Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3–T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision?

Hughes, Rob; Glynne‐Jones, Rob; Grainger, J.; Richman, P. I.; Makris, Andreas; Harrison, Mark; Ashford, Richard; Harrison, R. A.; Livingstone, J. I.; McDonald, Peter J.; Thomas, John M.; Mitchell, Ian C.; Northover, John; Phillips, R. K. S.; Wallace, Marina; Windsor, Alastair; Novell, J. R.

doi:10.1007/s00384-005-0749-y

Cited by 118 publications

(72 citation statements)

References 27 publications

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“…First, because CRT reduces normal lymphocyte levels commensurate with the regression grade of the primary tumor [22,23], the number of lymphocytes in LPNs without metastases may have dropped proportionally to the degree of TRG. Second, the effect of CRT on metastatic lymph nodes in the mesorectum is reportedly correlated with the TRG of the primary tumor [24,25]. Hence, the shrinking effect of CRT on enlarged LPNs, which are potentially metastatic, might be directly correlated with the degree of TRG.…”

Section: Discussionmentioning

confidence: 99%

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

et al. 2018

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Objective: Factors that predict rectal cancer metastasis to the lungs remain undefined. We investigated whether the lateral pelvic lymph node (LPN) sizes before and after chemoradiotherapy (CRT) correlate with lung metastasis after surgery for lower rectal cancer. Methods: Two hundred and forty patients with lower rectal cancer who received preoperative CRT and curative surgery between 2003 and 2017 were examined. Computed tomography-measured LPN sizes before and after CRT were retrospectively determined by 1 colorectal surgeon who was blinded to the patients’ clinical and pathological outcomes. Results: The 5-year cumulative lung metastasis rates were 15.2%. The mean LPN sizes in patients who developed lung metastasis were larger than those in patients who did not (pre-CRT: 8.7 vs. 6.3 mm, p = 0.003; post-CRT: 6.8 vs. 4.5 mm, p = 0.001). The cumulative lung metastasis rate in patients with large LPNs was higher than in those with small LPNs both before and after CRT. On multivariate analysis, lung metastasis was independently correlated with the LPN size only after CRT (hazard ratio [HR]: 5.58), together with the ypT stage (HR: 2.96) and the tumor location (HR: 0.38). Conclusions: LPN size after CRT is strongly predictive of postoperative lung metastasis in patients with lower rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

et al. 2018

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“…4,16 It is important to state that in some no local recurrences at all were found in groups of pCR patients. 6,17 Nevertheless, regardless of no local recurrences, chance of distant metastases still exists. Primary tumor can completely respond to neoadjuvant therapy, but the problem is distant micrometastatic focuses, which can stay undetected in the time of primary diagnostics.…”

Section: Discussionmentioning

confidence: 99%

“…These patients act similar as group of patients with no response to neoadjuvant therapy. 6,19 There remains an open question why achieving pCR means good prognosis. pCR is achieved in tumors, which themselves have a favourable biological profile with lesser susceptibility to local recurrences or distant metastases.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The use of neoadjuvant CRT leading to tumor shrinkage increases the likelihood of performing a sphincter preserving surgery and increases circumferential and distal margins in surgical specimen with reduction of lymphatic and vascular invasion. [6][7][8][9] Chemoradiation induces a tumor downstaging effect, which potentially improves the feasibility of a complete resection with benefits in local disease control. However, the type and remission rate to neoadjuvant CRT remains considerably variable.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of Tumor Regression in Locally Advanced Rectal Cancer after Preoperative Radiochemotherapy

Potisek¹

2015

Clin Med Rev Case Rep

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Disclosure: No potential conflicts of interest were disclosed.Background. The majority of rectal cancers are discovered in locally advanced forms (UICC stage II, III). Treatment consists of preoperative radiochemotherapy, followed by surgery 6-8 weeks later and finally by postoperative chemotherapy. The aim of this study was to find out if tumor regression affected long-term survival in patients with localy Results. Two hundred and two patients met inclusion criteria. Median follow-up was 53.2 months. Stage ypT0N0 (pathologic complete response, pCR) was observed in 14.8% of patients. Pathohistologic stage had statistically significant impact on survival (p = 0.001). 5-year survival in patients with pCR was>90%. Postoperative T and N status were also found to be statistically significant (p = 0.011 for ypT and p < 0.001 for ypN). According to multivariate analysis, tumor response to neoadjuvant therapy was the only independent prognostic factor (p = 0.003).Conclusions. Pathologic response of tumor to preoperative radiochemotherapy is an important prognostic factor for prediction of long-term survival of patients with locally advanced rectal cancer.

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“…On the other hand, no significant correlation was found between D8S264 and low histological response scoring (TRG2 and 1; p = 0.67). However, although chemoradiotherapy could induce a complete histological response, some data have shown that relapse is still observed after a complete histological response [21]. In our study, no MS could be linked to downstaging effects after preoperative chemoradiotherapy, but we specified a set of 8 MS alterations that predicted the sensitivity of a tumour to treatment.…”

Section: Discussionmentioning

confidence: 99%

Molecular Markers for Recurrence and Sensitivity to Preoperative Chemoradiotherapy in Locally Advanced Rectal Tumours

et al. 2014

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Background: The objective of our study is to provide predictive markers of locally advanced rectal tumour sensitivity to preoperative chemoradiotherapy in order to identify tumours that present a high risk of recurrence after standard total mesorectal excision surgery and preoperative chemoradiotherapy, according to histological response and microsatellite allelic imbalance (AI). Methods: Twenty-nine locally advanced tumours were included in the study and the genomic alterations and the tumour regression grade of paired rectal biopsies (before chemoradiotherapy) and carcinomas (after surgery) were assessed. Clinical and allelotyping data were analysed for local and distant recurrence. Results: The global AI frequency significantly decreased from 47.4 to 20.3% (p < 0.01) after preoperative treatment. Preoperative chemoradiotherapy significantly induced the loss of cells bearing AI at 8 microsatellites: D18S61, D8S264, D1S305, D10S191, D4S394, D14S65, D17S790 and D10S192. Among these, AI at the D8S264 locus was significantly associated with recurrence in our rectal tumour cohort (p = 0.039). Conclusion: Loss of AI at D8S264 is predictive of sensitivity to neoadjuvant treatment; thus, we concluded that the persistence of AI at D8S264 in rectal tumours after preoperative chemoradiotherapy could be considered a molecular marker of recurrence. i 2014 S. Karger AG, Basel

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Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3–T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision?

Cited by 118 publications

References 27 publications

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer

Prognostic Significance of Tumor Regression in Locally Advanced Rectal Cancer after Preoperative Radiochemotherapy

Molecular Markers for Recurrence and Sensitivity to Preoperative Chemoradiotherapy in Locally Advanced Rectal Tumours

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