Complete Pathological Response Following Radiochemotherapy for Locally Advanced Rectal Cancer: Short and Long-term Outcome

Iskander, Othman; Courtot, L.; Tabchouri, Nicolas; Artus, Alice; Michot, Nicolas; Müller, Olivier; Pabst-Giger, Urs; Bourlier, Pascal; Kraemer-Bucur, Aurore; Lecomte, Thierry; Guyétant, Serge; Chapet, S.; Calais, G.; Salamé, Ephrem; Ouaïssi, Mehdi

doi:10.21873/anticanres.13705

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…As a result, the identification of biologic markers associated with pCR and tumor downstaging have become an increasing focus of research. [8][9][10] The Kirsten rat sarcoma (KRAS) gene is one of the most common mutations found in colorectal cancer, which is seen in approximately 30%-50% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…Although several disease‐ and treatment‐related factors including histopathologic stage, tumor size, radiation therapy dosing, and timing of surgery 3 have been associated with pCR and low NAR scores, tumor biology appears to be the most important factor in determining response to treatment. As a result, the identification of biologic markers associated with pCR and tumor downstaging have become an increasing focus of research 8–10 . The Kirsten rat sarcoma ( KRAS ) gene is one of the most common mutations found in colorectal cancer, which is seen in approximately 30%–50% of cases.…”

Section: Introductionmentioning

confidence: 99%

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Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer

Zhou

Goffredo

Ginader

et al. 2020

Journal of Surgical Oncology

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Background: Mutation of the KRAS oncogene (mKRAS) in colorectal cancer has been associated with aggressive tumor biology, resistance to epidermal growth factor inhibitors, and decreased overall survival (OS). The aim of the current study was to analyze the association of mKRAS with pathologic complete response (pCR) and neoadjuvant rectal (NAR) score, and its impact on the survival of patients with locally advanced rectal cancer who were managed with multimodality therapy. Methods: The National Cancer Database was queried for stage II-III rectal cancer patients with a known KRAS status who underwent neoadjuvant chemoradiation therapy (nCRT) and proctectomy between 2004 and 2015. Results: In total, 1886 patients were identified; 12% had pCR and 36% had mKRAS. Patients with mKRAS were more likely to have advanced pathologic T stage, tumor deposits, perineural invasion, and elevated carcinoembryonic antigen levels (all p ≤ .05). After adjustment for available confounders, mKRAS status was not associated with pCR or NAR score. In multivariable analysis, patients with pCR and lower NAR score had better OS, whereas mKRAS was independently associated with a worse prognosis. Conclusion: In this cohort of locally advanced rectal cancer patients who underwent proctectomy after nCRT, mKRAS was not associated with lower pCR rates or NAR scores; however, these patients experienced worse survival.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer

Zhou

Goffredo

Ginader

et al. 2020

Journal of Surgical Oncology

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“…Interestingly, data from literature show a wide variety of response to neoadjuvant treatments, with complete clinical responses ranging from 8 to 30% [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Clinical Challenges In Rectal Cancermentioning

confidence: 99%

The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

Palma

Luglio

Tropeano

et al. 2020

IJMS

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The response to neoadjuvant chemoradiation (nCRT) is a critical step in the management of locally advanced rectal cancer (LARC) patients. Only a minority of LARC patients responds completely to neoadjuvant treatments, thus avoiding invasive radical surgical resection. Moreover, toxic side effects can adversely affect patients’ survival. The difficulty in separating in advances responder from non-responder patients affected by LARC highlights the need for valid biomarkers that guide clinical decision-making. In this context, microRNAs (miRNAs) seem to be promising candidates for predicting LARC prognosis and/or therapy response, particularly due to their stability, facile detection, and disease-specific expression in human tissues, blood, serum, or urine. Although a considerable number of studies involving potential miRNA predictors to nCRT have been conducted over the years, to date, the identification of the perfect miRNA signatures or single miRNA, as well as their use in the clinical practice, is still representing a challenge for the management of LARC patients. In this review, we will first introduce LARC and its difficult management. Then, we will trace the scientific history and the key obstacles for the identification of specific miRNAs that predict responsiveness to nCRT. There is a high potential to identify non-invasive biomarkers that circulate in the human bloodstream and that might indicate the LARC patients who benefit from the watch-and-wait approach. For this, we will critically evaluate recent advances dealing with cell-free nucleic acids including miRNAs and circulating tumor cells as prognostic or predictive biomarkers.

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“…Locally recurrent rectal cancer (LRRC) is defined as an intrapelvic recurrence following a primary rectal cancer resection, with or without distal metastasis. Concurrent preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery plus systemic chemotherapy is the first recommended standard treatment for patients with resectable rectal cancer (stage II-III) [ 1 – 3 ]. This treatment strategy has significantly decreased local recurrence rate and increased disease free survival (DFS) rate.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and dosimetry analysis of CT-guided 125I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer

Wang

Jiang

et al. 2020

Radiat Oncol

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Background: Locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) is a serious challenge for which no standard treatment is defined. In the present study, we investigated the feasibility of computed tomography (CT)-guided radioactive 125 I seed (RIS) implantation assisted with three-dimensional printing non-coplanar template (3D-PNCT) in LRRC patients who previously received surgery or EBRT. Methods: Sixty-six patients with LRRC treated by CT-guided RIS implantation in our institute from December 2015 to May 2019 were included. The treatment procedure included: preoperative CT localization, planning design, the printing of 3D individualized template, CT-guided RIS implantation assisted with 3D-PNCT, and postoperative dose evaluation. Therapeutic outcomes including local control (LC) and overall survival (OS) were retrospectively evaluated, as well as side effects. Results: All the patients had previously received surgery or EBRT. The median follow-up time was 12.2 (range, 2.5-35.9) months. The median radioactive activity of a single RIS was 0.6 (range, 0.43-0.72) mCi. The median number of RIS was 60, ranging from 10 to 175. The dosimetric parameters included D90 (140.7 ± 33.1) Gy, D100 (90.3 ± 138.6) Gy, and V100 (91.0 ± 13.3) %. Pain relief was achieved in 85.1% (40/47) of patients. Besides, 9.1% (6/66) of patients had severe side effects (≥grade 3), including perianal skin ulcer in 1 case, fistula, radiation proctitis, and intestinal obstruction each in two cases. Median OS time was 14.7 (95% confidence interval (CI): 13.0-16.3) months, and median LC time was 12.2 (95% CI: 9.1-15.2) months. Univariate analysis revealed that when D90 > 130 Gy or D100 > 55 Gy or V100 > 90%, the LC time was remarkably prolonged. However, none of the parameters significantly affected OS. Conclusions: CT-guided RIS implantation assisted with 3D-PNCT is an effective and safe salvage treatment strategy for patients with LRRC after EBRT or surgery. D90, D100, and V100 can be used as prognostic predictors. Trial registration: NCT03890926.

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Complete Pathological Response Following Radiochemotherapy for Locally Advanced Rectal Cancer: Short and Long-term Outcome

Cited by 10 publications

References 30 publications

Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer

Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer

The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

The efficacy and dosimetry analysis of CT-guided 125I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer

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