Response to Preoperative Chemoradiation in Stage II and III Rectal Cancer

Brown, Craig L.; Ternent, Charles A.; Thorson, Alan G.; Christensen, Mark A.; Blatchford, Garnet J.; Shashidharan, Maniamparampil; Haynatzki, Gleb

doi:10.1007/s10350-004-6714-y

Cited by 54 publications

(26 citation statements)

References 25 publications

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“…The mean age of the patients at the time of surgery (59 years) is in accordance with other investigations [7,8,9,10]. A higher percentage rate of males with rectal cancers (male:female ratio 2:1) is also described in other trials [8,9,10,11,12,13]. Therefore, we conclude that our study population is comparable with the literature.…”

Section: Discussionsupporting

confidence: 81%

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

et al. 2016

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Background: Tumor response after neoadjuvant radiochemotherapy (NRC) prior to surgery and other parameters are likely to have an influence on the survival rate of patients suffering from T3 rectal cancer. Methods: 51 patients (17 female, 34 male; 59.0 years; Apache < 9 points: 95.1%; ASA I-II 88.3% and ASA III 11.8%) were treated with NRC (50.4 Gy; 5-fluorouracil/folinic acid) 4-6 weeks prior to surgery because of uT3 rectal cancer (G2: 96%; adenocarcinoma 86.3%; cUICC II 62.7%). NRC led to a tumor response (TR) (ypT0-ypT2) in 45.1% (ypT0N0M0 7.8%). Results: Neither the age of patients nor Apache/ASA score, histology, UICC staging, ypTNM, Dukes staging, infiltration of vessels, surgical procedure, local recurrence nor TR had a significant influence on the patients' survival time. Patients with metachronous distant metastasis (MDM) during the follow-up period (mean: 8.2 years; 1 month to 14.5 years) and patients with ypN1-ypN2 had a significantly shorter survival time. Conclusions: NRC prior to surgery leads to a remarkable TR rate but has no significant impact of TR on the patients' survival time. Occurrence of MDM during the follow-up period and ypN1/N2 status do have a greater influence. It is necessary to investigate larger cohorts of patients in the future to obtain more conclusive results and to define factors with influence on survival.

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Section: Discussionsupporting

confidence: 81%

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

et al. 2016

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“…Demonstrating a complete remission is important not only because of its prognostic value but also because of the need of assessment of indications for the postoperative chemotherapy or radiotherapy, for the decision about the appropriate method of surgery [20,37,45,46,49,57,58,63,64] or to compare the effects of different treatment methods [45] . Zmora et al [58] showed that metastases to regional lymph nodes and cancer cells in the mesorectal tissue may be present in patients with complete tumor regression within the rectal wall (TRG 1, ypT0) [58] .…”

Section: Discussionmentioning

confidence: 99%

“…Joseph et al [55] showed that in patients with colon cancer at T1/T2 stage more lymph nodes must be studied than in patients with T3/T4 in order to reliably define stage pN0. However, frequently the surgical approach is completely different in patients with lower local stage a limited lymph node resection is performed [57] . In the presented study, "downstaging" parameter was evaluated exclusively in order to show cancer regression within the rectal wall ("T-downstaging").…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers r e f e r T RG 1 t o p a t i e n t s w i t h n o c a n c e r c e l l s i n t h e e n t i r e p o s t -s u r g i c a l s p e c i m e n [ 3 7 ] . T h e t e r mpathological complete response (pCR) of rectal cancer to preoperative radiotherapy regards the situation in which histopathological examination does not show the neoplasm in the rectal wall, lymph nodes and mesorectum [25,26,[35][36][37][38]46,[48][49][50][57][58][59][60][61] . This is in accordance with the definition developed by the WHO initiative [62] .…”

Section: Discussionmentioning

confidence: 99%

“…Also, interesting reports have been presented, showing that patients submitted to neo-adjuvant chemotherapy and receiving statins showed higher a pCR rate [72] . The percentage of patients with complete regression following longterm radiochemotherapy and radiotherapy ranged from 1/43 (2.3%) to 7/20 (35.0%) [5,17,[20][21][23][24][25][26][27][35][36][37][47][48][49][50][51][52][57][58][59][60][61]67,73] . The percentage of patients presenting complete cancer regression following short-term radiotherapy ranges between 0% and 10/191 (5.2%) [10,11,18,19,50] .…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Lukasz¹,

Liszka²,

Ewa³

et al. 2007

WJG

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INTRODUCTIONColorectal cancer is the third most common malignancy diagnosed in the USA [1] . The estimated colorectal cancer mortality in the USA in 2006 is 55 170 [2] . The primary treatment method for rectal cancer is surgery, namely anterior rectal resection, abdomino-perineal resection or local excision [3][4][5][6] . Preoperative radiotherapy and radiochemotherapy play an increasing role in the treatment of rectal cancer [7][8][9][10][11][12][13] . The effectiveness of neo-adjuvant therapy may be assessed and monitored by means of longterm survival follow up, incidence of local recurrence, estimation of the percentage of patients with primary high stage tumor suitable for radical surgery, estimation of the percentage of patients suitable for sphincter-saving surgery or by monitoring the tumor stage using visualizing diagnostic methods [14,15] . Transrectal ultrasound (TRUS) is a useful method for the assessment of the local tumor stage and the regional lymph node status prior to neo-adjuvant therapy [3,4,6,16] . Basing on TRUS and histopathological examination one can define the tumor reg ression parameter "T-downstaging". Lower ypT parameter value (local tumor stage assessed by the pathologist in surgical specimen following neo-adjuvant therapy) than uT (local Abstract AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS:Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS:Complete regression (ypT0, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging" and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5.No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION:Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients

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GLUT‐1 expression and response to chemoradiotherapy in rectal cancer

Brophy

Sheehan

McNamara

et al. 2009

Intl Journal of Cancer

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Preoperative chemoradiotherapy is used in locally advanced rectal cancer to reduce local recurrence and improve operability, however a proportion of tumors do not undergo significant regression. Identification of predictive markers of response to chemoradiotherapy would improve patient selection and may allow response modification by targeting of specific pathways. The aim of this study was to determine whether expression of glucose transporter-1 (GLUT-1) and p53 in pretreatment rectal cancer biopsies was predictive of tumor response to chemoradiotherapy. Immunohistochemical staining for GLUT-1 and p53 was performed on 69 pretreatment biopsies and compared to tumor response in the resected specimen as determined by the tumor regression grade (TRG) scoring system. GLUT-1 expression was significantly associated with reduced response to chemoradiotherapy and increasing GLUT expression correlated with poorer response (p 5 0.02). GLUT-1 negative tumors had a 70% probability of good response (TRG3/4) compared to a 31% probability of good response in GLUT-1 positive tumors. GLUT-1 may be a useful predictive marker of response to chemoradiotherapy in rectal cancer. ' 2009 UICC

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Response to Preoperative Chemoradiation in Stage II and III Rectal Cancer

Cited by 54 publications

References 25 publications

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

GLUT‐1 expression and response to chemoradiotherapy in rectal cancer

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