Response to Neoadjuvant Chemoradiation in Rectal Cancer: Time to Consider Risk-Adapted Adjuvant Chemotherapy

Zahrani, Ahmad Al; Mohammed, Mahfoudh; Ashari, Luai H.; Jabbar, Alaa Abdul; Homoud, Samar Al; Jubran, Ali Al; Manae, Hadeel Al; Bazarbashi, Shouki; Mohuiddin, Mohammed; Sanea, Nasser Al

doi:10.1093/annonc/mdt203.176

Cited by 4 publications

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“…The rate of complete pathological response (ypT0N0) was in agreement with previously published data, 6 – 8 and higher than that reported by Bazarbashi S et al and Soudy H, et al 9 , 10 A possible explanation is the higher percentage of more advanced and low-lying rectal cancers in the study populations of Bazarbashi S et al and Soudy H, et al 9 , 10 This study showed lower sphincter preservation rates in the presence of high downstaging rates; this may be explained by the fact that a substantial proportion of the patients were not operated on by colorectal surgeons. This warrants a recommendation that all rectal cancers must be handled by dedicated colorectal surgeons.…”

Section: Discussionsupporting

confidence: 91%

“… 16 However, the outcomes of preoperative CRT in the Saudi population have not been widely studied. 8 – 10 , 17 In this retrospective study from a single institution, the 5-year long-term outcomes have been shown to be similar to previously reported data in published reports. 8 , 18 Furthermore, hematological and non-hematological toxicities were similar to or less than those reported in other trials.…”

Section: Discussionsupporting

confidence: 83%

“… 8 – 10 , 17 In this retrospective study from a single institution, the 5-year long-term outcomes have been shown to be similar to previously reported data in published reports. 8 , 18 Furthermore, hematological and non-hematological toxicities were similar to or less than those reported in other trials. A possible explanation for a lower toxicity profile in this study is the preponderance of cancers localized at middle and upper regions of the rectum and the use of 3D conformal radiotherapy.…”

Section: Discussionsupporting

confidence: 83%

“…A retrospective study from King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia, that included 196 Saudi patients with LARC who were treated with preoperative CRT reported a 5-year survival rate of 84.3% and 79.8% for clinical stages II and III of LARC, respectively. 8 Later, Bazarbashi S et al reported the long-term outcome of preoperative CRT in 31 Saudi patients with LARC using concurrent oral capecitabine 825 mg/m 2 twice daily in a phase II trial. 9 The study reported complete pathological response (ypT0N0) in 6.5% of patients.…”

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confidence: 99%

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Five-year outcomes of preoperative chemoradiation for rectal carcinoma in Saudi population: single-institutional experience

Alsaeed

Tunio

Zubaidi

et al. 2015

Annals of Saudi Medicine

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OBJECTIVESPreoperative chemoradiation (CRT) followed by surgery is the standard treatment for locally advanced rectal cancer (LARC). The outcomes of preoperative CRT in Saudi patients with LARC have not been widely studied. The study reports long-term outcomes after preoperative CRT followed by curative surgery in Saudi patients with LARC.DESIGN AND SETTINGSA retrospective, single-institutional study performed in the tertiary care oncology center in Saudi Arabia.MATERIALS AND METHODSA total of 154 out of 204 patients with LARC were treated with preoperative CRT and followed by surgery at the oncology center between September 2005 and November 2012. Data regarding the response rates, toxicity profile, locoregional control (LRC), distant metastasis control (DMC), overall survival (OS), and disease-free survival (DFS) rates were analyzed.RESULTSThe median age of the study population was 56.6 years (range: 26–89). Predominant clinical stages were IIA (70 patients; 45.4%) and IIIB (49 patients; 31.8%). Majority of patients (79.8%) underwent a complete total mesorectal excision (TME). Complete pathological response (ypT0N0) was seen in 26 patients (16.8%). At 5 years, locoregional recurrence (LR) was reported in 12 patients (7.8%), and distant metastases were noted in 33 patients (21.4%). The 5-year cumulative LRC, DMC, OS, and DFS rates were 91%, 71.3%, 78%, and 64.8%, respectively. Stage, nodal status, circumferential margins, ypT0N0, and adjuvant chemotherapy were found to be important prognostic factors for DFS.CONCLUSIONThe results of preoperative CRT followed by surgery and adjuvant chemotherapy in Saudi population are comparable with international data.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

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Five-year outcomes of preoperative chemoradiation for rectal carcinoma in Saudi population: single-institutional experience

Alsaeed

Tunio

Zubaidi

et al. 2015

Annals of Saudi Medicine

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Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer

Alsuhaibani

Elashwah

Mahmood

et al. 2018

J Gastrointest Canc

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Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients

Elashwah

Alsuhaibani

Abduljabbar

et al. 2022

J Gastrointest Canc

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Purpose evaluating the outcome of preoperative simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) concomitant with Capecitabine in patients diagnosed with locally advanced rectal cancer (LARC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia during the period January 2013 -December 2019. ResultsTotal of134 patients were enrolled. The median age at diagnosis was 59 years. All patients received preoperative concurrent chemo-radiation therapy (CCRT) usingSIB-VMAT with oral capecitabine.Neoadjuvant chemotherapy was administered prior to CCRT in 32 patients (23.9%). The dose of radiation was 55 Gy in 94 patients (70.1%), while 40 patients (29.9%) received 50 Gy. All patients completed the CCRT treatment without breaks. No records of acute and late grade III and IV toxicities. Curative surgery was performed in all patients with a median interval of 11 (6-52) weeks between the end of CCRT and the date of surgery. No reported 30-days postoperative mortality and no grade III and IV Clavien-Dindo complications. PCR was reported in 26 patients (19.4%), while pathologically negative nodes (pN0) were achieved in 103 patients (76.9%). Adjuvant chemotherapy was utilized in 57 patients (42.5%). The 5-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 93.2%, 67.1%, and 87.3%, respectively. Only Tumor regression grade (TRG) was signi cantly correlated with LRFS, (p-value 0.043). On multivariate analysis, only (TRG) and achievement of pN0 were signi cantly correlated with DFS,(p value<0.001). ConclusionDose escalation utilizing (SIB-VMAT) in the preoperative treatment of LARC is well tolerated and provides effective local control.

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Response to Neoadjuvant Chemoradiation in Rectal Cancer: Time to Consider Risk-Adapted Adjuvant Chemotherapy

Cited by 4 publications

References 0 publications

Five-year outcomes of preoperative chemoradiation for rectal carcinoma in Saudi population: single-institutional experience

Five-year outcomes of preoperative chemoradiation for rectal carcinoma in Saudi population: single-institutional experience

Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer

Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients

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