T-Level Downstaging and Complete Pathologic Response After Preoperative Chemoradiation for Advanced Rectal Cancer Result in Decreased Recurrence and Improved Disease-Free Survival

Theodoropoulos, George; Wise, William E.; Padmanabhan, Anantha; Kerner, Bruce; Taylor, Charles W.; Aguilar, Pedro Serrano; Khanduja, K. S.

doi:10.1007/s10350-004-6325-7

Cited by 303 publications

(228 citation statements)

References 54 publications

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“…T he multidisciplinary management of rectal cancer patients has been witnessing a progressive change in the therapeutic approach of locally advanced tumors toward preoperative chemoradiation therapy (CRT), which is useful for tumor downsizing and downstaging, facilitating curative resection, decreasing the local recurrence rate, and improving patient survival (1)(2)(3)(4)(5)(6)(7). Tumor downstaging may lead to a partial or complete tumor regression, but in many cases, even if the tumor cell density is significantly decreased, the pathologic stage remains the same.…”

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confidence: 99%

Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Curvo-Semedo¹,

Portilha²,

Ruivo³

et al. 2012

Academic Radiology

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Rationale and Objectives: To prospectively evaluate perfusion computed tomography (CT) for assessment of changes in tumor vascularity after chemoradiation therapy (CRT) in locally advanced rectal cancer and to analyze the correlation between baseline perfusion parameters and tumor response. Materials and Methods:Twenty patients with rectal cancer underwent baseline perfusion CT before CRT, and in 11 an examination after CRT was also performed. For each tumor, blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product (PS) were quantified. The Mann-Whitney U test compared baseline perfusion parameters of responders and nonresponders and pre-and post-CRT measurements were compared by the Wilcoxon signed-rank test (P < .05 statistically significant for both tests).Results: Baseline BF was significantly lower (P = .013) and MTT was significantly higher (P = .006) in responders. Both were able to discriminate responders from nonresponders with a sensitivity of 80% and 100% and a specificity of 73.3% and 86.7%, respectively, for BF and MTT. Baseline BV and PS were not significantly different in responders and nonresponders. Perfusion parameters changed significantly in post-CRT scans compared to baseline: BF (P = .003), BV (P = .003), and PS (P = .008) decreased, whereas MTT increased (P = .006).Conclusion: Baseline BF and MTT can discriminate patients with a favorable response from those that fail to respond to CRT, potentially selecting high-risk patients with resistant tumors that may benefit from an aggressive preoperative treatment approach.

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Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Curvo-Semedo¹,

Portilha²,

Ruivo³

et al. 2012

Academic Radiology

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“…They can respond to neoadjuvant therapy or not, in the latter case they remain the source of tumor cells even after successful neoadjuvant treatment at the site of primary tumor. 15,18 According to our research, pT, pN and postoperative stage all importantly affect survival. Lower pT, no tumor cells in resected lymph nodes and lower postoperative stage mean better prognosis (p = 0.011; < 0.001 and 0.001 for pT, pN and postoperative stage, respectivelly).…”

Section: Discussionmentioning

confidence: 72%

“…Namely, in lymph nodes residual tumor cells may still be present. 18 Brasilian researchers were the first to introduce so-called »wait-and-see« approach in selected group of patients. 16,19 Those patients were not operated, yet were closely followed.…”

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confidence: 99%

“…It certainly diminishes possibility of local recurrences, but the main cause of death in rectal cancer patients are usually distant metastases, which can not always be prevented by neoadjuvant therapy. 18 Many studies show that high quality of radical total mesorectal excisions overweights multimodal treatment. The question remains whether chemotherapeutics and radiation are really so vital for rectal cancer patients.…”

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Prognostic Significance of Tumor Regression in Locally Advanced Rectal Cancer after Preoperative Radiochemotherapy

Potisek¹

2015

Clin Med Rev Case Rep

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Disclosure: No potential conflicts of interest were disclosed.Background. The majority of rectal cancers are discovered in locally advanced forms (UICC stage II, III). Treatment consists of preoperative radiochemotherapy, followed by surgery 6-8 weeks later and finally by postoperative chemotherapy. The aim of this study was to find out if tumor regression affected long-term survival in patients with localy Results. Two hundred and two patients met inclusion criteria. Median follow-up was 53.2 months. Stage ypT0N0 (pathologic complete response, pCR) was observed in 14.8% of patients. Pathohistologic stage had statistically significant impact on survival (p = 0.001). 5-year survival in patients with pCR was>90%. Postoperative T and N status were also found to be statistically significant (p = 0.011 for ypT and p < 0.001 for ypN). According to multivariate analysis, tumor response to neoadjuvant therapy was the only independent prognostic factor (p = 0.003).Conclusions. Pathologic response of tumor to preoperative radiochemotherapy is an important prognostic factor for prediction of long-term survival of patients with locally advanced rectal cancer.

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“…Все эти наблюдения отнесены к полному патологическому регрессу опухоли. Именно этот факт, по данным многих исследований, и определя-ет лучший результат комбинированного лечения у боль-ных раком прямой кишки [11,20,21]. В настоящее время хорошо известно, что определение характера регресса опухоли после химиолучевой терапии затруднительно и неточно, поэтому многие авторы предпочитают оце-нивать частоту полного клинического регресса опухоли [22,23,24].…”

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Multidisciplinary Approach in the Treatment of Patients With Rectal Cancer

Правосудов¹

2015

Zlokač. opuholi

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Хирургический метод является «золотым стандартом» в лечении больных раком прямой кишки. Целью хирургического лечения является сведение к минимуму частоты местных рецидивов, возникновение которых во многом зависит от качества операций. Краеугольным камнем в выборе лечебной тактики следует считать отношение опухоли к собственной фасции прямой кишки. Даже приме-няя современные хирургические методики, большинство опухолей прямой кишки ниже переходной складки брюшины следовало бы ле-чить используя предоперационную лучевую терапию. Предоперационная лучевая (х/л) терапия позволяет уменьшить частоту местных ре-цидивов и создать условия для увеличения числа сфинктеросохранающих операций. Степень регресса опухоли после химиолучевой терапии напрямую коррелирует с выживаемостью и частотой местных рецидивов. Регресс опухоли создает предпосылки для избавления больного с опухолью прямой кишки от послеоперационных осложнений и летальности, связанных с выполнением обширных радикальных операций. Использование стандартизированных систем для оценки степени регресса опухоли может предоставить ценную информацию центрам, специлизирующимся на лечении больных с данной патологией. МРТ малого таза является весьма эффективным инструментом в первичной оценке степени местнорегионарного распространения рака прямой кишки, включая отношение к мезоректальной фасции. Сложности в прогнозировании полного патологического регресса опухоли с помощью МРТ связаны, прежде всего, с проблемой диффе-ренциальной диагностики между постлучевыми и опухолевыми изменениями кишечной стенки и окружающих тканей. Мультидисциплинарный подход обеспечивает точность стадирования и способствует выработке оптимальной лечебной тактики у больных раком прямой кишки.Ключевые слова: рак прямой кишки, МРТ, химиолучевая терапия, полный клинический ответ, мультидисциплинарный подход.

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T-Level Downstaging and Complete Pathologic Response After Preoperative Chemoradiation for Advanced Rectal Cancer Result in Decreased Recurrence and Improved Disease-Free Survival

Cited by 303 publications

References 54 publications

Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

Prognostic Significance of Tumor Regression in Locally Advanced Rectal Cancer after Preoperative Radiochemotherapy

Multidisciplinary Approach in the Treatment of Patients With Rectal Cancer

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