Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Erlandsson, Johan; Lörinc, Ester; Ahlberg, Madelene; Pettersson, David; Holm, Torbjörn; Glimelius, Bengt; Martling, Anna

doi:10.1016/j.radonc.2019.03.016

Cited by 102 publications

(77 citation statements)

References 254 publications

(291 reference statements)

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“…Consequently, survival (OS) and time to recurrence (TTR) improved in the SC-RT delay surgery arm. [17] In the aforementioned study, pCR was 2.2% in the LC-RT-delay surgery arm. In our study, the pCR rate also was 3.9%.…”

Section: Discussionmentioning

confidence: 78%

Evaluation of Hematological/Pathological Prognostic Factors and Oncological Outcomes of Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radiotherapy

Avcı¹

2020

TJ Oncol

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In this study, we aimed to present our results of overall survival (OS), progression-free survival (PFS) and local control (LC) in approximately five years of follow-up of the patients with locally advanced rectal cancer who underwent neoadjuvant radiotherapy (RT) and to investigate both the pathological and hematological parameters that affect the survival. METHODS A total of 76 patients with a pathologic diagnosis of rectum adenocarcinoma and clinical stage I-IVA who underwent neoadjuvant RT between August 2014 and March 2019 were evaluated retrospectively in this study. Eighty-five percent of the patients received 45/50 Gy doses of RT concomitantly with oral capecitabine. Fifty-eight patients (78.4%) underwent surgery. The median time between the completion of RT and surgery was 65 days. RESULTS The median follow-up was 25 months. The 2-year OS, PFS and LC rates were 85%, 83.7% and 85.2%, respectively. Positive radial surgical margin was a significant prognostic factor for OS and PFS, but not for LC. The factor affecting OS, PFS and LC was adverse tumor histology (undifferentiated). The prolongation of the time from completion of RT to surgery caused OS and LC to deteriorate. Local control significantly decreased in patients without concomitant chemotherapy. Among all the hematological parameters (e.g. albumin, WBC, platelet, neutrophil, CA 19-9), only pre RT Hb levels significantly correlated with OS but not with PFS. CEA's response to neoadjuvant treatment (NAT) significantly increased OS and PFS. CONCLUSION Adverse tumor histology, the prolonged time from completion of RT to surgery, CEA's response to NAT and pre RT Hb levels were essential factors that affect survival.

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Section: Discussionmentioning

confidence: 78%

Evaluation of Hematological/Pathological Prognostic Factors and Oncological Outcomes of Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radiotherapy

Avcı¹

2020

TJ Oncol

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“…However, the trial revealed that there was no signi cant difference in OS and DFS among the three groups. Besides, the pCR rate in the SC group with delayed surgery (10%) was superior to the other two groups 10 . In the present study, the pCR rate in the SC group (25%) was found to be better compared to the LC group (18.1%), and both were higher than 10%.…”

Section: Pathological Response To Therapymentioning

confidence: 82%

Comparing neoadjuvant long-course chemoradiotherapy with short-course radiotherapy in rectal cancer

Wang

Long

Liu

et al. 2020

Preprint

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Background:The purpose of this study was to compare short-course radiotherapy (SC) or neoadjuvant long-course chemoradiotherapy (LC) treatment for locally advanced rectal cancer patients.Methods:Patients with a diagnosis of locally advanced rectal cancer (LARC) who had undergone neoadjuvant radiotherapy before surgery between 2013 and 2018 at the medical center in China were included in this study. All patients’ MRI confirmed T2N+M0 or T3-4N0-3M0 clinical stages. Patients in the SC group received pelvic radiotherapy with a dose of 5×5 Gy (with or without chemotherapy at any time), followed by immediate or delayed surgery. Patients in the LC group received a dose of 50-50.4 Gy in 25-28 fractions, concomitantly with FOLFOX or capecitabine-based chemotherapy, followed by surgery 4-6 weeks later. All clinical data were retrospectively collected, and long-term follow-up was completed and recorded at the same time.Results:A total of 170 were eligible to participate in this study, 32 patients in the SC group, and 138 in the LC group. The median follow-up time of living patients was 39 months. The disease-free survival (DFS) and overall survival (OS) rates in the SC group and LC group at 3 years, were, 84.9% versus 72.4% (P= 0.273) and 96.2% versus 87.2% (P= 0.510), respectively. The complete pathological response (pCR) rates in the SC group and LC group were, 25% versus 18.1% (the difference was not statistically significant, P=0.375), respectively. However, the SC group had better node(N) downstaging compared to the LC group (P=0.011).Conclusions:There were no differences observed in DFS and OS between short-course radiotherapy and long-course chemoradiation, and both can be used as treatment options for patients with locally advanced rectal cancer.

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“…Figure 3 shows the design of these two trials. However, they have several differences, which are further discussed below and are described in Tables 1 and 2. An important phase 3 study, the Stockholm III trial, demonstrated that surgery can be safely delayed after SCRT for up to 12 weeks, and that this approach leads to an increased pCR rate without affecting postoperative complications [12,33]. Other studies have also examined the possibility of exploiting this window to administer systemic treatment, and ultimately, to move the regimen administered in the adjuvant setting to the preoperative one [34,35].…”

Section: Total Neoadjuvant Treatment As a New Standard Of Care For Larcmentioning

confidence: 99%

“…Interestingly, the Dutch M1 trial demonstrated that in patients with stage IV rectal cancer, administering SCRT on the primary tumor followed by FOLFOX-bevacizumab chemotherapy and then surgery after 6-8 weeks resulted in downstaging the primary tumor in 47% of patients with a 26% pCR rate in the primary tumor [36], and almost one third of patients were alive after a median follow up of more than 8 years [37]. An important phase 3 study, the Stockholm III trial, demonstrated that surgery can be safely delayed after SCRT for up to 12 weeks, and that this approach leads to an increased pCR rate without affecting postoperative complications [12,33]. Other studies have also examined the possibility of The patient population in the RAPIDO trial consisted of those with MRI-defined high-risk locally advanced disease including cT4a/b, extramural vascular invasion, cN2, involved mesorectal fascia or enlarged lateral lymph nodes considered to be infiltrated.…”

Section: Total Neoadjuvant Treatment As a New Standard Of Care For Larcmentioning

confidence: 99%

Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer

Papaccio

Roselló

Huerta

et al. 2020

Cancers

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Most clinical practice guidelines recommend a selective approach for rectal cancer after clinical staging. In low-risk patients, upfront surgery may be an appropriate option. However, in patients with MRI-defined high-risk features such as extramural vascular invasion, multiple nodal involvement or T4 and/or tumors close to or invading the mesorectal fascia, a more intensive preoperative approach is recommended, which may include neoadjuvant or preoperative chemotherapy. The potential benefits include better compliance than postoperative chemotherapy, a higher pathological complete remission rate, which facilitates a non-surgical approach, and earlier treatment of micrometastatic disease with improved disease-free survival compared to standard preoperative chemoradiation or short-course radiation. Two recently reported phase III randomized trials, RAPIDO and PRODIGE 23, show that adding neoadjuvant chemotherapy to either standard short-course radiation or standard long-course chemoradiation in locally advanced rectal cancer patients reduces the risk of metastasis and significantly prolongs disease-related treatment failure and disease-free survival. This review discusses these potentially practice-changing trials and how they may affect our current understanding of treating locally advanced rectal cancers.

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Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

Cited by 102 publications

References 254 publications

Evaluation of Hematological/Pathological Prognostic Factors and Oncological Outcomes of Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radiotherapy

Evaluation of Hematological/Pathological Prognostic Factors and Oncological Outcomes of Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radiotherapy

Comparing neoadjuvant long-course chemoradiotherapy with short-course radiotherapy in rectal cancer

Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer

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