Prognostic Implications of Pathological Response to Neoadjuvant Chemoradiation in Pathologic Stage III Rectal Cancer

Karagkounis, Georgios; Thai, Leo; Mace, Adam G.; Wiland, Homer O.; Pai, Rish K.; Steele, Scott R.; Church, James M.; Kalady, Matthew F.

doi:10.1097/sla.0000000000002719

Cited by 53 publications

(38 citation statements)

References 14 publications

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“…Except for the sphincter preservation rate, demographic, clinical and surgical characteristics were no different between groups ( Table 1). The median interval between radiotherapy and surgery was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14) weeks, 8 (6-10) weeks in the 8-week group and 13 (11)(12)(13)(14) weeks in the 12week group.…”

Section: Resultsmentioning

confidence: 99%

Randomized controlled trial of 8 weeks’ vs 12 weeks’ interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer

et al. 2019

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Aim The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks’ interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer. Method This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3‐4N0M0, TxN+M0) rectal cancer were randomized into 8‐ and 12‐week interval groups. All the patients received long‐course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5‐fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end‐point was pCR. Secondary end‐points were sphincter preservation, postoperative morbidity and mortality. Results Two‐hundred and fifty‐two patients (n = 125 in the 8‐week group, n = 127 in the 12‐week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8‐week group and 23.6% (n = 30) in the 12‐week group (P = 0.021). Sphincter‐preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12‐week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083). Conclusion Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2‐fold increase in pCR rate without any difference in mortality and morbidity.

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Section: Resultsmentioning

confidence: 99%

Randomized controlled trial of 8 weeks’ vs 12 weeks’ interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer

et al. 2019

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“…Other studies have also shown a prognostic effect of response to neoadjuvant treatment. 196,197 In addition to its prognostic value, there is some initial evidence of predictive value to neoadjuvant treatment response. Subgroup analysis of the EORTC 22921 trial showed that patients downstaged to ypT0-2 were more likely to benefit from adjuvant chemotherapy than those with ypT3-4 staging.…”

Section: Preoperative Chemotherapy Without Chemortmentioning

confidence: 99%

Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Benson¹,

Venook²,

Al-Hawary³

et al. 2018

J Natl Compr Canc Netw

806

670

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Rectal Cancer address diagnosis, staging, surgical management, perioperative treatment, management of recurrent and metastatic disease, disease surveillance, and survivorship in patients with rectal cancer. This portion of the guidelines focuses on the management of localized disease, which involves careful patient selection for curative-intent treatment options that sequence multimodality therapy usually comprised of chemotherapy, radiation, and surgical resection.

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“…Resistance to chemotherapy and radiation therapy Despite the growing number of new therapeutic modalities, chemotherapy and radiotherapy remain the mainstays in the standard of care for many advanced-stage malignancies (André et al, 2015;Berry et al, 2005;Karagkounis et al, 2018;Pignon et al, 2009). These conventional treatments are more than palliative, as they prevent disease recurrence and provide survival benefit when the disease is responsive (Karagkounis et al, 2018). Unfortunately, only a small percentage of patients are complete responders.…”

Section: Il-17 In Anticancer Therapiesmentioning

confidence: 99%

The role of interleukin-17 in tumor development and progression

Zhao

Xing

Herjan

et al. 2019

Journal of Experimental Medicine

159

128

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IL-17, a potent proinflammatory cytokine, has been shown to intimately contribute to the formation, growth, and metastasis of a wide range of malignancies. Recent studies implicate IL-17 as a link among inflammation, wound healing, and cancer. While IL-17–mediated production of inflammatory mediators mobilizes immune-suppressive and angiogenic myeloid cells, emerging studies reveal that IL-17 can directly act on tissue stem cells to promote tissue repair and tumorigenesis. Here, we review the pleotropic impacts of IL-17 on cancer biology, focusing how IL-17–mediated inflammatory response and mitogenic signaling are exploited to equip its cancer-promoting function and discussing the implications in therapies.

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Prognostic Implications of Pathological Response to Neoadjuvant Chemoradiation in Pathologic Stage III Rectal Cancer

Abstract: AJCC response score after nCRT is a novel prognostic factor in pathologic stage III rectal cancer and may guide surveillance and adjuvant therapy decisions.

Cited by 53 publications

References 14 publications

Randomized controlled trial of 8 weeks’ vs 12 weeks’ interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer

Randomized controlled trial of 8 weeks’ vs 12 weeks’ interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer

Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

The role of interleukin-17 in tumor development and progression

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