Predictive factors of histological response after preoperative concomitant radiochemotherapy in middle and low rectal cancer

Asmae Ouabdelmoumen, ali sbai, FOUAD ELMEJJATTI, ZOUHOUR BOUGHALEB, NAIMA ABDA, LOUBNA MEZOUAR

Abstract


Objective: The aim of our study was to identify potential predictive factors beyond pathologic response after neoadjuvant radiochemotherapy.

Patients and Methods: Between January 2009 and December 2014, 40 patients with rectal carcinoma were included in the study. The treatment consisted of radiation ranging between 39 and 50.4 Gy associated with a concomitant chemotherapy with capecitabine. The correlation between histological response (complete response and downstaging) and potential predictive factors was investigated.

Results: Complete response was 15% (06 patients), tumor regression of 32.5% (13 patients), and the absence of tumor response of 52.5% (21 patients). In univariate analysis, the circumferential extension of the tumor was significantly associated with tumor downstaging (p = 0.007) and complete tumor response (p = 0.001). However, the delay between the RCT and the surgery was a significant predictor for downstaging (p = 0.02).
Conclusion: the parietal circumferential extension was a potential predictor of pathologic complete response (pCR) and downstaging after neoadjuvant chemoradiation. The time between the radiochemotherapy and the surgery was a significant predictor for downstaging. Delaying surgery beyond 8 weeks seems to result in the highest probability of pCR.

Keywords: Rectal cancer, adenocarcinoma, neoadjuvant radiochemotherapy, histologic response, predictive factors

Full Text:

PDF (FULL TEXT)

References


Herszényi L and Tulassay Z. Epidemiology of gastroin¬testinal and liver tumors. Eur Rev Med Pharmacol Sci. 2010; 14 (4), pp. 249-58.

https://www.ncbi.nlm.nih.gov/pubmed/20496531

Heald RJ, Huband EM and Ryall RD. The Mesorectum in Rectal Cancer Surgery. The clue to pelvic recurrence?. Br. J. Surg. 1982; 69 (10), pp. 613-6

https://www.ncbi.nlm.nih.gov/pubmed/?term=The+Mesorectum+in+Rectal+Cancer+Surgery.+The+clue+to+pelvic+recurrence%3F

Cohen AM and Minsky BD. A phase I trial of preoperative radiation, proctectomy, and endoanal reconstruction. Arch Surg 1990; 125 (2), pp. 247–51

https://www.ncbi.nlm.nih.gov/pubmed/?term=A+phase+I+trial+of+preoperative+radiation%2C+proctectomy%2C+and+endoanal+reconstruction.+Arch+Surg+1990

Mohiuddin M, Regine WF, Marks GJ and Marks JW. High-dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum. Int J Radiat Oncol Biol Phys. 1998; 40 (3), pp. 569–74

https://www.ncbi.nlm.nih.gov/pubmed/?term=High-dose+preoperative+radiation+and+the+challenge+of+sphincter-preservation+surgery+for+cancer+of+the+distal+2+cm+of+the+rectum

Dhadda AS, Zaitoun AM and Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine – optimising the timing of surgical resection. Clin Oncol (R Coll Radiol). 2009; 21 (1), pp. 23–31. DOI: 10.1016/j.clon.2008.10.011

Benzoni E, Intersimone D, Terrosu G, Bresadola V, Cojutti A, Cerato F, et al. Prognostic value of tumour regression grading and depth of neoplastic infiltration within the perirectal fat after combined neoadjuvant chemo-radiotherapy and surgery for rectal cancer. J Clin Pathol. 2006; 59 (5), pp. 505–512. DOI: 10.1136/jcp.2005.031609

Park JH. , Yoon SM, Yu CS, Kim JH, Kim TW and Kim JC. Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer. 2011; 117 (16), pp. 3703- 12. DOI: 10.1002/cncr.25943

Sobin LH and Compton CC. TNM seventh edition: what's new, what's changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer 2010; 116, pp. 5336-39. DOI: 10.1002/cncr.25537

Dworak O, Keilholz L and Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis, 1997; 12 (1), pp. 19-23

.https://www.ncbi.nlm.nih.gov/pubmed/?term=Dworak+O%2C+Keilholz+L%2C+Hoffmann+A+.+Pathological+features+of+rectal+cancer+after+preoperative+radiochemotherapy

De campos-Lobato LF, Stocchi L, Da luz Moreira A, Kalady MF, Geisler D, Dietz D , et al. Downstaging Without Complete Pathologic Response After Neoadjuvant Treatment Improves Cancer Outcomes for cIII but not cII Rectal Cancers. Ann Surg Oncol. 2010; 17 (7), pp.1758–66. DOI: 10.1245/s10434-010-0924-4

Jonas J, Moroni E, Cavallaro A, Colasanti M, Sautter-Bihl ML, Frenzel H, et al. T-level downstaging and complete pathologic response after preoperative long-term radiochemotherapy for locally advanced rectal cancer. G Chir. 2007; 28 (3): 65-71

https://www.ncbi.nlm.nih.gov/pubmed/?term=T-level+downstaging+and+complete+pathologic+response+after+preoperative+long-term+radiochemotherapy+for+locally+advanced+rectal+cancer

Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Wolff RA, , et al. Predictors of Tumor Response and Downstaging in Patients Who Receive Preoperative Chemoradiation for Rectal Cancer. Cancer. 2007; 109 (9):1750-55. DOI: 10.1002/cncr.22625

Petrelli F, Sgroi G, Sarti E and Barni S. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: a meta-analysis of published studies. Ann Surg. 2016; 263 (3): 458-64. DOI: 10.1097/SLA.0000000000000368

Habr-Gama A, Perez RO, Nadalin W, Nahas SC, Ribeiro U Jr, Silva E Sousa AH Jr, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastro intest Surg. 2005; 9 (1): 90–101. DOI: 10.1016/j.gassur.2004.10.010

Kalady MF, De Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 2009; 250 (4):582-89. DOI: 10.1097/SLA.0b013e3181b91e63.

Sloothaak DAM, Geijsen DE, Van Leersum NJ, Punt CJ, Buskens CJ, Bemelman WA, et al. Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. British Journal of Surgery.2013; 100 (7): 933–39. DOI: 10.1002/bjs.9112

Probst CP, Becerra AZ, Aquina CT, Tejani MA, Wexner SD, Garcia-Aguilar J, et al. Extended intervals after neoadjuvant therapy in locally advanced rectal cancer: the key to improved tumor response and potential organ preservation. J Am Coll Surg. 2015; 221 (2): 430–40. DOI: 10.1016/j.jamcollsurg.2015.04.010

Brown G and Evans J. Timing of surgery following chemoradiotherapy in rectal Cancer. Indian J Med Paediatr Oncol. 2014; 35 (4): 235-6. DOI: 10.4103/0971-5851.144959

Al-Sukhni E, Attwood K, Mattson DM, Gabriel E, Nurkin SJ. Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. Ann Surg Oncol. 2016; 23 (4): 1177–86. DOI: 10.1245/s10434-015-5017-y.

Zeng WG, Liang JW, Wang Z, Zhang XM, Hu JJ, Hou HR, et al. Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Chin J Cancer. 2015; 34 (10): 468-74. DOI:10.1186/s40880-015-0033-7

Lee JH, Kim SH, Kim JG, Cho HM, Shim BY. Preoperative chemoradiotherapy (CRT) followed by laparoscopic surgery for rectal cancer: predictors of the tumor response and the long-term oncologic outcomes. Int J Radiat Oncol Biol Phys. 2011; 81 (2): 431–8. DOI: 10.1016/j.ijrobp.2010.05.019

Wallin U, Rothenberger D, Lowry A, Luepker R, Mellgren A. CEA: a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer. Dis Colon Rectum. 2013; 56 (7): 859–68. DOI: 10.1097/DCR.0b013e31828e5a72

Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum. 2013; 56 (6): 698–703. DOI: 10.1097/DCR.0b013e3182837e5b

Park YA, Sohn SK, Seong J, Baik SH, Lee KY, Kim NK, et al. Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer. J Surg Oncol. 2006; 93 (2): 145–50. DOI: 10.1002/jso.20320

Farnault B, Moureau-Zabotto L, De Chaisemartin C, Esterni B, Lelong B, Viret F et al. Predictive factors of tumour response after neoadjuvant chemoradiation for locally advancedrectal cancer and correlation of these factors with survival. Cancer Radiother. 2011; 15: 279-86. DOI: 10.1016/j.canrad.2011.01.005.

Yang KL, Yang SH, Liang WY, Kuo YJ, Lin JK, Lin TC, et al. Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery. Radiat Oncol. 2013; 8:43. DOI: 10.1186/1748-717X-8-43

Kleiman A, Al-Khamis A, Farsi A, Kezouh A, Vuong T, Gordon PH, et al. Normalization of CEA levels post-neoadjuvant therapy is a strong predictor of pathologic complete response in rectal cancer. J Gastrointest Surg. 2015; 19 (6): 1106–12. DOI: 10.1007/s11605-015-2814-3

Garland ML, Vather R, Bunkley N, Pearse M, Bissett IP. Clinical tumor size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Colorectal Dis. 2014; 29 (3): 301–7. DOI: 10.1007/s00384-013-1821-7

Kim IY, You SH, Kim YW. Neutrophil-lymphocyte ratio predicts pathologic tumor response and survival after preoperative chemoradiation for rectal cancer. BMC Surg. 2014; 14: 94. DOI: 10.1186/1471-2482-14-94

Park CH, Kim HC, Cho YB, Yun SH, Lee WY, Park YS, et al. Predicting tumor response after preoperative chemoradiation using clinic parameters in rectal cancer. World J. Gastroenterol. 2011; 17:5310–6. DOI:10.3748/wjg.v17.i48.5310

Elmessiry MM, Abouelnagah GM, Elzeiny MM, Gebaly AA, Awad AT, Attia GE, et al. Predictors of tumor response to neoadjuvant chemoradiation in locally advanced rectal cancer Egyptian patients. Arch Clin Exp Surg. 2015; 4:21–8. DOI:10.5455/aces.20140407022911

Lin AY, Wong WD, Shia J, Minsky BD, Temple LK, Guillem JG, et al. Predictive clinicopathologic factors for limited response of T3 rectal cancer to combined modality therapy. Int J Colorectal Dis. 2008; 23 (3):243- 9. DOI: 10.1007/s00384-007-0406-8

Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, et al. Modified FOLFOX6 With or Without Radiation Versus Fluorouracil and Leucovorin With Radiation in Neoadjuvant Treatment of Locally Advanced Rectal Cancer: Initial Results of the Chinese FOWARC Multicenter, Open-Label, Randomized Three-Arm Phase III Trial. J Clin Oncol. ; 34 (27): 3300-7. DOI: 10.1200/JCO.2016.66.6198

Wiltshire KL, Ward IG, Swallow C, Oza AM, Cummings B, Pond GR, et al. Preoperative radiation with concurrent chemotherapy for resectable rectal cancer: effect of dose escalation on pathologic complete response, local recurrence-free survival, disease-free survival, and overall survival. Int J Radiat Oncol Biol Phys. 2006; 64 (3): 709–16. DOI: 10.1016/j.ijrobp.2005.08.012

Mass M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011; 29(35): 4633-40. DOI: 10.1200/JCO.2011.37.7176




DOI (PDF (FULL TEXT)): http://dx.doi.org/10.22034/APJCC.2018.3.3.23

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Asia Pacific Journal of Cancer Care


 

  

PORTICO

 

Asia Pacific Organization for Cancer Prevention 

West Asia Organization for Cancer Prevention