Corrigendum: Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect

Ayestaran, Adriana; Serrano, Javier; Cambeiro, Mauricio; Palma, Jacobo; Meiriño, R.; Morcillo, Miguel A.; Lapuente, Fernando; Chiva, Luis; Aguilar, Borja; Azcona, Diego; Pedrero, Diego; Pascau, Javier; Delgado, José Miguel Pardo; Aristu, Javier; Alonso, Alberto Valdés; Prezado, Yolanda

doi:10.3389/fonc.2022.1116433

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“…The remaining systemic treatment component in multimodal management should be risk-adapted to the ypN status (not to insist in agents used in the neoadjuvant segment if proven resistance is present). Additional intensification for pelvic tumor control promotion in ypN+ patients can be further explored using a combination of strategies including the use of spacers and proton therapy [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Post-Chemoradiation Metastatic, Persistent and Resistant Nodes in Locally Advanced Rectal Cancer: Metrics and Their Impact on Long-Term Outcome

Calvo,

Tudela,

Serrano

et al. 2023

Cancers

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Background: The purpose of this study was to evaluate the long-term oncological progression pattern of locally advanced rectal cancer patients with post-neoadjuvant nodal metastatic disease (ypN+) and correlate potential prognostic features associated with proven radiochemoresistant nodal biology. Methods: Individual patient data (100 variables) from a 20-year consecutive single-institution multidisciplinary experience (1995–2015), delivering multimodal therapy to rectal cancer patient candidates for radical treatment, including a neoadjuvant component and surgical resection with or without intraoperative radiotherapy followed by optional adjuvant chemotherapy. The ypN+ disease data was registered in the context of initial staging categories post-neoadjuvant T status (ypT). Results: Data on 487 patients showed histologically confirmed diagnoses of metastatic nodal disease in 108 specimens (ypN+, 22.1). There was a significant age difference (p = 0.009) between the ypN groups: age ≥ 65 was 57.6% in pN0 and 43.5% in ypN+ and patients aged < 65 constituted 42.4% of pN0 and 56.5% of ypN+. According to the clinical stage there were statistically significant differences (p = 0.001) in the categories’ distribution: ypN+ patients 10.8% were stage II and 89.2% were stage III. Univariant analysis on outcome variables showed statistically significant differences in overall survival at 7 years (63.8% vs. 55.7%, p = 0.016) disease-free survival (DFS) (78% vs. 53.8%, p = 0.000) and local recurrence-free survival (LRFS) (93.6% vs. 84%, p = 0.002). Conclusions: The presence of nodal metastases (ypN+) after neoadjuvant therapy containing long-course pelvic irradiation severely impacts the long-term outcome for patients with locally advanced rectal cancer and correlates with multiple clinical and therapeutic variable metrics. Implementation of local and systemic therapies should be adapted and intensified in relation to the finding of ypN+ category in surgical specimens.

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Section: Discussionmentioning

confidence: 99%