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LA Franca A, Muttillo EM, Madaffari I, Massimi F, Longo G, Ceccacci A, Angelicone I, DE Giacomo F, Sperduti I, Balducci G, Osti MF, Mercantini P. Lymph Node Metastasis in Extraperitoneal Rectal Cancer After Neoadjuvant Therapy: An Unsolved Problem? Anticancer Res 2023; 43:2813-2820. [PMID: 37247907 DOI: 10.21873/anticanres.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM Thanks to the promising benefits obtained in terms of quality of life, there has been growing interest in organ-sparing approaches after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer, mainly represented by transanal local excision and watch-and-wait. The main mandatory criterion is complete lymph nodal response (pN0). However, considering the reduced specificity of current radiological means in identifying one-to-one correspondence between clinical and pathological staging, the problem of underestimating lymph nodal involvement remains unsolved. The aim of this study was to identify the true percentage of patients eligible for conservative surgery and possible predictive factors. PATIENTS AND METHODS Data for 59 patients with rectal cancer treated with nCRT followed by total mesorectal excision were analyzed. Patients with metastatic tumors and tumors treated with up-front surgery were excluded. Our primary endpoint was the pathological lymph nodal response rate after neoadjuvant chemoradiotherapy. The secondary endpoint was to identify predictive factors for lymph nodal response. RESULTS The percentage of patients with pN0 was 62.71%, while in 37.28%, an organ-sparing approach would have not been oncologically correct. Parameters associated with pN0 were lower tumor size (T0-T2) (p=0.013) and lower grading (<G3) (p=0.06). Parameters associated with poorer disease-free survival were pN+ (p=0.019), higher lymph node ratio (p=0.001), and higher stage (p=0.038). CONCLUSION Organ-sparing approaches may be a promising option in patients with extraperitoneal rectal cancerthat respond to nCRT. Nevertheless, it is essential to consider the limit of lymph node metastases to ensure oncological safety and, especially in cases with advanced tumors, total mesorectal excision should be the approach of choice.
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Affiliation(s)
- Alice LA Franca
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Edoardo Maria Muttillo
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy;
| | - Isabella Madaffari
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Fanny Massimi
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Longo
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alice Ceccacci
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Ilaria Angelicone
- Radiotherapy Oncology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Flavia DE Giacomo
- Radiotherapy Oncology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit - Clinical Trials Center, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Genoveffa Balducci
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Mercantini
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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DE Sanctis V, DI Rocco A, Cox MC, Valeriani M, Congedi FP, Anzellini D, Massaro M, Vullo G, Facondo G, DE Giacomo F, Alfò M, Prosperi D, Pizzichini P, Pelliccia S, Tafuri A, Martelli M, Osti MF. Residual Site Radiotherapy After Immunochemotherapy in Primary Mediastinal B-Cell Lymphoma: A Monoinstitutional Retrospective Study. In Vivo 2021; 34:1407-1413. [PMID: 32354938 DOI: 10.21873/invivo.11921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
AIM To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progression-free (PFS) and overall (OS) survival in patients with primary mediastinal lymphoma (PMBCL), following rituximab and chemotherapy treatment (ICHT). PATIENTS AND METHODS The study included 34 patients with PMBCL treated between 2006 and 2014 with ICHT with/without autologous stem cell transplantation and RSRT. Between the end of ICHT/stem cell transplantation and RSRT, patients were evaluated with 18F-fluorodeoxyglucose positron-emission tomography. The gross tumor volume included morphological mediastinal residual disease after ICHT/SCT. The percentage of LC, PFS and OS were assessed. RESULTS All patients received RSRT with a median dose of 30 Gy. Median follow-up was 82 months. One patient out of 34 (3%) showed progressive disease 9 months from diagnosis. The 10-year PFS and OS were 97% and 97% respectively. CONCLUSION RSRT in patients with PMBCL treated with ICHT did not impact unfavorably on LC and patient survival.
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Affiliation(s)
- Vitaliana DE Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Alice DI Rocco
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Maria Christina Cox
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Francesca Perrone Congedi
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Flavia DE Giacomo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Prosperi
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pizzichini
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabrina Pelliccia
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Agostino Tafuri
- Hematology Institute, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.,Department of Clinic and Molecular Medicine and Hematology, Sapienza, University of Rome and S. Andrea University Hospital of Rome, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Hematology Institute, Sapienza University of Rome, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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