Predictive Factors of Tumor Response After Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer

Moureau-Zabotto, Laurence; Farnault, B.; Chaisemartin, Cécile de; Esterni, Benjamin; Lelong, Bernard; Viret, F.; Giovannini, Marc; Monges, Geneviève; Delpero, Jean‐Robert; Bories, Erwan; Turrini, Olivıer; Viens, Patrice; Salem, Naji

doi:10.1016/j.ijrobp.2010.02.025

Cited by 69 publications

(53 citation statements)

References 60 publications

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“…Various systems have been developed specifically for the assessment of residual tumor burden, and they can be classified into two main categories, namely stage based and cellular based. The former focuses on the stage shift in the treated specimen and includes tumor (T) and nodal (N) downstaging, while the latter is based on the amount of residual viable tumor in relation to remodeling fibrous tissue in the rectal wall [4][5][6][7][8][9][10][11][12]. A number of studies have consistently demonstrated the prognostic relevance of downstaging, whereas that of cellular-response grading has been an issue of m u c h d i s c u s s i o n [ 4 , 7 -9 , 1 2 - 1 5 ] .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

et al. 2015

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Most patients with rectal cancer receive neoadjuvant radiochemotherapy (RCT), causing a variable decrease in tumor mass. We evaluated the prognostic impact of pathologic parameters reflecting tumor response to RCT, either directly or indirectly. Seventy-six rectal cancer patients receiving neoadjuvant RCT between 2006 and 2009 were included. We studied the association between disease-free survival (DFS) and the "classical" clinicopathologic features as well as tumor deposits, circumferential resection margin (CRM), Dworak regression grade, and tumor and nodal downstaging. Patients with tumor downstaging had a longer DFS (p = 0.05), indicating a more favorable prognosis when regression was accompanied by a decrease in tumor infiltrative depth, referred to as tumor shrinkage. Moreover, tumor downstaging was significantly associated with larger CRM and nodal downstaging (p = 0.02), suggesting that shrinkage of the primary tumor was associated with a decreased nodal tumor load. Higher Dworak grade did not correlate with tumor downstaging, nor with higher CRM or prolonged DFS. This implies that tumor mass decrease was sometimes due to fragmentation rather than shrinkage of the primary tumor. Lastly, the presence of tumor deposits was clearly associated with reduced DFS (p = 0.01). Assessment of tumor shrinkage after RCT via tumor downstaging and CRM is a good way of predicting DFS in rectal cancer, and shrinkage of the primary tumor is associated with a decreased nodal tumor load. Assessing regression based on the amount of tumor in relation to stromal fibrosis does not accurately discern tumor fragmentation from tumor shrinkage, which is most likely the reason why Dworak grade had less prognostic relevance.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

et al. 2015

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“…Clinicopathological factors associated with the CRT response to rectal cancer include the levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, and fibrinogen; the histological grade and mucinous histology; tumor size, volume, circumference, and movability; the hemoglobin level and blood lymphocyte counts; the clinical T or N stage; and the distance from the tumor to the anal verge [21,[45][46][47][48][49][50][51][52][53][54][55][56][57]. Of these factors, the serum CEA level has been the most relevant [48][49][50].…”

Section: Predictive Markers Clinicopathological Factorsmentioning

confidence: 99%

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organsparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

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“…Different cutoff level for CEA was found to be significant for prediction of pCR in several studies. Most studies proposed 5 ng/ml [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and others 2.5 ng/ml [9,28], 3 ng/ml [29,30], 3.5 ng/ml [31,32] or 6 ng/ml [22]. Therefore, elevated CEA level was defined as ≥ 5 ng/ml, and normal CEA level refers to <5 ng/ml in current study.…”

Section: Data Extraction and Definitionsmentioning

confidence: 99%

“…As indicated in the search flow diagram (Figure 1), 14 studies [13][14][15][16][18][19][20][21][22][23][25][26][27] published from 2006 to 2015 fulfilled the inclusion criteria and were finally included in the meta-analysis. The characteristics of included studies are summarized in Table 1.…”

Section: Description Of Eligible Studiesmentioning

confidence: 99%

“…Several studies have demonstrated conflicting results for the use of CEA as a significant predictor of response to nCRT. Some studies found that patients with a normal pretreatment CEA level (<5 ng/ml) had better responses to CRT than those with elevated CEA level (≥ 5 ng/ml) [13][14][15][16][17][18][19][20], while controversy exists in other studies [21,22]. We therefore performed a meta-analysis to evaluate the predictive value of pretreatment CEA levels, normally available in clinical practice, on the attainment of pCR after nCRT for rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Pretreatment Serum Cea as a Predictive Biomarker for the Response to Neoadjuvant Chemoradiotherapy: A Meta-Analysis in Rectal Cancer

Yu¹,

Chen²,

Cai³

2015

J Carcinog Mutagen

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Predictive Factors of Tumor Response After Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer

Cited by 69 publications

References 60 publications

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Pretreatment Serum Cea as a Predictive Biomarker for the Response to Neoadjuvant Chemoradiotherapy: A Meta-Analysis in Rectal Cancer

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