Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

Macchia, G.; Gambacorta, Maria Antonietta; Masciocchi, C.; Chiloiro, G.; Mantello, G.; Benedetto, Maika di; Lupattelli, Marco; Palazzari, Elisa; Belgioia, Liliana; Bacigalupo, Almalina; Sainato, A.; Montrone, S.; Turri, Lucia; Caroli, Angela; Paoli, Antonino De; Matrone, Fabio; Capirci, Carlo; Montesi, Giampaolo; Niespolo, R.M.; Osti, Mattia Falchetto; Caravatta, L.; Galardi, A.; Genovesi, Domenico; Rosetto, M.E.; Boso, Caterina; Sciacero, Piera; Giaccherini, L.; Parisi, Salvatore; Fontana, Antonella; Filippone, F.; Picardi, V.; Morganti, Alessio Giuseppe; Valentini, Vincenzo

doi:10.1016/j.ctro.2017.04.004

Cited by 50 publications

(47 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have revealed that a prolonged TTS significantly increased the odds of pCR for esophageal and rectal patients with nCRT 8,9,11,12 and gastric cancer patients with NAC 10 . Another study showed that a longer TTS from the end of nCRT to surgery did not increase the rate of pCR in esophageal cancer 14 .…”

Section: Discussionmentioning

confidence: 98%

“…However, the risk of primary or metastatic tumor regrowth is increasing. Some studies have indicated that extending TTS might increase the proportion of patients with a pathologic complete response (pCR) among rectal cancer patients receiving neoadjuvant chemoradiotherapy (nCRT) 8,9 . In addition, for esophageal cancer patients with nCRT and gastric cancer patients with NAC, studies revealed that patients with a longer TTS had significantly higher pCR rates and better prognosis 10‐12 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

et al. 2020

View full text Add to dashboard Cite

Background Neoadjuvant chemotherapy (NAC) has been widely performed in the treatment of colorectal cancer liver metastasis (CRLM) patients, but the optimal timing of surgery after NAC is unclear. The aim of this study was to investigate the optimal timing of surgery. Methods From December 2010 to May 2018, 101 consecutive patients who received NAC followed by liver resection for CRLM were included in this study. The main outcome parameters were pathological response, progression‐free survival (PFS), and overall survival (OS). The effect of time to surgery (TTS) on patient outcomes, defined as a high TTS and a low TTS according to an X‐tile analysis, was investigated. To adjust for potential selection bias, propensity score matching at 1:2 was performed with two high TTS patients matched to one low TTS patient. Kaplan‐Meier curves, logistic regression analyses, and Cox regression models were used for the data analysis. Results The optimal cut‐off value for the TTS was 5 weeks by X‐tile analysis. The patients in this study were divided into low (≤5 weeks, n = 27) and high (>5 weeks, n = 74) TTS groups. Patients with a high TTS were more likely to have an unfavorable pathological response (75.7% vs 48.1%, P = .008). In multivariate analysis, a low TTS significantly predicted a better pathological response (OR = 3.397, 95% CI: 1.116‐10.344, P = .031). Compared to patients with a high TTS, patients with a low TTS had significantly better PFS (P < .001, mPFS: 16 months vs 7 months) and better OS (P = .037, mOS: not reached vs 36 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 2.041, 95% CI: 1.152‐3.616, P = .014) but not OS. After propensity matching, the patients with a low TTS had significantly better PFS (P < .001, mPFS: 18.2 months vs 10 months) and an equivalent OS (P = .115, mOS: not reached vs 41 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 3.031, 95% CI: 1.494‐6.149, P = .002) but not OS. Conclusion The longer TTS after the completion of NAC may be disadvantageous for a favorable pathological response and long‐term PFS. These results should be validated prospectively in a randomized trial.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Pathological complete response (pCR), which was defined as the absence of tumor cells in the surgical specimen, both at the primary tumor site and at regional lymph nodes, 24 – 26 has been used as an endpoint in numerous trials of neoadjuvant systemic therapy for breast cancer, and molecular subtypes have been independently associated with pCR rate. 27 In the Collaborative Trials in Neoadjuvant Breast Cancer (CTneoBC) pooled analysis, 25 which assessed the relationship between pCR and long-term outcome, the absence of residual invasive cancer in the breast and axillary nodes with the presence or absence of in situ cancer provided a better association with improved outcomes than eradication of invasive tumor from the breast alone.…”

Section: Pathological Featuresmentioning

confidence: 99%

Predicting the response to neoadjuvant therapy for early-stage breast cancer: tumor-, blood-, and imaging-related biomarkers

Tan¹,

Yang²,

Yang³

et al. 2018

CMAR

View full text Add to dashboard Cite

Neoadjuvant therapy (NAT) has been used increasingly in patients with locally advanced or early-stage breast cancer. However, the accurate evaluation and prediction of response to NAT remain the great challenge. Biomarkers could prove useful to identify responders or nonresponders, or even to distinguish between early and delayed responses. These biomarkers could include markers from the tumor itself, such as versatile proteins, genes, and ribonucleic acids, various biological factors or peripheral blood cells, and clinical and pathological features. Possible predictive markers could also include multiple features from functional imaging, such as standard uptake values in positron emission tomography, apparent diffusion coefficient in magnetic resonance, or radiomics imaging biomarkers. In addition, cells that indirectly present the immune status of tumor cells and/or their host could also potentially be used as biomarkers, eg, tumor-infiltrating lymphocytes, tumor-associated macrophages, and myeloid-derived suppressor cells. Though numerous biomarkers have been widely investigated, only estrogen and/or progesterone receptors and human epidermal growth factor receptor have been proven to be reliable biomarkers to predict the response to NAT. They are the only biomarkers recommended in several international guidelines. The other aforementioned biomarkers warrant further validation studies. Some multigene profiling assays that are commercially available, eg, Oncotype DX and MammaPrint, should be used with caution when extrapolated to NAT settings. A panel of combined multilevel biomarkers might be able to predict the response to NAT more robustly than individual biomarkers. To establish such a panel and its prediction model, reliable methods and extensive clinical validation are warranted.

show abstract

“…MRI scans were carried out a median of 6 weeks after the completion of CRT. Although we acknowledge that there is a move towards scanning at 8e10 weeks in order to perform surgery later [31], the mrTRG validation by the MERCURY group was carried out on scans at 6 weeks, so we feel that this is valid. We must acknowledge that in order to maintain the quality of the mrTRG, these were re-graded by a radiologist aware of the project, which may have potentially introduced some bias in the grading.…”

Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer

et al. 2020

View full text Add to dashboard Cite

Aims: Doseeresponse curves suggest that higher doses of radiotherapy improve the complete response rate in rectal cancer. The UK adopted the EXPERT trial dose and fractionation, 45 Gy in 25 fractions to the pelvis with a sequential 9 Gy in five fractions to the gross tumour, in patients where the aim was to maximise the complete response. In the Oxford University Hospital NHS Foundation Trust (Oxford, UK) we deliver a biological equivalent dose (BED5) in selected patients using intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) in 25 fractions. We carried out a retrospective analysis of our series to: (i) document the toxicity of this protocol; (ii) ascertain whether dose constraints from RTOG 0822 were appropriate; (iii) assess the response. Materials and methods: The demographics and treatment details for all consecutive patients treated with this protocol were collected using electronic systems. Patients received 45 Gy to the elective nodes and 52 Gy using a SIB to the gross tumour with capecitabine chemotherapy using IMRT or RapidArc plans. Acute toxicity was collected prospectively during weekly reviews. For the purpose of this study, a dedicated gastrointestinal radiologist reviewed all baseline and posttreatment magnetic resonance images and assigned a magnetic resonance tumour regression grade (mrTRG). Results: Seventy-one patients were identified. Seventy completed radiotherapy with a median overall treatment time of 34 days (range 32e36 days); 67.6% received full-dose chemotherapy, with 21.2% receiving a reduced dose. There was a 4.2% incidence of grade 3þ non-haematological toxicity and 1.5% grade 3 þ haematological toxicity. 4.2% were admitted during their radiotherapy, with one death due to a pelvic abscess. The RTOG 0822 constraints were achieved in !75% of cases, other than the high-dose bladder constraint. mrTRG 1e2 was seen in 47.8%, with mrTRG 1 seen in 23.9%. Conclusions: We suggest that our protocol shows acceptable acute toxicity, with promising mrTRG results, and could be adopted by centres as an IMRT equivalent dose for EXPERT dose and fractionation.

show abstract

Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

Cited by 50 publications

References 39 publications

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

Predicting the response to neoadjuvant therapy for early-stage breast cancer: tumor-, blood-, and imaging-related biomarkers

Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer

Contact Info

Product

Resources

About