The Addition of Preoperative Radiation Is Insufficient for Lateral Pelvic Control in a Subgroup of Patients With Low Locally Advanced Rectal Cancer: A Post Hoc Study of a Randomized Controlled Trial

Xie, Yumo; Lin, Jie; Wang, Xiaolin; Wang, Puning; Zhuang, Zhuokai; Zou, Qi; Cai, Du; Huang, Zenghong; Bai, Liangliang; Tang, Ge; Huang, Meijin; Wang, Jianping; Yu, Huichuan; Luo, Yanxin

doi:10.1097/dcr.0000000000001935

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…48 Furthermore, enlarged nodes seen on radiologic evaluation must be carefully interpreted during nICI treatment, because they could be metastasis-free and a result of immune activation, as opposed to those found during nCRT. 49 Together, our findings underscore the importance of multimodal evaluation, which may provide additional evidence to facilitate the identification of patients achieving good response. This study had some limitations.…”

Section: Discussionmentioning

confidence: 56%

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors

Xie

Lin

Zhang

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Immune checkpoint inhibitor (ICI) treatment in patients with microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) tumors holds promise in reshaping organ preservation in rectal cancer. However, the benefits are accompanied by distinctive patterns of response, introducing a dilemma in the response evaluation for clinical decision-making. Patients and Methods: Patients with locally advanced rectal cancer with MSI-H/dMMR tumors receiving neoadjuvant ICI (nICI) treatment (n=13) and matched patients receiving neoadjuvant chemoradiotherapy (nCRT; n=13) were included to compare clinical response and histopathologic features. Results: Among the 13 patients receiving nICI treatment, in the final radiologic evaluation prior to surgery (at a median of 103 days after initiation of therapy), progressive disease (n=3), stable disease (n=1), partial response (n=7), and complete response (n=2) were observed. However, these patients were later confirmed as having pathologic complete response, resulting in pseudoprogression and pseudoresidue with incidences of 23.1% (n=3) and 76.9% (n=10), respectively, whereas no pseudoprogression was found in the 13 patients receiving nCRT. We further revealed the histopathologic basis underlying the pseudoprogression and pseudoresidue by discovering the distinctive immune-related regression features after nICI treatment, including fibrogenesis, dense lymphocytes, and plasma cell infiltration. Conclusions: Pseudoprogression and pseudoresidue were unique and prevalent response patterns in MSI-H/dMMR rectal cancer after nICI treatment. Our findings highlight the importance of developing specific strategies for response evaluation in neoadjuvant immunotherapy to identify patients with a good response in whom sphincter/organ-preserving or watch-and-wait strategies may be considered.

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Section: Discussionmentioning

confidence: 56%

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors

Xie

Lin

Zhang

et al. 2023

Journal of the National Comprehensive Cancer Network

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“…According to the NCCN Guideline for Rectal Cancer, patients in SYSU cohort were treated and followed up with the details described in previous publications. 22 , 23 , 24 , 25 Briefly, after surgery, patients were observed every 3–6 months for the first 2 years and every 6 months for the next 3 years. Routine visits include pertinent medical history, medical examination, and measurement of serum CEA and CA19‐9 levels.…”

Section: Methodsmentioning

confidence: 99%

Clinical spectrum of rectal cancer identifies hallmarks of early‐onset patients and next‐generation treatment strategies

et al. 2022

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Background The incidence of colorectal cancer is increasing among young adults and more rectal cancers are reported. This study aimed to identify the clinical features specific for early‐onset rectal cancer and provide insights on cancer management. Methods Early‐onset (<50 years) and late‐onset (≥50 years) rectal cancer patients from a referral tertiary care center (SYSU cohort) and Surveillance Epidemiology and End Results database (SEER cohort) were included to perform a comprehensive comparison on clinical information. Results A total of 552 and 80,341 patients with stages I–III rectal cancer were included in the SYSU and SEER cohorts, respectively. In the SYSU cohort, early‐onset diseases had significantly higher prevalence of family history of cancer and history of HBV infection and lower incidence of comorbidities ( p < 0.05). In addition, early‐onset patients presented more frequently with advanced node stage (N2 stage: 16.9 vs. 9.3%, p = 0.017) and high‐risk features, including mucinous or signet cell carcinomas (21.8 vs. 12.9%, p = 0.014), poorly differentiated tumors (28.8 vs. 15.4%, p = 0.002), and perineural invasion (14.5 vs. 7.9%, p = 0.027) compared with late‐onset patients. However, early‐onset patients received more neoadjuvant (18.5 vs. 11.2%, p = 0.032) and adjuvant treatments (71.0 vs. 45.8%, p < 0.001), and they had better overall survival in both SYSU (HR 0.57, 95% CI: 0.34–0.95; p = 0.029) and SEER (HR 0.38, 95% CI: 0.37–0.40; p < 0.001) cohorts. Conclusion Early‐onset rectal cancers are distinct from late‐onset cases in clinicopathological features, treatment modalities, and outcomes. The clinical trials and studies that are specific for young populations are needed to develop optimal strategies for cancer screening, treatment, and surveillance.

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“…The population and related strategies of cancer treatment in the trial are detailed in references [13,14] . All locally advanced rectal cancer patients received neoadjuvant therapy prior to surgical treatment.…”

Section: Data Collection and Preparationmentioning

confidence: 99%

A Generative Adversarial Network (GAN)-based Three-dimensional Rectal Cancer Pathological Complete Response Prediction Framework

Li,

Xie,

et al. 2023

Preprint

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Colorectal cancer affects the health of the global public, and the increasing proportion of cases has attracted widespread attention. This phenomenon has made the treatment of colorectal cancer an inevitable topic in the global medical community, and has sparked interest in using deep learning models for early detection and diagnosis of colorectal cancer. This study proposes a method based on Three-dimensional (3D) Magnetic Resonance Imaging (MRI) data to predict the complete pathological remission of rectal cancer patients. To improve prediction accuracy, we employ an improved Deep Convolutional Generative Adversarial Network (DCGAN) for data augmentation and optimize the 3D network with different attention modules. Specifically, we employed a DCGAN generator for data augmentation. Instead of using deconvolution operations as in the DCGAN generator, we utilized upsampling and convolution operations to diminish the impact of "artifacts" on the generated images. Additionally, we enhanced the image quality by utilizing an improved AlexNet-based discriminator architecture. Furthermore, we utilize the Convolutional Block Attention Module (CBAM) for feature extraction and capturing spatial and channel information. The experimental results of this study demonstrate significant improvements in accuracy, specificity, and sensitivity through the application of data augmentation and attention mechanisms. In detail, the accuracy is improved to 0.778, specificity to 0.796, and sensitivity to 0.754. Compared to the baseline network, these values have increased by 8.8%, 9.9%, and 9.1% respectively. These findings indicate that the method we propose offers a potential tool for doctors to avoid unnecessary surgical procedures.

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The Addition of Preoperative Radiation Is Insufficient for Lateral Pelvic Control in a Subgroup of Patients With Low Locally Advanced Rectal Cancer: A Post Hoc Study of a Randomized Controlled Trial

Abstract: Supplemental Digital Content is available in the text.

Cited by 8 publications

References 32 publications

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors

Prevalent Pseudoprogression and Pseudoresidue in Patients With Rectal Cancer Treated With Neoadjuvant Immune Checkpoint Inhibitors

Clinical spectrum of rectal cancer identifies hallmarks of early‐onset patients and next‐generation treatment strategies

A Generative Adversarial Network (GAN)-based Three-dimensional Rectal Cancer Pathological Complete Response Prediction Framework

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