. The addition of oxaliplatin to the neo-adjuvant treatment has been shown to improve disease-free survival from 71.2% to 75.9% (P = 0.03). This editorial was planned to clarify the optimal treatment in patients with locally advanced rectal cancer, considering the results from CAO/ARO/AIO-04 study. De Felice F, Musio D, Izzo L, Tombolini V. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues.

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Neoadjuvant-intensified treatment for rectal cancer: Time to change?

Abstract: The results of this study suggest oxaliplatin chemotherapy has a beneficial effect on overall survival, likely due to an increase in local tumor control.

Cited by 42 publications

References 33 publications

Clinical predictive factors of pathologic complete response in locally advanced rectal cancer

Clinical predictive factors of pathologic complete response in locally advanced rectal cancer

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: The debate continues

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