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Benej M, Hoyd R, Kreamer M, Wheeler CE, Grencewicz DJ, Choueiry F, Chan CHF, Zakharia Y, Ma Q, Dodd RD, Ulrich CM, Hardikar S, Churchman ML, Tarhini AA, Robinson LA, Singer EA, Ikeguchi AP, McCarter MD, Tinoco G, Husain M, Jin N, Tan AC, Osman AEG, Eljilany I, Riedlinger G, Schneider BP, Benejova K, Kery M, Papandreou I, Zhu J, Denko N, Spakowicz D. The Tumor Microbiome Reacts to Hypoxia and Can Influence Response to Radiation Treatment in Colorectal Cancer. CANCER RESEARCH COMMUNICATIONS 2024; 4:1690-1701. [PMID: 38904265 PMCID: PMC11234499 DOI: 10.1158/2767-9764.crc-23-0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/26/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024]
Abstract
Tumor hypoxia has been shown to predict poor patient outcomes in several cancer types, partially because it reduces radiation's ability to kill cells. We hypothesized that some of the clinical effects of hypoxia could also be due to its impact on the tumor microbiome. Therefore, we examined the RNA sequencing data from the Oncology Research Information Exchange Network database of patients with colorectal cancer treated with radiotherapy. We identified microbial RNAs for each tumor and related them to the hypoxic gene expression scores calculated from host mRNA. Our analysis showed that the hypoxia expression score predicted poor patient outcomes and identified tumors enriched with certain microbes such as Fusobacterium nucleatum. The presence of other microbes, such as Fusobacterium canifelinum, predicted poor patient outcomes, suggesting a potential interaction between hypoxia, the microbiome, and radiation response. To experimentally investigate this concept, we implanted CT26 colorectal cancer cells into immune-competent BALB/c and immune-deficient athymic nude mice. After growth, in which tumors passively acquired microbes from the gastrointestinal tract, we harvested tumors, extracted nucleic acids, and sequenced host and microbial RNAs. We stratified tumors based on their hypoxia score and performed a metatranscriptomic analysis of microbial gene expression. In addition to hypoxia-tropic and -phobic microbial populations, analysis of microbial gene expression at the strain level showed expression differences based on the hypoxia score. Thus, hypoxia gene expression scores seem to associate with different microbial populations and elicit an adaptive transcriptional response in intratumoral microbes, potentially influencing clinical outcomes. SIGNIFICANCE Tumor hypoxia reduces radiotherapy efficacy. In this study, we explored whether some of the clinical effects of hypoxia could be due to interaction with the tumor microbiome. Hypoxic gene expression scores associated with certain microbes and elicited an adaptive transcriptional response in others that could contribute to poor clinical outcomes.
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Affiliation(s)
- Martin Benej
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Rebecca Hoyd
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - McKenzie Kreamer
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Caroline E Wheeler
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Dennis J Grencewicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Fouad Choueiry
- Department of Health Sciences, The Ohio State University, Columbus, Ohio
| | - Carlos H F Chan
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Yousef Zakharia
- Division of Oncology, Hematology and Blood & Marrow Transplantation, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Qin Ma
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Rebecca D Dodd
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Cornelia M Ulrich
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Sheetal Hardikar
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Ahmad A Tarhini
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Lary A Robinson
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eric A Singer
- Department of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Alexandra P Ikeguchi
- Department of Hematology/Oncology, Stephenson Cancer Center of University of Oklahoma, Oklahoma City, Oklahoma
| | - Martin D McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ning Jin
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Aik C Tan
- Department of Oncological Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Biomedical Informatics, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Afaf E G Osman
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Islam Eljilany
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Clinical Science Lab, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gregory Riedlinger
- Department of Precision Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Bryan P Schneider
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Katarina Benejova
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Martin Kery
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ioanna Papandreou
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jiangjiang Zhu
- Department of Health Sciences, The Ohio State University, Columbus, Ohio
| | - Nicholas Denko
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Daniel Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Mohammed A, Bakry A, Gharieb S, Hanna A, Obaya A, Abdelhady W, Metwalli A. Predictive Value of Tumor-Infiltrating Lymphocytes and Ki-67 for Pathological Response to Total Neoadjuvant Therapy in Rectal Cancer. J Gastrointest Cancer 2024; 55:869-876. [PMID: 38358621 DOI: 10.1007/s12029-024-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Patients with locally advanced rectal cancer (LARC) who underwent total neoadjuvant therapy (TNT) showed an increase in the percentage of complete pathological response (pCR). The purpose of this study was to determine the correlation between Ki-67, tumor-infiltrating lymphocytes (TIL), and TNT in LARC patients. METHOD In total, one hundred fifty-nine patients with LARC were included in this prospective study. The international working group was used to categorize the TIL into three groups based on the percentage and density of staining: group 0 (0-10%), group 1 (11-59%), and group 2 (≥ 60%). Ki-67 expression was classified as low (≤ 50%) or high (> 50%). RESULT Most patients had tumor grade III (74.2%) and T2-T3 (78.6%). Lymph node involvement (48.7%) and tumor size ≥ 3 cm were detected in approximately half of the patients. Forty-four percent of patients had a high Ki-67 index; 15.7% of patients belonged to group 1, and 21.4% belonged to group 2. pCR was detected in 18.2% of the patients. TIL and Ki-67 levels were significantly correlated with pCR (p = 0.001 and 0.003 for multivariate analysis and 0.001 and 0.03 for univariate analysis, respectively). CONCLUSION There was a statistically significant correlation between Ki-67, TIL, and pCR following TNT protocol, which may help maximize the therapeutic outcome.
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Affiliation(s)
- Amrallah Mohammed
- Medical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Adel Bakry
- Medical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shimaa Gharieb
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amira Hanna
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Obaya
- Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Waleed Abdelhady
- Surgical Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Cai Y, Chen M, Ye F, Liu Z, Luo S, Huang L, Kang L. The clinical relevance of adjuvant chemotherapy in locally advanced rectal cancer patients achieving near pathological complete response following neoadjuvant chemoradiotherapy: Insights from ypT stage. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108001. [PMID: 38364330 DOI: 10.1016/j.ejso.2024.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/20/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Near-pathological complete response (Near-pCR) patients constitute a distinct subgroup with limited research attention. The clinical relevance of adjuvant chemotherapy (ACT) in this patient cohort remains uncertain. METHODS We conducted a retrospective analysis of 245 patients with locally advanced rectal cancer (LARC) who achieved near-pCR following neoadjuvant chemoradiotherapy (NCRT) between 2011 and 2018. Based on their receipt of ACT or not (non-ACT), patients were divided into two groups. We examined their characteristics, treatment modalities, and survival outcomes, particularly focusing on 5-year disease-free survival (DFS) and 5-year overall survival (OS). RESULTS Among the 245 near-pCR patients, 191 (77.96%) received ACT, and 42 (17.14%) experienced disease recurrence. All 54 (22.04%) Patients in the non-ACT group exhibited a lower 5-year DFS rate (72.2% vs. 85.9%, P = 0.014) and a similar 5-year OS rate (87.0% vs. 91.1%, P = 0.351). Interestingly, those with ypT3-T4 stage tumors demonstrated a worse DFS (76.8% vs. 89.9%, P = 0.010) and OS (87.5% vs. 97.0%, P = 0.004) compared to their counterparts with ypT1-T2 stage tumors. Patients with Non-Downstage tumors showed inferior DFS (76.9% vs. 88.3%, P = 0.025) and OS (87.2% vs. 93.0%, P = 0.166) in comparison to patients with Downstage tumors. The ACT subgroup in patients with Downstage demonstrated statistically better 5-year DFS (93.0% vs. 71.4%, P = 0.001) but analogous survival rates for 5-year OS (OS: 94.0% vs. 89.3%, P = 0.402). Pathological T stage 3-4, perineural invasion (PNI) (positive) and ACT were independent factors influencing 5-year DFS in multivariate analysis. Both univariate and multivariate analysis demonstrated a link between serum carcinoembryonic antigen (CEA) before treatment ≥5 ng/ml and shorter 5-year OS. Notably, near-pCR patients with positive lymph nodes experienced notably diminished 5-year DFS in the absence of ACT post-surgery (61.1% vs. 93.2%, P < 0.001). CONCLUSIONS ACT demonstrated a significant positive impact on the prognosis of select near-pCR patients, particularly those with ypT1-T2 stage tumors and positive lymph nodes. ypT staging may emerge as a valuable criterion for precise post-surgical ACT guidance in near-pCR patients.
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Affiliation(s)
- Yebing Cai
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Mian Chen
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Fujin Ye
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Zhanzhen Liu
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Shuangling Luo
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Liang Huang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China.
| | - Liang Kang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China.
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Sert F, Ozturk M, Yalman D, Ozkok S. Does neoadjuvant rectal score predict treatment outcomes better than the all grading systems used in neoadjuvantly treated rectal cancer? Asian J Surg 2023; 46:4378-4384. [PMID: 36280480 DOI: 10.1016/j.asjsur.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND /Objective: To compare the prognostic value of the yield pathologic (yp) stage, used 4 tumor regression grading (TRG) systems, and neoadjuvant rectal score(NARS) in patients with locally advanced rectal cancer (LARC) who received long-term neoadjuvant chemoradiotherapy (nCRT). METHODS Between 2005 and 2017, we included 302 patients with LARC who treated with nCRT. Postoperative pathological responses were graded by using Dworak, American Joint Committee on Cancer, Mandart, Memorial Sloan Kettering Cancer Center, grading systems and NARS([5ypN-3(kT-pT)+12]2/9,61) calculations. Their results were compared in terms of treatment outcomes. RESULTS The median follow-up time was 51 months (range 5-136). There was a significant relation between cT stage and the response in used grading systems(p < 0,001). Median overall(OS), local recurrence free(LRFS), and distant metastasis free(MFS) survival rates were 50, 48, and 45 months, respectively. 5-year OS, LRFS, and MFS rates were 71%, 92%, and 72%, respectively. According to the NARS and treatment response grating systems, a significant difference was found between the low risk and high risk groups in terms of OS, LRFS, and MFS rates. While it was not seen any difference in terms of OS and MFS, NARS was found to predict LRFS better than other grading systems. In multivariate analysis, high NARS was found to be correlated with worse OS and worse MFS. On the other hand, pCR was the another important factor affecting treatment outcomes. CONCLUSIONS While used systems except NARS group patients according to ypT status in surgical tissue, NARS add the value of ypN status in addition to ypT status. It could be suggested to use NARS to predict LRFS.
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Affiliation(s)
- Fatma Sert
- Ege University Hospital, Department of Radiation Oncology, Izmir, Turkey.
| | - Meltem Ozturk
- Ege University Hospital, Department of Radiation Oncology, Izmir, Turkey
| | - Deniz Yalman
- Ege University Hospital, Department of Radiation Oncology, Izmir, Turkey
| | - Serdar Ozkok
- Ege University Hospital, Department of Radiation Oncology, Izmir, Turkey
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Nakano H, Shiinoki T, Tanabe S, Nakano T, Takizawa T, Utsunomiya S, Sakai M, Tanabe S, Ohta A, Kaidu M, Nishio T, Ishikawa H. Multicomponent mathematical model for tumor volume calculation with setup error using single-isocenter stereotactic radiotherapy for multiple brain metastases. Phys Eng Sci Med 2023; 46:945-953. [PMID: 36940064 DOI: 10.1007/s13246-023-01241-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
We evaluated the tumor residual volumes considering six degrees-of-freedom (6DoF) patient setup errors in stereotactic radiotherapy (SRT) with multicomponent mathematical model using single-isocenter irradiation for brain metastases. Simulated spherical gross tumor volumes (GTVs) with 1.0 (GTV 1), 2.0 (GTV 2), and 3.0 (GTV 3)-cm diameters were used. The distance between the GTV center and isocenter (d) was set at 0-10 cm. The GTV was simultaneously translated within 0-1.0 mm (T) and rotated within 0°-1.0° (R) in the three axis directions using affine transformation. We optimized the tumor growth model parameters using measurements of non-small cell lung cancer cell lines' (A549 and NCI-H460) growth. We calculated the GTV residual volume at the irradiation's end using the physical dose to the GTV when the GTV size, d, and 6DoF setup error varied. The d-values that satisfy tolerance values (10%, 35%, and 50%) of the GTV residual volume rate based on the pre-irradiation GTV volume were determined. The larger the tolerance value set for both cell lines, the longer the distance to satisfy the tolerance value. In GTV residual volume evaluations based on the multicomponent mathematical model on SRT with single-isocenter irradiation, the smaller the GTV size and the larger the distance and 6DoF setup error, the shorter the distance that satisfies the tolerance value might need to be.
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Affiliation(s)
- Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan. .,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan.
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Yamaguchi University, Minamikogushi 1-1-1 Ube, Yamaguchi, Japan
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Toshimichi Nakano
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Takeshi Takizawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan.,Department of Radiation Oncology, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-Ku, Niigata-Shi, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Madoka Sakai
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Shunpei Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Atsushi Ohta
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata-Shi, Niigata, Japan
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Development of a method for digital assessment of tumor regression grade in patients with rectal cancer following neoadjuvant therapy. J Pathol Inform 2022; 13:100152. [PMID: 36605115 PMCID: PMC9808016 DOI: 10.1016/j.jpi.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Neoadjuvant chemo-radiotherapy (nCRT) followed by surgical resection is the standard treatment strategy in patients with locally advanced rectal cancer (RC). The pathological effect of nCRT is assessed by determining the tumor regression grade (TRG) of the resected tumor. Various methods exist for assessing TRG and all are performed manually by the pathologist with an accompanying risk of interobserver variation. Automated digital image analysis could be a more objective and reproducible approach to evaluate TRG. This study aimed at developing a digital method to assess TRG in RC following nCRT, and correlate the results to the currently used Mandard method. A deep learning-based semi-automatic Epithelium-Tumor area Percentage (ETP) algorithm enabling quantification of tumor regression by determining the percentage of residual tumor epithelium out of the total tumor area was developed. The ETP was quantified in 50 cases treated with nCRT and 25 cases with no prior nCRT served as controls. Median ETP was 39.25% in untreated compared with 6.64% in patients who received nCRT (P < .001). The ETP of the resected tumors treated with nCRT increased along with increasing Mandard grade (P < .001). As new treatment strategies in RC are emerging, performing an accurate and reproducible evaluation of TRG is important in the assessment of treatment response and prognosis. TRG is often used as an outcome point in clinical trials. The ETP algorithm is capable of performing a precise and objective value of tumor regression.
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Li M, Xiao Q, Venkatachalam N, Hofheinz RD, Veldwijk MR, Herskind C, Ebert MP, Zhan T. Predicting response to neoadjuvant chemoradiotherapy in rectal cancer: from biomarkers to tumor models. Ther Adv Med Oncol 2022; 14:17588359221077972. [PMID: 35222695 PMCID: PMC8864271 DOI: 10.1177/17588359221077972] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is a major contributor to cancer-associated morbidity worldwide and over one-third of CRC is located in the rectum. Neoadjuvant chemoradiotherapy (nCRT) followed by surgical resection is commonly applied to treat locally advanced rectal cancer (LARC). In this review, we summarize current and novel concepts of neoadjuvant therapy for LARC such as total neoadjuvant therapy and describe how these developments impact treatment response. Moreover, as response to nCRT is highly divergent in rectal cancers, we discuss the role of potential predictive biomarkers. We review recent advances in biomarker discovery, from a clinical as well as a histopathological and molecular perspective. Furthermore, the role of emerging predictive biomarkers derived from the tumor environment such as immune cell composition and gut microbiome is presented. Finally, we describe how different tumor models such as patient-derived cancer organoids are used to identify novel predictive biomarkers for chemoradiotherapy (CRT) in rectal cancer.
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Affiliation(s)
- Moying Li
- Medical Faculty Mannheim, Heidelberg
University, Mannheim
| | - Qiyun Xiao
- Department of Medicine II, Mannheim University
Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim,
Germany
| | - Nachiyappan Venkatachalam
- Department of Medicine II, Mannheim University
Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim,
Germany
| | - Ralf-Dieter Hofheinz
- Department of Medicine III, Mannheim University
Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim,
GermanyMannheim Cancer Center, Medical Faculty Mannheim, Heidelberg
University, Mannheim, Germany
| | - Marlon R. Veldwijk
- Department of Radiation Oncology, Mannheim
University Hospital, Medical Faculty Mannheim, Heidelberg University,
Mannheim, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Mannheim
University Hospital, Medical Faculty Mannheim, Heidelberg University,
Mannheim, Germany
| | - Matthias P. Ebert
- Department of Medicine II, Mannheim University
Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim,
GermanyMannheim Cancer Center, Medical Faculty Mannheim, Heidelberg
University, Mannheim, GermanyDKFZ-Hector Cancer Institute, University
Medical Center Mannheim, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Internal Medicine II, Mannheim
University Hospital, Medical Faculty Mannheim, Heidelberg University,
Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyMannheim Cancer Center,
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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8
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Baek JH, Baek DW, Kang BW, Kim HJ, Park SY, Park JS, Choi GS, Kim JG. Prognostic Impact of the Neoadjuvant Rectal Score as Compared With the Tumor Regression Grade and Yield Pathologic TNM Stage in Patients With Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy. In Vivo 2021; 34:1993-1999. [PMID: 32606172 DOI: 10.21873/invivo.11997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM The present study compared the prognostic value of the yield pathologic (yp) stage, tumor regression grade (TRG), and neoadjuvant rectal (NAR) score in patients with locally advanced rectal cancer (LARC) who received neoadjuvant chemoradiotherapy (nCRT). PATIENTS AND METHODS For the assessment of tumor regression, the Dworak grading system was used. The NAR score was calculated using the following equation: (5ypN-3[cT-ypT]+12)2÷9.61. RESULTS In univariate analysis, the NAR score and ypTNM stage were significantly associated with DFS [hazard ratio (HR)=2.514, p<0.001 and HR=3.200, p<0.001] and OS (HR=2.292, p=0.001 and HR=2.859, p<0.001), whereas the TRG was significantly associated with only DFS (HR=2.008, p=0.017). In multivariate analysis, the ypTNM stage was the only independent prognostic factor for DFS (HR=3.796, p<0.001) and OS (HR=3.591, p=0.0034). CONCLUSION Only the ypTNM stage was significantly associated with survival outcomes in multivariate analysis, suggesting that it is the most powerful prognostic factor of nCRT in patients with LARC.
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Affiliation(s)
- Jin Ho Baek
- Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea
| | - Dong Won Baek
- Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea
| | - Byung Woog Kang
- Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea
| | - Hye Jin Kim
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Su Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jun Seok Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gyu Seog Choi
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Gwang Kim
- Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Kyungpook National University Cancer Research Institute, Daegu, Republic of Korea
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9
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Lino-Silva LS, Guzmán-López JC, Salazar-García JA, Chávez-Hernández JD, Gamboa-Domínguez A, Chiquete E, Mohar A, Morales-Soto J, Salcedo-Hernández RA. Interobserver Variability in Assessing Pathologic Response to Preoperative Treatment in Rectal Cancer: Standardization of an Evaluation Method and Comparisons Between Published Scales. J Gastrointest Cancer 2021; 51:709-713. [PMID: 31760577 DOI: 10.1007/s12029-019-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Evaluating tumor response of rectal cancer to preoperative chemoradiotherapy (NCRT) has a prognostic value on overall survival; however, grading tumor response is a controversial issue due to lack of reproducibility and the lack of information about the standardization of the evaluation. METHODS We performed this study to examine the variability between observers' assessment of the pathological responses to NCRT using a systematic quantitative grading system based on a percentage of tumor response against the proportion of residual tumor burden. As a secondary aim, we classified the tumor response according to six published systems to determine the correlation between the observers into each grading system. RESULTS From 70 cases, the mean age was 60.6 ± 11.78 years, 36 (51.47%) patients were female, the pathological T stage was pT3 in 48.6% of cases, pT2 in 32.9%, pT1 in 11.4% and 7.1% in pT4, whereas 40% had lymph node metastasis. The median lymph node count was ten lymph nodes (range 6-43). Our method of tumor regression evaluation has a good intraclass correlation (ICC) value. From the scales compared regarding interobserver agreement, the Ryan's and Royal College of Pathologists showed fair agreement (but good ICC); the scales from Dworak, Becker, and Rizk showed substantial agreement (and good to excellent ICC values); and the scale from Rödel showed almost-perfect agreement. RESULTS All the evaluated systems showed good interobserver agreement, but the best interobserver agreement was reached with the Rödel's scale.
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Affiliation(s)
- Leonardo S Lino-Silva
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico.
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico.
| | - Janet C Guzmán-López
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico
| | - Jenny A Salazar-García
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
| | - Jazmín D Chávez-Hernández
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico
| | - Armando Gamboa-Domínguez
- Surgical pathology, Medical Sciences and Nutrition National Institute "Salvador Zubirán", Mexico City, Mexico
| | - Erwin Chiquete
- Neurology división, Medical Sciences and Nutrition National Institute "Salvador Zubirán", Mexico City, Mexico
| | - Alejandro Mohar
- Biomedics Research Institute, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
| | - Jonathan Morales-Soto
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
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10
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Anuje M, Pawaskar P, Sivan A, Lokhande C, Ahmed I, Patil D. Use of Poly (Ethylene Glycol) Coated Superparamagnetic Iron Oxide Nanoparticles as Radio Sensitizer in Enhancing Colorectal Cancer Radiation Efficacy. J Med Phys 2021; 46:278-285. [PMID: 35261497 PMCID: PMC8853453 DOI: 10.4103/jmp.jmp_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/14/2021] [Accepted: 08/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGORUND The aim of the radiotherapy is to deliver a lethal dose to tumor while reducing the impact on the normal tissue. This reduction in impact can be achieved to have a greater therapeutic ratio by using nanoparticles as radiosensitizer. MATERIALS AND METHODS In this article, the potential role of superparamagnetic iron oxide nanoparticles (SPIONs) as radiosensitization enhancer on HT 29 cell lines for different concentrations (0.007to 0.25 mg/ml) and different radiation doses (0.5to 2 Gy) of 6MV photon beam is presented. RESULTS The highest sensitization enhancement ratio (SER) value was observed with 2 Gy for 0.25 mg/ml concentration. Radio sensitization increases with increase in the concentration of nanoparticles. Combination of 6MV energy radiation and polyethylene glycol (PEG) coated SPIONs results in increasing cell killing of HT 29 as compared to cell killing with radiation therapy alone. CONCLUSION The results reveal that PEG coated nanoparticle might be a potential candidate to work as radiotherapy sensitizer in colorectal cancer.
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Affiliation(s)
- Madhuri Anuje
- Department of Medical Physics, Center for Interdisciplinary Research, DY Patil Education Society (Deemed to be) University, Kolhapur, Maharashtra, India,Integrated Cancer Treatment and Research Centre, Pune, Maharashtra, India
| | - Padamaja Pawaskar
- Department of Medical Physics, Center for Interdisciplinary Research, DY Patil Education Society (Deemed to be) University, Kolhapur, Maharashtra, India,Address for correspondence: Dr. Padamaja Pawaskar, Department of Medical Physics, Center for Interdisciplinary Research, DY Patil Education Society (Deemed to be) University, Kolhapur - 416 006, Maharashtra, India. E-mail:
| | - Ajay Sivan
- Integrated Cancer Treatment and Research Centre, Pune, Maharashtra, India
| | - Chandrakant Lokhande
- Department of Medical Physics, Center for Interdisciplinary Research, DY Patil Education Society (Deemed to be) University, Kolhapur, Maharashtra, India
| | - Imtiaz Ahmed
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital, Belgaum, Karnataka, India
| | - Dhanashree Patil
- Dr. Prabhakar Kore Basic Science Research Centre, KLE Academy of Higher Education and Research (KLE University), Belgaum, Karnataka, India
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11
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González I, Bauer PS, Chapman WC, Alipour Z, Rais R, Liu J, Chatterjee D. Clinicopathologic determinants of pathologic treatment response in neoadjuvant treated rectal adenocarcinoma. Ann Diagn Pathol 2020; 45:151452. [PMID: 31945621 PMCID: PMC7195850 DOI: 10.1016/j.anndiagpath.2019.151452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/31/2022]
Abstract
Neoadjuvant treatment (NAT) followed by total mesorectal excision is currently considered the standard of treatment for rectal adenocarcinoma. The degree of pathologic treatment response (pTR) correlates significantly with the recurrence free survival and overall survival (OS). However, it remains unclear which clinical and pathologic factors are associated with a more robust response to NAT, including showing pathologic complete response (pCR). Chemokine receptor 4 (CXCR4) overexpression has been associated with unfavorable OS in some studies. In this study, we sought to evaluate the clinicopathologic determinants of pTR in neoadjuvant treated rectal adenocarcinoma (NAT-RA). We retrospectively identified 91 patients who underwent pre-treatment diagnostic biopsy, NAT, and surgical resection at our institution. The archival slides were reviewed for pathologic features in the pre-treatment biopsies and for assessment of pTR in the resection specimens according to the current College of American Pathologist (CAP)'s guidelines. pCR was obtained in 16.5% of the cases, whereas 20.9% had near pCR, 30.8% had partial response, and 31.9% had a poor/no response. CXCR4 immunohistochemical analysis was also performed on the pre-treatment biopsies. Lower pre-treatment cT-stage (p = 0.019) and pre-treatment AJCC cTNM stage groups (p = 0.004), longer time interval between completion of NAT and resection (p = 0.022), and presence of tumor-infiltrating lymphocytes in the pre-treatment biopsies (p = 0.019) were significantly associated with a better pTR. CXCR4 nuclear expression was associated with a lower percentage of residual tumor (p = 0.036). Pre-treatment CEA levels, tumor differentiation, CAP treatment response groups and lower percentage of residual tumor were associated with a better OS.
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Affiliation(s)
- Iván González
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - Philip S Bauer
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - Zahra Alipour
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - Rehan Rais
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - Jingxia Liu
- Section of Oncologic Biostatistics, Division of Public Health, Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, United States
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, United States.
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12
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Habiba K, Aziz K, Sanders K, Santiago CM, Mahadevan LSK, Makarov V, Weiner BR, Morell G, Krishnan S. Enhancing Colorectal Cancer Radiation Therapy Efficacy using Silver Nanoprisms Decorated with Graphene as Radiosensitizers. Sci Rep 2019; 9:17120. [PMID: 31745177 PMCID: PMC6864075 DOI: 10.1038/s41598-019-53706-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
Metal nanoparticles have significant interaction cross-sections with electromagnetic waves due to their large surface area-to-volume ratio, which can be exploited in cancer radiotherapy to locally enhance the radiation dose deposition in tumors. We developed a new type of silver nanoparticle composite, PEGylated graphene quantum dot (GQD)-decorated Silver Nanoprisms (pGAgNPs), that show excellent in vitro intracellular uptake and radiosensitization in radiation-sensitive HCT116 and relatively radiation-resistant HT29 colorectal cancer cells. Furthermore, following biodistribution analysis of intravenously injected nanoparticles in nude mice bearing HCT116 tumors radiosensitization was evaluated. Treatment with nanoparticles and a single radiation dose of 10 Gy significantly reduces the growth of colorectal tumors and increases the survival time as compared to treatment with radiation only. Our findings suggest that these novel nanoparticles offer a promising paradigm for enhancing colorectal cancer radiation therapy efficacy.
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Affiliation(s)
- Khaled Habiba
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Kathryn Aziz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Keith Sanders
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Carlene Michelle Santiago
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Biology, University of Puerto Rico -Rio Piedras Campus, San Juan, PR, 00925-2537, USA.,Molecular Sciences Research Center, University of Puerto Rico, San Juan, Puerto Rico, 00926-2614, USA
| | | | - Vladimir Makarov
- Molecular Sciences Research Center, University of Puerto Rico, San Juan, Puerto Rico, 00926-2614, USA.,Department of Physics, University of Puerto Rico -Rio Piedras Campus, San Juan, PR, 00925-2537, USA
| | - Brad R Weiner
- Molecular Sciences Research Center, University of Puerto Rico, San Juan, Puerto Rico, 00926-2614, USA.,Department of Chemistry, University of Puerto Rico -Rio Piedras Campus, San Juan, PR, 00925-2537, USA.,Comprehensive Cancer Center, University of Puerto Rico, San Juan, PR, 00936-3027, USA
| | - Gerardo Morell
- Molecular Sciences Research Center, University of Puerto Rico, San Juan, Puerto Rico, 00926-2614, USA.,Department of Physics, University of Puerto Rico -Rio Piedras Campus, San Juan, PR, 00925-2537, USA.,Comprehensive Cancer Center, University of Puerto Rico, San Juan, PR, 00936-3027, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA.
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13
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Peacock O, Chang GJ. "Watch and Wait" for complete clinical response after neoadjuvant chemoradiotherapy for rectal cancer. MINERVA CHIR 2019; 74:481-495. [PMID: 31580047 DOI: 10.23736/s0026-4733.19.08184-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of rectal cancer has evolved substantially over recent decades, becoming increasingly complex. This was once a disease associated with high mortality and limited treatment options that typically necessitated a permanent colostomy, has now become a model for multidisciplinary evaluation, treatment and surgical advancement. Despite advances in the rates of total mesorectal excision, decreased local recurrence and increased 5-year survival rates, the multimodal treatment of rectal cancer is associated with a significant impact on long-term functional and quality of life outcomes including risks of bowel, bladder and sexual dysfunction, and potential need for a permanent stoma. There is great interest in strategies to decrease the toxicity of treatment, including selective use of radiation, chemotherapy or even surgery. The modern concept of selective use of surgery for patients with rectal cancer are based on the observed pathological complete response in approximately 10-20% of patients following long-course chemoradiation therapy. While definitive surgical resection remains the standard of care for all patients with non-metastatic rectal cancer, a growing number of studies are providing supportive evidence for a watch-and-wait, organ preserving approach in highly selected patients with rectal cancer. However, questions regarding the heterogeneity of patient selection, optimal method for inducing pathological complete response, methods and intervals for assessing treatment response and adequacy of follow-up remain unanswered. The aim of this review is to provide an up-to-date summary of the current evidence for the watch-and-wait management of rectal cancer following a complete clinical response after neoadjuvant chemoradiation.
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Affiliation(s)
- Oliver Peacock
- Colorectal Surgical Oncology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - George J Chang
- Colorectal Surgical Oncology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA -
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14
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Zhang W, Ye YJ, Ren XW, Huang J, Shen ZL. [Detection of preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:542-547. [PMID: 31209429 DOI: 10.19723/j.issn.1671-167x.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To detect the preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing. METHODS The clinicopathological data of 30 patients with locally advanced rectal cancer were collected prospectively, including 9 indicators (general conditions, imaging data before radiotherapy and chemotherapy, pathological data of biopsy before radiotherapy and chemotherapy, and tumor differentiation degree, etc.), in order to analyze the correlation between them and tumor regression grading (TRG) after radiotherapy and chemotherapy for rectal cancer. At the same time, frozen specimens of colonoscopy biopsy before neoadjuvant therapy were collected from these 30 patients, and transcriptome second-generation sequencing was performed for bioinformatics analysis to screen out the genes that might drive the radio chemotherapy sensitivity of rectal cancer. RESULTS Among the 30 patients with rectal cancer, 9 had complete pathological remission, 12 had partial remission, and 9 had poor remission. The degree of pathological TRG remission after radiotherapy and chemotherapy for rectal cancer was negatively correlated with the preoperative MRI T stage (P=0.046), and positively correlated with preoperative MRI rectal cancer extravascular invasion (EMVI) (P=0.003). Transcriptome second-generation sequencing of the obtained 217 transcripts (P<0.05) for signal pathway enrichment analysis, and multiple cell signal transduction pathways related to antigen presentation could be found. The high expression of HSPA1A, HSPA1B and EXOSC2 was positively correlated with postoperative pathological remission (P<0.05). The high expression of DNMBP, WASH8P, FAM57A, and SGSM2 was positively correlated with postoperative pathological remission (P<0.05). CONCLUSION Preoperative NMR detection of extra-tumoral vascular invasion (EMVI-positive) in patients with rectal cancer was significantly better than that of EMVI-negative patients after chemoradiotherapy. Patients with high expressions of HSPA1A, HSPA1B and EXOSC2 had poor postoperative pathological remission, while patients with high expressions of genes, such as DMNMB, WASH8P, FAM57A, and SGSM2 had good postoperative pathological remission. Based on the molecular characteristics of rectal cancer radiotherapy and chemotherapy, attempts to block or enhance the molecular pathways associated with chemosensitivity of rectal cancer, are to be made to further explore new candidate therapeutic targets that can increase the sensitivity of radiotherapy and chemotherapy for rectal cancer.
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Affiliation(s)
- W Zhang
- Department of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Y J Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China
| | - X W Ren
- Biodynamic Optical Imaging Center, School of Life Sciences, Peking University, Beijing 100871, China
| | - J Huang
- Department of Immunology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - Z L Shen
- Department of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China
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15
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Jeon SH, Song C, Chie EK, Kim B, Kim YH, Chang W, Lee YJ, Chung JH, Chung JB, Lee KW, Kang SB, Kim JS. Delta-radiomics signature predicts treatment outcomes after preoperative chemoradiotherapy and surgery in rectal cancer. Radiat Oncol 2019; 14:43. [PMID: 30866965 PMCID: PMC6417065 DOI: 10.1186/s13014-019-1246-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/28/2019] [Indexed: 12/31/2022] Open
Abstract
Background To develop and compare delta-radiomics signatures from 2- (2D) and 3-dimensional (3D) features that predict treatment outcomes following preoperative chemoradiotherapy (CCRT) and surgery for locally advanced rectal cancer. Methods In total, 101 patients (training cohort, n = 67; validation cohort, n = 34) with locally advanced rectal adenocarcinoma between 2008 and 2015 were included. We extracted 55 features from T2-weighted magnetic resonance imaging (MRI) scans. Delta-radiomics feature was defined as the difference in radiomics feature before and after CCRT. Signatures were developed to predict local recurrence (LR), distant metastasis (DM), and disease-free survival (DFS) from 2D and 3D features. The least absolute shrinkage and selection operator regression was used to select features and build signatures. The delta-radiomics signatures and clinical factors were integrated into Cox regression analysis to determine if the signatures were independent prognostic factors. Results The radiomics signatures for LR, DM, and DFS were developed and validated using both 2D and 3D features. Outcomes were significantly different in the low- and high-risk patients dichotomized by optimal cutoff in both the training and validation cohorts. In multivariate analysis, the signatures were independent prognostic factors even when considering the clinical parameters. There were no significant differences in C-index from 2D vs. 3D signatures. Conclusions This is the first study to develop delta-radiomics signatures for rectal cancer. The signatures successfully predicted the outcomes and were independent prognostic factors. External validation is warranted to ensure their performance. Electronic supplementary material The online version of this article (10.1186/s13014-019-1246-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, 81 Oedae-ro, Mohyeon-eup, Cheoin-gu, Yongin, 17035, Republic of Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Won Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Beom Chung
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
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16
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Kim CH, Yeom SS, Lee SY, Kim HR, Kim YJ, Lee KH, Lee JH. Prognostic Impact of Perineural Invasion in Rectal Cancer After Neoadjuvant Chemoradiotherapy. World J Surg 2019; 43:260-272. [PMID: 30151676 DOI: 10.1007/s00268-018-4774-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perineural invasion (PNI) has emerged as an important factor related to colorectal cancer spread; however, the impact of neoadjuvant chemoradiotherapy (nCRT) on PNI remains unclear. Herein, we investigated the prognostic value of PNI, along with lymphovascular invasion (LVI), in rectal cancer patients treated with nCRT. METHODS This single-center observational study of pathologic variables, including PNI and LVI, analyzed 1411 invasive rectal cancer patients (965 and 446 patients treated with primary resection and nCRT, respectively). RESULTS The overall detection rates of LVI and PNI were 16.7 and 28.8%, respectively. The incidence of LVI was significantly lower in patients treated with nCRT (8.1 vs. 20.6%, P < .001); this was confirmed by multivariate analysis. However, PNI was not affected by nCRT (with nCRT 28.3% vs. without nCRT 29.1%, P = .786). In the 446 patients with nCRT, multivariate analysis revealed that PNI was an independent prognostic factor for both disease-free survival (DFS) and overall survival (OS). For the prediction of both 5-year DFS and OS, the C-index for the combinations of T-stage with the PNI (TPNI) system showed favorable result, especially in patients with a total number of harvested lymph nodes <8. CONCLUSION PNI is a meaningful prognostic factor for rectal cancer patients treated with nCRT, especially when <8 lymph nodes are harvested. The lack of influence of nCRT on the PNI incidence suggests that residual tumor cells with PNI are more radioresistant or biologically aggressive than those without.
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Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Seung-Seop Yeom
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea.
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Kyung Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Jae Hyuk Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
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17
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Song C, Chung JH, Kang SB, Kim DW, Oh HK, Lee HS, Kim JW, Lee KW, Kim JH, Kim JS. Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System. Cancers (Basel) 2018; 10:cancers10090319. [PMID: 30205529 PMCID: PMC6162780 DOI: 10.3390/cancers10090319] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery primarily in patients with pathological stage (ypStage) II and III rectal cancer. The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR, TRG 3/4, n = 122) or a poor response (PR, TRG 1/2, n = 209). At a median follow-up of 65 months, five-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). Patients with a GR and ypStage II disease had a five-year DFS that was indistinguishable from that of patients with ypStage 0–I disease (92.3% vs. 90.7%, p = 0.885). Likewise, patients with a GR and ypStage III disease had a five-year DFS similar to those with ypStage II disease (76.0% vs. 75.9%, p = 0.789). A new modified staging system that incorporates grouped TRG (GR vs. PR) was developed. The prognostic performance of this modified stage and the ypStage was compared with the Harrell C statistic. C statistic of the modified stage was higher than that of the ypStage (0.784 vs. 0.757, p = 0.012). The results remained robust after multivariate Cox regression analyses. In conclusion, a GR to neoadjuvant CRT is an independent predictor of good DFS and overall survival and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.
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Affiliation(s)
- Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
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18
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Kong JC, Guerra GR, Warrier SK, Lynch AC, Michael M, Ngan SY, Phillips W, Ramsay G, Heriot AG. Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis. Colorectal Dis 2018; 20:574-585. [PMID: 29582537 DOI: 10.1111/codi.14106] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/01/2018] [Indexed: 02/08/2023]
Abstract
AIM The current standard of care for locally advanced rectal cancer involves neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision. There is a spectrum of response to neoadjuvant therapy; however, the prognostic value of tumour regression grade (TRG) in predicting disease-free survival (DFS) or overall survival (OS) is inconsistent in the literature. METHOD This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was undertaken using Ovid MEDLINE, Embase and Google Scholar. Inclusion criteria were Stage II and III locally advanced rectal cancer treated with long-course CRT followed by radical surgery. The aim of the meta-analysis was to assess the prognostic implication of each TRG for rectal cancer following neoadjuvant CRT. Long-term prognosis was assessed. The main outcome measures were DFS and OS. A random effects model was performed to pool the hazard ratio (HR) from all included studies. RESULTS There were 4875 patients from 17 studies, with 775 (15.9%) attaining a pathological complete response (pCR) and 719 (29.9%) with no response. A significant association with OS was identified from a pooled-estimated HR for pCR (HR = 0.47, P = 0.002) and nonresponding tumours (HR = 2.97; P < 0.001). Previously known tumour characteristics, such as ypN, lymphovascular invasion and perineural invasion, were also significantly associated with DFS and OS, with estimated pooled HRs of 2.2, 1.4 and 2.3, respectively. CONCLUSION In conclusion, the degree of TRG was of prognostic value in predicting long-term outcomes. The current challenge is the development of a high-validity tests to predict pCR.
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Affiliation(s)
- J C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G R Guerra
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Craig Lynch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - M Michael
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - S Y Ngan
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - W Phillips
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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19
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Ruhl R, Rana S, Kelley K, Espinosa-Diez C, Hudson C, Lanciault C, Thomas CR, Liana Tsikitis V, Anand S. microRNA-451a regulates colorectal cancer proliferation in response to radiation. BMC Cancer 2018; 18:517. [PMID: 29720118 PMCID: PMC5932766 DOI: 10.1186/s12885-018-4370-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/15/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer-related death. The biologic response of CRC to standard of care adjuvant therapies such as chemotherapy and radiation are poorly understood. MicroRNAs (miRs) have been shown to affect CRC progression and metastasis. Therefore, we hypothesized that specific miRs modulate CRC response to chemoradiation. METHODS In this study, we used miR expression profiling and discovered a set of microRNAs upregulated rapidly in response to either a single 2 Gy dose fraction or a 10 Gy dose of γ-radiation in mouse colorectal carcinoma models. We used gain and loss-of-function studies in 2D and 3Dcell proliferation assays and colony formation assays to understand the role of the top miR candidate from our profiling. We used Student's T-tests for simple comparisons and two-factor ANOVA for evaluating significance. RESULTS The most upregulated candidate at early time points in our signature, miR-451a inhibited tumor cell proliferation and attenuated surviving fraction in longer-term cultures. Conversely, inhibition of miR-451a increased proliferation, tumorsphere formation, and surviving fraction of tumor cells. Using a bioinformatics approach, we identified four genes, CAB39, EMSY, MEX3C, and EREG, as targets of miR-451a. Transfection of miR-451a decreased both mRNA and protein levels of these targets. Importantly, we found miR-451a expression was high and CAB39, EMSY levels were low in a small subset of rectal cancer patients who had a partial response to chemoradiation when compared to patients that had no response. Finally, analysis of a TCGA colorectal cancer dataset revealed that CAB39 and EMSY are upregulated at the protein level in a significant number of CRC patients. Higher levels of CAB39 and EMSY correlated with poorer overall survival. CONCLUSIONS Taken together, our data indicates miR-451a is induced by radiation and may influence colorectal carcinoma proliferation via CAB39 and EMSY pathways.
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Affiliation(s)
- Rebecca Ruhl
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Shushan Rana
- Department of Radiation Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Katherine Kelley
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Cristina Espinosa-Diez
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Clayton Hudson
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Christian Lanciault
- Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - V Liana Tsikitis
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Sudarshan Anand
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. .,Department of Radiation Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
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20
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Sada YH, Tran Cao HS, Chang GJ, Artinyan A, Musher BL, Smaglo BG, Massarweh NN. Prognostic value of neoadjuvant treatment response in locally advanced rectal cancer. J Surg Res 2018; 226:15-23. [PMID: 29661280 DOI: 10.1016/j.jss.2018.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/22/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND For locally advanced rectal cancer, response to neoadjuvant radiation has been associated with improved outcomes but has not been well characterized in general practice. The goals of this study were to describe disease response rates after neoadjuvant treatment and to evaluate the association between disease response and survival. MATERIALS AND METHODS Retrospective cohort study of patients aged 18-80 y with clinical stage II and III rectal adenocarcinoma in the National Cancer Database (2006-2012). All patients underwent radical resection after neoadjuvant treatment. Treatment responses were defined as follows: no tumor response; intermediate-T and/or N downstaging with residual disease; and complete-ypT0N0. Multivariable, multinomial regression was used to evaluate the association between neoadjuvant radiation use and disease response. Multivariable Cox regression was used to evaluate the association between disease response and overall risk of death. RESULTS Among 12,024 patients, 12% had a complete and 30% an intermediate response. Neoadjuvant chemotherapy alone was less likely to achieve an intermediate (relative risk ratio: 0.70 [0.56-0.88]) or a complete response (relative risk ratio: 0.59 [0.41-0.84]) relative to neoadjuvant radiation. Tumor response was associated with improved 5-y overall survival (complete = 90.2%, intermediate = 82.0%, no response = 70.5%; log-rank, P < 0.001). Complete and intermediate pathologic responses were associated with decreases in risk of death (hazard ratio: 0.40 [0.34-0.48] and 0.63 [0.57-0.69], respectively) compared to no response. Primary tumor and nodal response were independently associated with decreased risk of death. CONCLUSIONS Neoadjuvant radiation is associated with treatment response, and pathologic response is associated with improved survival. Pathologic response may be an early benchmark for the oncologic effectiveness of neoadjuvant treatment.
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Affiliation(s)
- Yvonne H Sada
- Houston VA Center for Innovations In Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas.
| | - Hop S Tran Cao
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - George J Chang
- Department of Surgical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Avo Artinyan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Brandon G Smaglo
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Nader N Massarweh
- Houston VA Center for Innovations In Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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21
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Perineural Invasion Predicts for Distant Metastasis in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation and Surgery. Am J Clin Oncol 2017; 40:561-568. [PMID: 26703815 DOI: 10.1097/coc.0000000000000214] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The benefit of adjuvant chemotherapy in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and surgery is controversial. We examined the association of perineural invasion (PNI) with outcomes to determine whether PNI could be used to risk-stratify patients. MATERIALS AND METHODS We performed a retrospective study of 110 patients treated with nCRT and surgery for LARC at our institution from 2004 to 2011. Eighty-seven patients were identified in our final analysis. We evaluated the association of PNI with locoregional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival, using log-rank and Cox proportional hazard modeling. RESULTS Fourteen patients (16%) were PNI+ and 73 patients (84%) were PNI-. The median follow-up was 27 months (range, 0.9 to 84 mo). The median DMFS was 13.5 months for PNI+ and median not reached (>40 mo) for PNI- (P<0.0001). The median DFS was 13.5 months for PNI+ and 39.8 months for PNI- (P<0.0001). In a multivariate model including 7 pathologic variables, type of surgery, time to surgery from end of nCRT, and use of adjuvant chemotherapy, PNI remained a significant independent predictor of DMFS (hazard ratio 9.79; 95% confidence interval, 3.48-27.53; P<0.0001) and DFS (hazard ratio 5.72; 95% confidence interval, 2.2-14.9; P=0.0001). CONCLUSIONS For patients with LARC treated with nCRT, PNI found at the time of surgery is significantly associated with worse DMFS and DFS. Our data support testing the role of adjuvant chemotherapy in patients with PNI and perhaps other high-risk features.
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22
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Prediction of N0 Irradiated Rectal Cancer Comparing MRI Before and After Preoperative Chemoradiotherapy. Dis Colon Rectum 2017; 60:1184-1191. [PMID: 28991083 DOI: 10.1097/dcr.0000000000000894] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The prediction of lymph node status using MRI has an impact on the management of rectal cancer, both before and after preoperative chemoradiotherapy. OBJECTIVE The purpose of this study was to maximize the negative predictive value and sensitivity of mesorectal lymph node imaging after chemoradiotherapy because postchemoradiation node-negative patients may be treated with rectum-sparing approaches. DESIGN This was a retrospective study. SETTINGS The study was conducted at a tertiary care hospital. PATIENTS Sixty-four patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy and MRI for staging and the assessment of response were evaluated. MAIN OUTCOME MEASURES The sums of the sizes of all mesorectal lymph nodes in each patient on both prechemoradiotherapy and postchemoradiotherapy imaging data sets were calculated to determine the lymph node global size reduction rates, taking these to be the outcomes of the histopathologic findings. Other included measures were interobserver agreement regarding the prediction of node status based on morphologic criteria and the diagnostic performance of contrast-enhanced images. RESULTS Using a cutoff value of a 70% lymph node global size reduction rate with only 15 node-positive patients on histopathology, the sensitivity in the prediction of nodal status and negative predictive value were 93% (95% CI, 70.2%-98.8%) and 97% (95% CI, 82.9%-99.8%) for observer 1 and 100% (95% CI, 79.6%-100%) and 100% (95% CI, 62.9%-100%) for observer 2. The areas under the receiver operating characteristic curves for the 2 observers were 0.90 (95% CI, 0.82-0.98; p < 0.0001) for observer 1 and 0.65 (95% CI, 0.50-0.79; p = 0.08) for observer 2. The efficacy of the morphologic criteria and contrast-enhanced images in predicting node status was limited after chemoradiotherapy. LIMITATIONS This study is limited by its small sample size and retrospective nature. CONCLUSIONS Assessing the lymph node global size reduction rate value reduces the risk of undetected nodal metastases and may be helpful in better identifying suitable candidates for the local excision of early stage rectal cancer. See Video Abstract at http://links.lww.com/DCR/A412.
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23
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McCoy MJ, Hemmings C, Anyaegbu CC, Austin SJ, Lee-Pullen TF, Miller TJ, Bulsara MK, Zeps N, Nowak AK, Lake RA, Platell CF. Tumour-infiltrating regulatory T cell density before neoadjuvant chemoradiotherapy for rectal cancer does not predict treatment response. Oncotarget 2017; 8:19803-19813. [PMID: 28177891 PMCID: PMC5386723 DOI: 10.18632/oncotarget.15048] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/07/2017] [Indexed: 12/21/2022] Open
Abstract
Neoadjuvant (preoperative) chemoradiotherapy (CRT) decreases the risk of rectal cancer recurrence and reduces tumour volume prior to surgery. However, response to CRT varies considerably between individuals and factors associated with response are poorly understood. Foxp3+ regulatory T cells (Tregs) inhibit anti-tumour immunity and may limit any response to chemotherapy and radiotherapy. We have previously reported that a low density of Tregs in the tumour stroma following neoadjuvant CRT for rectal cancer is associated with improved tumour regression. Here we have examined the association between Treg density in pre-treatment diagnostic biopsy specimens and treatment response, in this same patient cohort. We aimed to determine whether pre-treatment tumour-infiltrating Treg density predicts subsequent response to neoadjuvant CRT. Foxp3+, CD8+ and CD3+ cell densities in biopsy samples from 106 patients were assessed by standard immunohistochemistry (IHC) and evaluated for their association with tumour regression grade and survival. We found no association between the density of any T cell subset pre-treatment and clinical outcome, indicating that tumour-infiltrating Treg density does not predict response to neoadjuvant CRT in rectal cancer. Taken together with the findings of the previous study, these data suggest that in the context of neoadjuvant CRT for rectal cancer, the impact of chemotherapy and/or radiotherapy on anti-tumour immunity may be more important than the state of the pre-existing local immune response.
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Affiliation(s)
- Melanie J McCoy
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, 6009, Australia
| | - Chris Hemmings
- Department of Anatomic Pathology, St John of God Pathology, Wembley, WA, 6014, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
| | - Chidozie C Anyaegbu
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia
| | - Stephanie J Austin
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
| | - Tracey F Lee-Pullen
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
| | - Timothy J Miller
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, WA, 6959, Australia
| | - Nikolajs Zeps
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, 6009, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Richard A Lake
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, 6009, Australia
| | - Cameron F Platell
- Colorectal Research Unit, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia.,School of Surgery, University of Western Australia, Crawley, WA, 6009, Australia
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24
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Suzuki T, Sadahiro S, Tanaka A, Okada K, Saito G, Miyakita H, Akiba T, Yamamuro H. A Modified Classification of Prognostic Factors Based on Pathological Stage and Tumor Regression Grade in Patients with Rectal Cancer Who Receive Preoperative Chemoradiotherapy. Oncology 2017; 93:287-294. [PMID: 28728151 DOI: 10.1159/000478266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The histologic response to neoadjuvant chemoradiotherapy (CRT) has been intimately related to outcomes in locally advanced rectal cancer. However, reliable prognostic factors have yet to be established. SUBJECTS AND METHODS The study group comprised 198 patients with locally advanced rectal cancer who received CRT. A modified classification based on the combination of ypStage and tumor regression grade (TRG) was developed. ypStage II with TRG 2 was classified as ypTRGstage IIA, and ypStage II with TRG 3 or 4 was classified as ypTRGstage IIB. ypStage 0 and ypStage I were classified as ypTRGstage I, and ypStage III was classified as ypTRGstage III. RESULTS The 5-year disease-free survival (DFS) was 83% in ypTRGstage I, 86% in ypTRGstage IIA, 57% in ypTRGstage IIB, and 60% in ypTRGstage III (p = 0.0001). The 5-year DFS in ypTRGstage IIA did not differ significantly from that in ypStage 0 (p = 0.865) or ypStage I (p = 0.585). The 5-year DFS in ypStage IIB did not differ from that in ypStage III (p = 0.912). Multivariate analysis showed that ypTRGstage was an independent risk factor for DFS. CONCLUSION A modified classification allows patients with ypStage II locally advanced rectal cancer to be clearly divided into two groups: responders and nonresponders.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
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25
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Jermyn M, Mercier J, Aubertin K, Desroches J, Urmey K, Karamchandiani J, Marple E, Guiot MC, Leblond F, Petrecca K. Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy. Cancer Res 2017; 77:3942-3950. [PMID: 28659435 DOI: 10.1158/0008-5472.can-17-0668] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
Abstract
Effectiveness of surgery as a cancer treatment is reduced when all cancer cells are not detected during surgery, leading to recurrences that negatively impact survival. To maximize cancer cell detection during cancer surgery, we designed an in situ intraoperative, label-free, optical cancer detection system that combines intrinsic fluorescence spectroscopy, diffuse reflectance spectroscopy, and Raman spectroscopy. Using this multimodal optical cancer detection system, we found that brain, lung, colon, and skin cancers could be detected in situ during surgery with an accuracy, sensitivity, and specificity of 97%, 100%, and 93%, respectively. This highly sensitive optical molecular imaging approach can profoundly impact a wide range of surgical and noninvasive interventional oncology procedures by improving cancer detection capabilities, thereby reducing cancer burden and improving survival and quality of life. Cancer Res; 77(14); 3942-50. ©2017 AACR.
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Affiliation(s)
- Michael Jermyn
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Quebec, Canada
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jeanne Mercier
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Kelly Aubertin
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - Joannie Desroches
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Quebec, Canada
| | | | - Jason Karamchandiani
- Division of Neuropathology, Department of Pathology, McGill University, Montreal, Quebec, Canada
| | | | - Marie-Christine Guiot
- Division of Neuropathology, Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Frederic Leblond
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Quebec, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - Kevin Petrecca
- Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
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26
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Haddad P, Miraie M, Farhan F, Fazeli MS, Alikhassi A, Maddah-Safaei A, Aghili M, Kalaghchi B, Babaei M. Addition of oxaliplatin to neoadjuvant radiochemotherapy in MRI-defined T3, T4 or N+ rectal cancer: a randomized clinical trial. Asia Pac J Clin Oncol 2017; 13:416-422. [DOI: 10.1111/ajco.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/15/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Peiman Haddad
- Radiation Oncology Research Centre; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Monir Miraie
- Cancer Research Centre & Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Farshid Farhan
- Cancer Research Centre & Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Mohammad-Sadegh Fazeli
- Colorectal Surgery Department; Imam-Khomeini Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Afsaneh Alikhassi
- Radiology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Afsaneh Maddah-Safaei
- Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Mahdi Aghili
- Radiation Oncology Research Centre & Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Bita Kalaghchi
- Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Mohammad Babaei
- Radiation Oncology Department; Cancer Institute; Tehran University of Medical Sciences; Tehran Iran
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27
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Gunther JR, Chadha AS, Shin US, Park IJ, Kattepogu KV, Grant JD, Weksberg DC, Eng C, Kopetz SE, Das P, Delclos ME, Kaur H, Maru DM, Skibber JM, Rodriguez-Bigas MA, You YN, Krishnan S, Chang GJ. Preoperative radiation dose escalation for rectal cancer using a concomitant boost strategy improves tumor downstaging without increasing toxicity: A matched-pair analysis. Adv Radiat Oncol 2017; 2:455-464. [PMID: 29114614 PMCID: PMC5605486 DOI: 10.1016/j.adro.2017.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 12/22/2016] [Accepted: 04/04/2017] [Indexed: 02/08/2023] Open
Abstract
Purpose Pathologic complete response to neoadjuvant chemoradiation therapy (CRT) is associated with improved outcomes for patients with locally advanced rectal cancer (LARC). Increased response rates have been reported with higher radiation doses, but these studies often lack long-term outcome and/or toxicity data. We conducted a case-control analysis of patients with LARC who underwent definitive CRT to determine the efficacy and safety of intensified treatment with a concomitant boost (CB) approach. Methods and materials From 1995 to 2003, a phase 2 protocol examined CRT with 5-fluorouracil and CB radiation therapy (52.5 Gy in 5 weeks) for patients with LARC. Seventy-six protocol patients were matched (case-control approach) for surgery type, tumor (T) stage, and clinical nodal (N) stage with patients who received standard dose (SD) CRT (5-fluorouracil, 45 Gy). A chart review was performed. McNemar's test and Kaplan-Meier analyses were used for statistical analysis. Results The SD and CB groups did not differ in tumor circumferential involvement and length, but the tumors of CB patients were closer to the anal verge (4.7 vs 5.7 cm; P = .02). Although tumor downstaging was higher in the CB cohort (76% vs 51%; P < .01), pathologic complete response rates did not differ (CB, 17.1% vs SD, 15.8%, P = 1.00). The incidence of grade ≥3 radiation-related toxicities was low and similar in both groups (CB, 10% vs SD, 3%, P = .22). Postoperative (anastomotic leak, wound complications/abscess, bleeding) and late (small bowel obstruction, stricture) complication rates did not differ between the groups (P > .05). The median follow-up was 11.9 years. The 5-year local control rates were higher for CB (100.0%) compared with SD (90.0%) patients (P = .01). CB patients had higher rates of 10-year progression-free survival (71.9% vs 57.6%, P < .01) and overall survival (71.6% vs 62.4%, P = .01) compared with SD patients. Conclusions CRT dose escalation for patients with LARC is safe and effective. The improved T-downstaging and local control observed in CB patients should encourage further dose escalation studies.
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Affiliation(s)
- Jillian R Gunther
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Awalpreet S Chadha
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Ui Sup Shin
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - In Ja Park
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Kiran V Kattepogu
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jonathan D Grant
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - David C Weksberg
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Scott E Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Marc E Delclos
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Harmeet Kaur
- Department of Diagnostic Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Dipen M Maru
- Department of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - John M Skibber
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Miguel A Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - George J Chang
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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Geva R, Davidovics H, Soyfer S, Pelles-Avraham S, Klausner JM, Inbar M, Tulchinsky H. Does residual microscopic disease after chemoradiotherapy for locally advanced rectal cancer translate into a good clinical outcome? Colorectal Dis 2017; 19:237-242. [PMID: 27474791 DOI: 10.1111/codi.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/17/2016] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to assess the progression-free and overall survival of patients with residual microscopic disease following neoadjuvant chemoradiotherapy and rectal resection for locally advanced rectal cancer. METHOD Two-hundred and thirty-four consecutive rectal cancer patients who had neoadjuvant chemoradiotherapy followed by radical resection (from May 2000 to April 2012) were divided according to pathological tumour response: residual microscopic disease (MIC), complete response (pCR) and partial/no response (non-CR). Data on the neoadjuvant regime, treatment-to-surgery interval, final pathology, type of operation, operative time, postoperative complications, length of hospital stay, disease recurrence and mortality were compared between the groups. RESULTS There were 13 (5.5%) MIC patients, 48 (20.5%) with pCR and 173 (73.9%) with non-CR group. The groups were demographically comparable. MIC patients had more retrieved lymph nodes compared with the non-CR and pCR patients (median 13 compared with 8 and 10, respectively, P = 0.0086). The 5-year overall survival rates were 93.4% for the pCR and MIC patients vs 82.1% for the non-CR patients (P = 0.0324). The 5-year progression-free survival was 85.2% for the pCR and MIC patients vs 73.8% for the non-CR patients (P = 0.086). CONCLUSION We have identified and assessed a new pathological subgroup of rectal cancer patients who had residual microscopic disease after neoadjuvant therapy. The survival analysis aligned them closely with pCR patients.
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Affiliation(s)
- R Geva
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - H Davidovics
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - S Soyfer
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - S Pelles-Avraham
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - J M Klausner
- Division of Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Inbar
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - H Tulchinsky
- Division of Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kanehira M, Futagawa Y, Furukawa K, Shiba H, Uwagawa T, Yanaga K. Radical resection of a primary unresectable duodenal cancer after chemotherapy using S-1 and cisplatin: report of a case. Surg Case Rep 2017; 3:34. [PMID: 28224561 PMCID: PMC5319935 DOI: 10.1186/s40792-017-0304-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/06/2017] [Indexed: 11/12/2022] Open
Abstract
Background Therapeutic outcomes and prognosis of primary unresectable duodenal cancer remains unsatisfactory, because effective chemotherapy is not established. Case presentation A 71-year-old male diagnosed with unresectable duodenal carcinoma with distant lymph node metastases was judged inoperable (cT3N2M1 cStage in UICC7th). Duodenal obstruction developed due to tumor growth, and the patient underwent laparoscopic gastro-jejunostomy and then combined chemotherapy using S-1 and cisplatin. Abdominal CT revealed reduction of the tumor, and lymph node swelling almost disappeared after chemotherapy. He underwent subtotal stomach-preserving pancreaticoduodenectomy and lymph node dissection including the para-aortic region. The final stage was fT3N1M0, StageIIIA in UICC7th. He developed pancreatic fistula (ISGPF grade B), which subsided, and he was discharged 29 days after operation. He underwent adjuvant chemotherapy using S-1 for 1 year, and he remains well without recurrence. Conclusions S-1/cisplatin combination chemotherapy allowed R0 resection for advanced duodenal cancer.
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Affiliation(s)
- Masaru Kanehira
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yasuro Futagawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tadashi Uwagawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Müllerian Origin Treated With Neoadjuvant Chemotherapy. Int J Gynecol Cancer 2016; 25:823-9. [PMID: 25828750 DOI: 10.1097/igc.0000000000000434] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the role of CA-125 percent reduction after neoadjuvant chemotherapy in predicting the extent of the interval debulking surgery (IDS) and outcomes in patients with advanced-stage müllerian carcinoma. METHODS Patients who received neoadjuvant chemotherapy for advanced-stage müllerian carcinoma from 2000 to 2013 were identified. Percent reduction in CA-125 was categorized into 2 groups: ≥ 90% (CA ≥ 90%) and <90% (CA < 90%) reduction from prechemotherapy to preoperative CA-125. RESULTS Of the 115 patients identified, 73% had CA ≥ 90% and 27% had CA < 90%. Optimal and complete IDS were achieved in 87% and 38%, respectively. Compared with the CA < 90% group, the CA ≥ 90% group was more likely to have complete IDS (P = 0.035), less likely to have a bowel resection (P < 0.001), and more likely to have no viable tumor/microscopic disease with treatment effect (P < 0.001). No difference in overall survival (OS; P = 0.81) and progression-free survival (PFS; P = 0.60) was noted between the groups. In multivariable analysis, CA ≥ 90% was not a predictor of PFS (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.65-1.79; P = 0.77) or OS (HR, 1.45; 95% CI, 0.73-2.9; P = 0.29). Patients with preoperative CA-125 < 20 had significantly longer OS (P = 0.05) and PFS (P = 0.005) than did those with preoperative CA-125 ≥ 20. In multivariable analysis, preoperative CA-125 < 20 was a predictor of PFS (HR, 0.37; 95% CI, 0.20-0.66; P < 0.001) but not OS (HR, 0.64; 95% CI, 0.34-1.21; P = 0.17). CONCLUSIONS A reduction in CA-125 of at least 90% is associated with complete IDS, favorable pathologic response, and fewer bowel resections. A preoperative CA-125 < 20 suggests improved outcome. These findings are helpful for treatment planning and patient counseling.
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31
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McCoy MJ, Hemmings C, Miller TJ, Austin SJ, Bulsara MK, Zeps N, Nowak AK, Lake RA, Platell CF. Low stromal Foxp3+ regulatory T-cell density is associated with complete response to neoadjuvant chemoradiotherapy in rectal cancer. Br J Cancer 2015; 113:1677-86. [PMID: 26645238 PMCID: PMC4702002 DOI: 10.1038/bjc.2015.427] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/05/2015] [Accepted: 11/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Foxp3+ regulatory T cells (Tregs) play a vital role in preventing autoimmunity, but also suppress antitumour immune responses. Tumour infiltration by Tregs has strong prognostic significance in colorectal cancer, and accumulating evidence suggests that chemotherapy and radiotherapy efficacy has an immune-mediated component. Whether Tregs play an inhibitory role in chemoradiotherapy (CRT) response in rectal cancer remains unknown. METHODS Foxp3+, CD3+, CD4+, CD8+ and IL-17+ cell density in post-CRT surgical samples from 128 patients with rectal cancer was assessed by immunohistochemistry. The relationship between T-cell subset densities and clinical outcome (tumour regression and survival) was evaluated. RESULTS Stromal Foxp3+ cell density was strongly associated with tumour regression grade (P=0.0006). A low stromal Foxp3+ cell density was observed in 84% of patients who had a pathologic complete response (pCR) compared with 41% of patients who did not (OR: 7.56, P=0.0005; OR: 5.27, P=0.006 after adjustment for presurgery clinical factors). Low stromal Foxp3+ cell density was also associated with improved recurrence-free survival (HR: 0.46, P=0.03), although not independent of tumour regression grade. CONCLUSIONS Regulatory T cells in the tumour microenvironment may inhibit response to neoadjuvant CRT and may represent a therapeutic target in rectal cancer.
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Affiliation(s)
- M J McCoy
- St John of God Subiaco Hospital, PO Box 14, Subiaco, WA 6904, Australia.,School of Medicine and Pharmacology, University of Western Australia, M503, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - C Hemmings
- St John of God Pathology, PO Box 646, Wembley, WA 6913, Australia.,School of Surgery, University of Western Australia, M507, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - T J Miller
- St John of God Subiaco Hospital, PO Box 14, Subiaco, WA 6904, Australia.,School of Surgery, University of Western Australia, M507, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - S J Austin
- St John of God Subiaco Hospital, PO Box 14, Subiaco, WA 6904, Australia
| | - M K Bulsara
- Institute for Health Research, University of Notre Dame, PO Box 1225, Fremantle, WA 6959, Australia
| | - N Zeps
- St John of God Subiaco Hospital, PO Box 14, Subiaco, WA 6904, Australia.,School of Surgery, University of Western Australia, M507, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - A K Nowak
- School of Medicine and Pharmacology, University of Western Australia, M503, 35 Stirling Highway, Crawley, WA 6009, Australia.,Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - R A Lake
- School of Medicine and Pharmacology, University of Western Australia, M503, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - C F Platell
- St John of God Subiaco Hospital, PO Box 14, Subiaco, WA 6904, Australia.,School of Surgery, University of Western Australia, M507, 35 Stirling Highway, Crawley, WA 6009, Australia
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McCoy MJ, Hemmings C, Hillery S, Penter C, Bulsara MK, Zeps N, Platell CF. Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression? ANZ J Surg 2015; 87:E233-E239. [DOI: 10.1111/ans.13394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Melanie J. McCoy
- Colorectal Cancer Research Group; St John of God Subiaco Hospital; Perth Western Australia Australia
- School of Medicine and Pharmacology; The University of Western Australia; Perth Western Australia Australia
| | - Chris Hemmings
- Division of Anatomic Pathology; St John of God Pathology; Perth Western Australia Australia
- School of Surgery; The University of Western Australia; Perth Western Australia Australia
| | - Simon Hillery
- Division of Anatomic Pathology; St John of God Pathology; Perth Western Australia Australia
| | - Cheryl Penter
- Colorectal Cancer Research Group; St John of God Subiaco Hospital; Perth Western Australia Australia
| | - Max K. Bulsara
- Institute for Health Research; University of Notre Dame Australia; Fremantle Western Australia Australia
| | - Nik Zeps
- Colorectal Cancer Research Group; St John of God Subiaco Hospital; Perth Western Australia Australia
- School of Surgery; The University of Western Australia; Perth Western Australia Australia
| | - Cameron F. Platell
- Colorectal Cancer Research Group; St John of God Subiaco Hospital; Perth Western Australia Australia
- School of Surgery; The University of Western Australia; Perth Western Australia Australia
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Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy. Clin Transl Oncol 2015; 18:714-21. [PMID: 26474872 DOI: 10.1007/s12094-015-1422-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/26/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Pathological findings remain the most significant prognostic factor. The presence of mucin pools and their prognostic significance is a controversial issue. The aim of this study was to analyze the incidence of cellular and acellular mucin pools and their clinical significance. METHODS Four-hundred and forty-six consecutive prospectively collected specimens from patients with LARC treated with long-course preoperative CRT and surgery were analyzed. Kaplan-Meier analysis was performed. RESULTS Mucin pools were present in 182 specimens (40.8 %); 66 (14.7 %) were acellular, and viable tumor cells were identified in 116 (26 %). The complete pathological response rate was 13.5 % (60 of 446). With a median follow-up of 79.0 months, the 5- and 10-year disease-free survivals for patients with acellular and cellular mucin pools were 81.5, 78.1, 63.7 and 61.2 %, respectively (p ≤ 0.026). The presence of cells in the colloid response to treatment was associated with a 17.8 and 16.9 % decrease in 5- and 10-year disease survival vs. acellular colloid response. CONCLUSIONS Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.
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34
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George TJ, Allegra CJ, Yothers G. Neoadjuvant Rectal (NAR) Score: a New Surrogate Endpoint in Rectal Cancer Clinical Trials. CURRENT COLORECTAL CANCER REPORTS 2015; 11:275-280. [PMID: 26321890 PMCID: PMC4550644 DOI: 10.1007/s11888-015-0285-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The conduct of clinical trials in colorectal cancer has historically relied upon endpoints such as disease-free (DFS) or overall survival (OS). While ideal, these endpoints require long-term follow-up, thus contributing to a slow pace of scientific progress in clinical research. Identification of short-term endpoints to serve as surrogates for DFS and OS would enable more rapid determination of success or failure of an experimental intervention and thus facilitate more scientific discovery and progress leading to clinical practice improvements. In rectal cancer clinical trials, there have been few validated alternatives to DFS and OS, including pathologic complete response (ypCR). The neoadjuvant rectal (NAR) score was developed as a composite short-term endpoint for clinical trials involving neoadjuvant therapy for rectal cancer. The NAR score is based upon variables routinely collected and available to clinical investigators during the conduct of prospective studies. Based upon two independent validation datasets, the NAR score predicts OS in rectal cancer clinical trials better than ypCR. While final dataset validation is ongoing, the NAR score offers an opportunity to incorporate a novel surrogate endpoint into early phase rectal cancer clinical trials.
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Affiliation(s)
- Thomas J. George
- />University of Florida Health Cancer Center, Gainesville, 1600 SW Archer Rd, PO Box 100278, Gainesville, FL 32610 USA
- />NRG Oncology, Four Penn Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 19103 USA
| | - Carmen J. Allegra
- />University of Florida Health Cancer Center, Gainesville, 1600 SW Archer Rd, PO Box 100278, Gainesville, FL 32610 USA
- />NRG Oncology, Four Penn Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 19103 USA
| | - Greg Yothers
- />University of Pittsburgh, One Sterling Plaza, 201 N Craig St, Ste 350, Pittsburgh, PA 15213 USA
- />NRG Oncology, Four Penn Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 19103 USA
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35
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Bergsland EK. Is more not better?: combination therapies in colorectal cancer treatment. Hematol Oncol Clin North Am 2015; 29:85-116. [PMID: 25475574 DOI: 10.1016/j.hoc.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The treatment of colorectal cancer has evolved dramatically in recent years with the availability of new chemotherapeutic agents and inhibitors of the vascular endothelial growth factor- and epidermal growth factor-signaling pathways. The incremental benefit of each individual line of therapy for advanced disease is relatively small. Advances in our ability to select patients should improve the cost-effectiveness of our treatment strategies (avoiding unnecessary toxicity in the patients who are unlikely to benefit and accepting the potential for adverse events in the patients who stand to benefit the most from a given regimen).
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Affiliation(s)
- Emily K Bergsland
- Department of Medicine, Division of Hematology and Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, A727, San Francisco, CA 94115, USA.
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Beppu N, Matsubara N, Noda M, Yamano T, Kakuno A, Doi H, Kamikonya N, Yamanaka N, Yanagi H, Tomita N. Pathologic evaluation of the response of mesorectal positive nodes to preoperative chemoradiotherapy in patients with rectal cancer. Surgery 2015; 157:743-51. [DOI: 10.1016/j.surg.2014.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/20/2014] [Accepted: 10/01/2014] [Indexed: 02/08/2023]
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37
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Burbach JPM, Verkooijen HM, Intven M, Kleijnen JPJE, Bosman ME, Raaymakers BW, van Grevenstein WMU, Koopman M, Seravalli E, van Asselen B, Reerink O. RandomizEd controlled trial for pre-operAtive dose-escaLation BOOST in locally advanced rectal cancer (RECTAL BOOST study): study protocol for a randomized controlled trial. Trials 2015; 16:58. [PMID: 25888548 PMCID: PMC4344756 DOI: 10.1186/s13063-015-0586-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/30/2015] [Indexed: 01/28/2023] Open
Abstract
Background Treatment for locally advanced rectal cancer (LARC) consists of chemoradiation therapy (CRT) and surgery. Approximately 15% of patients show a pathological complete response (pCR). Increased pCR-rates can be achieved through dose escalation, thereby increasing the number patients eligible for organ-preservation to improve quality of life (QoL). A randomized comparison of 65 versus 50Gy with external-beam radiation alone has not yet been performed. This trial investigates pCR rate, clinical response, toxicity, QoL and (disease-free) survival in LARC patients treated with 65Gy (boost + chemoradiation) compared with 50Gy standard chemoradiation (sCRT). Methods/design This study follows the ‘cohort multiple randomized controlled trial’ (cmRCT) design: rectal cancer patients are included in a prospective cohort that registers clinical baseline, follow-up, survival and QoL data. At enrollment, patients are asked consent to offer them experimental interventions in the future. Eligible patients—histologically confirmed LARC (T3NxM0 <1 mm from mesorectal fascia, T4NxM0 or TxN2M0) located ≤10 cm from the anorectal transition who provided consent for experimental intervention offers—form a subcohort (n = 120). From this subcohort, a random sample is offered the boost prior to sCRT (n = 60), which they may accept or refuse. Informed consent is signed only after acceptance of the boost. Non-selected patients in the subcohort (n = 60) undergo sCRT alone and are not notified that they participate in the control arm until the trial is completed. sCRT consists of 50Gy (25 × 2Gy) with concomitant capecitabine. The boost (without chemotherapy) is given prior to sCRT and consists of 15 Gy (5 × 3Gy) delivered to the gross tumor volume (GTV). The primary endpoint is pCR (TRG 1). Secondary endpoints include acute grade 3–4 toxicity, good pathologic response (TRG 1-2), clinical response, surgical complications, QoL and (disease-free) survival. Data is analyzed by intention to treat. Discussion The boost is delivered prior to sCRT so that GTV adjustment for tumor shrinkage during sCRT is not necessary. Small margins also aim to limit irradiation of healthy tissue. The cmRCT design provides opportunity to overcome common shortcomings of classic RCTs, such as slow recruitment, disappointment-bias in control arm patients and poor generalizability. Trial registration The Netherlands Trials Register NL46051.041.13. Registered 22 August 2013. ClinicalTrials.gov NCT01951521. Registered 18 September 2013.
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Affiliation(s)
- J P Maarten Burbach
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Helena M Verkooijen
- Trial Bureau Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Martijn Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Jean-Paul J E Kleijnen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Mirjam E Bosman
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Bas W Raaymakers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Bram van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Onne Reerink
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
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Beppu N, Matsubara N, Noda M, Yamano T, Doi H, Kamikonya N, Yamanaka N, Yanagi H, Tomita N. The timing of surgery after preoperative short-course S-1 chemoradiotherapy with delayed surgery for T3 lower rectal cancer. Int J Colorectal Dis 2014; 29:1459-66. [PMID: 25164441 DOI: 10.1007/s00384-014-1997-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to analyze the influence of variations in clinical practice regarding the timing of surgery with short-course chemoradiotherapy with delayed surgery (SCRT-delay) for lower rectal cancer. METHODS A total of 171 patients with T3 N0-2 lower rectal cancer treated with SCRT-delay (25 Gy/10 fractions/5 days (S-1); days 1-10) were retrospectively evaluated. The median waiting period of 30 days was used as a discriminator (group A: waiting period, ≤30 days; group B: waiting period, ≥31 days). Preoperative treatment responses and oncological outcomes were analyzed. RESULTS The mean waiting periods for groups A and B were 24.4 ± 5.3 and 41.4 ± 12.3 days, respectively. There were no statistically significant differences between the two groups in any of the clinical variables. The clinicopathological outcomes were as follows: T downstaging (43.5 vs 37.2 %; p = 0.400), negative yp N (67.1 vs 75.6 %; p = 0.218), pCR (7.1 vs 1.2 %; p = 0.119). The 5-year local recurrence-free survival (89.3 vs 87.6 %; p = 0.956), the recurrence-free survival (82.2 vs 78.8 %; p = 0.662), and the overall survival (88.5 vs 84.4 %; p = 0.741), all of which were similar between the two groups. CONCLUSIONS The longer waiting period did not increase the tumor downstaging and not improve the oncological outcomes for T3 lower rectal cancer treated with SCRT-delay. In addition, considering that the impaired leukocyte response occurred during the sub-acute period, any time after the sub-acute period (day 12) up to 30 days after radiotherapy would be a suitable waiting period.
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Affiliation(s)
- Naohito Beppu
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan,
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Burbach JPM, den Harder AM, Intven M, van Vulpen M, Verkooijen HM, Reerink O. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol 2014; 113:1-9. [PMID: 25281582 DOI: 10.1016/j.radonc.2014.08.035] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/25/2014] [Accepted: 08/31/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE We conducted a systematic review and meta-analysis to quantify the pathological complete response (pCR) rate after preoperative (chemo)radiation with doses of ⩾60Gy in patients with locally advanced rectal cancer. Complete response is relevant since this could select a proportion of patients for which organ-preserving strategies might be possible. Furthermore, we investigated correlations between EQD2 dose and pCR-rate, toxicity or resectability, and additionally between pCR-rate and chemotherapy, boost-approach or surgical-interval. METHODS AND MATERIALS PubMed, EMBASE and Cochrane libraries were searched with the terms 'radiotherapy', 'boost' and 'rectal cancer' and synonym terms. Studies delivering a preoperative dose of ⩾60 Gy were eligible for inclusion. Original English full texts that allowed intention-to-treat pCR-rate calculation were included. Study variables, including pCR, acute grade ⩾3 toxicity and resectability-rate, were extracted by two authors independently. Eligibility for meta-analysis was assessed by critical appraisal. Heterogeneity and pooled estimates were calculated for all three outcomes. Pearson correlation coefficients were calculated between the variables mentioned earlier. RESULTS The search identified 3377 original articles, of which 18 met our inclusion criteria (1106 patients). Fourteen studies were included for meta-analysis (487 patients treated with ⩾60 Gy). pCR-rate ranged between 0.0% and 44.4%. Toxicity ranged between 1.3% and 43.8% and resectability-rate between 34.0% and 100%. Pooled pCR-rate was 20.4% (95% CI 16.8-24.5%), with low heterogeneity (I2 0.0%, 95% CI 0.00-84.0%). Pooled acute grade ⩾3 toxicity was 10.3% (95% CI 5.4-18.6%) and pooled resectability-rate was 89.5% (95% CI 78.2-95.3%). CONCLUSION Dose escalation above 60 Gy for locally advanced rectal cancer results in high pCR-rates and acceptable early toxicity. This observation needs to be further investigated within larger randomized controlled phase 3 trials in the future.
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Affiliation(s)
| | | | - Martijn Intven
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | | | - Onne Reerink
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
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Response to Subsequent Docetaxel in a Patient Cohort With Metastatic Castration-Resistant Prostate Cancer After Abiraterone Acetate Treatment. Clin Genitourin Cancer 2014; 12:e167-72. [DOI: 10.1016/j.clgc.2014.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/21/2022]
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Is there a role for adjuvant chemotherapy in pathological complete response rectal cancer tumors following neoadjuvant chemoradiotherapy? J Cancer Res Clin Oncol 2014; 140:1489-94. [PMID: 24849731 DOI: 10.1007/s00432-014-1712-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/12/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the contribution of neoadjuvant chemotherapy in rectal cancer patients with pathological complete response (pCR). METHODS Data were collected on all consecutive locally advanced rectal cancer patients treated with neoadjuvant chemotherapy and later resected in our institution between 2001 and 2013. Surgery was performed by a single proctology team, and tumor specimens were evaluated by the hospital pathologists. RESULTS The medical records of 260 patients were analyzed, and 54 patients of those patients were found to have achieved pCR (20.8 %). Two of those patients were lost to follow-up. Thirty-five of the 54 pCR patients received adjuvant chemotherapy (Group A) and 17 did not (Group B). With the sole exception of the Group A patients being younger than the Group B patients (60.9 ± 11.9 vs. 68.7 ± 10.8 years, respectively, p = 0.0272), all other evaluated parameters were identical between the two groups. There was no advantage for the administration of adjuvant chemotherapy for disease-free survival (DFS) and overall survival (OS). CONCLUSIONS Adjuvant chemotherapy played no part in disease-free survival and OS of patients with rectal cancer who had been treated with neoadjuvant chemotherapy and achieved pCR. Our findings indicate a tendency for adjuvant chemotherapy to be administered to younger rectal cancer patients. A randomized trial should be conducted to resolve the question of whether they derive any benefit from it.
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You KY, Gao YH. Can quantified pathologic response assessed as residual tumor burden be a promising staging system for patients with rectal cancer treated with chemoradiation followed by surgery? Cancer 2014; 120:1281-2. [PMID: 24474633 DOI: 10.1002/cncr.28560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kai Yun You
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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