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Doi H, Yokoyama H, Beppu N, Fujiwara M, Harui S, Kakuno A, Yanagi H, Hishikawa Y, Yamanaka N, Kamikonya N. Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer. Cancers (Basel) 2021; 13:cancers13164112. [PMID: 34439265 PMCID: PMC8394890 DOI: 10.3390/cancers13164112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Both short- and long-course neoadjuvant radiotherapy (NA-RT) followed by surgery have been adopted as standard treatments for locally advanced rectal cancer (LARC). We hypothesized that a modified short-course radiotherapy (mSC-RT) using an accelerated hyperfractionated regimen, with a dose of 2.5 Gy twice daily up to a total dose of 25 Gy in 10 fractions, can provide a favorable therapeutic ratio in comparison with the conventional regimens. Ninety-seven consecutive LARC patients undergoing mSC-RT followed by delayed surgery were analyzed in this retrospective study. Additionally, potential prognostic factors for overall survival (OS) were also assessed. The results showed that mSC-RT followed by delayed surgery achieved equivalent anti-tumor efficacy and acute toxicity that were comparable with long- and short-course NA-RT, respectively. A neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 was independently associated with poor OS in LARC patients receiving mSC-RT. Thus, mSC-RT can be a promising alternative to both standard long- and short-course NA-RT regimens. Abstract This study aimed to assess the clinical outcomes and predictive factors of neoadjuvant modified short-course radiotherapy (mSC-RT) for locally advanced rectal cancer (LARC). Data from 97 patients undergoing mSC-RT followed by radical surgery for LARC were retrospectively analyzed. A 2.5 Gy dose twice daily up to a total dose of 25 Gy in 10 fractions was administered through mSC-RT, and this was delivered with oral chemotherapy in 95 (97.9%) patients. Radical surgery was performed 6 (range, 3–13) weeks after mSC-RT. The median follow-up among surviving patients was 43 (8–86) months. All patients completed neoadjuvant radiotherapy with no acute toxicity grade ≥ 3. Three- and five-year local control rates were 96.3% and 96.3%, respectively. Three- and five-year overall survival (OS) rates were 92.7% and 79.8%, respectively. Univariate analyses revealed that poor OS was associated with no concurrent administration of capecitabine, C-reactive-protein-to-albumin ratio ≥ 0.053, carcinoembryonic antigen ≥ 3.4 ng/mL, and neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 (P = 0.045, 0.001, 0.041, and 0.001, respectively). Multivariate analyses indicated that NLR ≥ 1.83 was independently associated with poor OS (p = 0.018). mSC-RT followed by delayed surgery for LARC was deemed feasible and resulted in good clinical outcomes, whereas poor OS was associated with high NLR.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
- Correspondence: ; Tel.: +81-72-366-0221; Fax: +81-72-368-2388
| | - Hiroyuki Yokoyama
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Hyogo, Nishinomiya 663-8501, Japan
| | - Naohito Beppu
- Department of Surgery, Meiwa Hospital, 4-31 Agenaruo, Hyogo, Nishinomiya 663-8186, Japan; (N.B.); (H.Y.); (N.Y.)
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Hyogo, Nishinomiya 663-8501, Japan
| | - Masayuki Fujiwara
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Hyogo, Nishinomiya 663-8501, Japan
| | - Shogo Harui
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
| | - Ayako Kakuno
- Department of Pathology, Meiwa Hospital, 4-31 Agenaruo, Hyogo, Nishinomiya 663-8186, Japan;
| | - Hidenori Yanagi
- Department of Surgery, Meiwa Hospital, 4-31 Agenaruo, Hyogo, Nishinomiya 663-8186, Japan; (N.B.); (H.Y.); (N.Y.)
| | - Yoshio Hishikawa
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
| | - Naoki Yamanaka
- Department of Surgery, Meiwa Hospital, 4-31 Agenaruo, Hyogo, Nishinomiya 663-8186, Japan; (N.B.); (H.Y.); (N.Y.)
| | - Norihiko Kamikonya
- Department of Radiation Oncology, Meiwa Cancer Clinic, 3-39 Agenaruocho, Hyogo, Nishinomiya 663-8186, Japan; (H.Y.); (M.F.); (S.H.); (Y.H.); (N.K.)
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Hyogo, Nishinomiya 663-8501, Japan
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Wilson K, Flood M, Narasimhan V, Pham T, Warrier S, Ramsay R, Michael M, Heriot A. Complete pathological response in rectal cancer utilising novel treatment strategies for neo-adjuvant therapy: A systematic review. Eur J Surg Oncol 2021; 47:1862-1874. [PMID: 33814240 DOI: 10.1016/j.ejso.2021.03.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Locally advanced rectal cancer is routinely treated with neo-adjuvant long course chemoradiotherapy or short course radiotherapy, followed by total mesorectal excision. Not all patients respond to this treatment and there has been an emergence of novel treatment strategies designed to improve outcomes for these patients. This systematic review aims to assess the current novel neo-adjuvant treatment strategies being utilised in the treatment of patients with rectal cancer and how these impact pathological complete response (pCR) rates. METHODS A systematic review of the literature was performed to evaluate pathological response in patients with rectal cancer receiving novel neo-adjuvant therapy. EMBASE and Medline electronic databases were searched for relevant articles. Articles published between January 2008 and February 2019 were retrieved. Included studies underwent critical appraisal and complete pathological response rates were recorded. RESULTS Of the initial 1074 articles identified, 217 articles fulfilled the inclusion criteria, of these 60 articles (4359 patients) were included. Neo-adjuvant therapy delivered included novel long course chemoradiation therapy, neoadjuvant chemotherapy alone, addition of a biological agent, total neo-adjuvant therapy, novel short course radiation therapy and studies utilising biomarkers to select patients for therapy. Complete pathological response rates ranged from 0 to 60%. CONCLUSION A validated novel neo-adjuvant therapy that significantly increases pCR rates in patients with rectal cancer has not been identified.
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Affiliation(s)
- K Wilson
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia.
| | - M Flood
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - V Narasimhan
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - T Pham
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - S Warrier
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia
| | - R Ramsay
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Differentiation and Transcription Laboratory, Sir Peter MacCallum Cancer Centre, Australia
| | - M Michael
- Peter MacCallum Cancer Centre, Department of Medical Oncology, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
| | - A Heriot
- Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia; Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia
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