Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients

Valentini, Vincenzo; Coco, Claudio; Picciocchi, Aurelio; Morganti, Alessio Giuseppe; Trodella, Lucio; Ciabattoni, Antonella; Cellini, Francesco; Barbaro, Brunella; Cogliandolo, S; Nuzzo, Gennaro; Doglietto, GB; Ambesi-Impiombato, Fabrizio; Cosimelli, Maurizio

doi:10.1016/s0360-3016(02)02764-5

Cited by 304 publications

(181 citation statements)

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“…Toxicity was significant in one study with 16% not completing protocol (Rodel et al, 2000). Patients with T or N downstaging have been shown to have a significantly improved local control, freedom from distant metastasis, disease-free survival and overall survival (Valentini et al, 2002). Despite a low pCR rate, our pathological downstaging rate of 74% would be clinically meaningful to this group of patients with advanced disease.…”

Section: Discussionmentioning

confidence: 92%

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n ¼ 30, CT alone n ¼ 6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m À2 day À1 for 12 weeks) with mitomycin C (MMC) (7 mg m À2 i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m À2 day À1 and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4 -9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range ¼ 40 -85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI ¼ 64 -91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in one patient. Neoadjuvant systemic chemotherapy as a prelude to synchronous chemoradiation can be administered with negligible risk of disease progression and produces considerable symptomatic response with associated tumour regression.

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Section: Discussionmentioning

confidence: 92%

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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“…Preoperative chemoradiotherapy is widely used as an effective method in treatment of locally advanced rectal cancer (1,2). However, treatment responses among patients differ, even in those with similar tumor histopathological types and clinical stages (3).…”

Section: Introductionmentioning

confidence: 99%

The role of plasma cell-free DNA detection in predicting preoperative chemoradiotherapy response in rectal cancer patients

Sun

Zhu

et al. 2013

Oncology Reports

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Abstract. In the present study, we studied the relationship between plasma cell-free DNA and the effect of preoperative chemoradiotherapy in patients with rectal cancer. The concentration, KRAS mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status of cell-free DNA were measured by using polymerase chain reaction (PCR) analyses. The response to chemoradiotherapy was assessed using tumor regression grading (TRG) scores. The cell-free DNA concentrations in patients with rectal cancer (n=34) were significantly higher compared to healthy controls (n=10). The 400-base pair (bp) DNA concentration, 400-/100-bp DNA ratio decreased significantly after chemoradiotherapy in the good response group. The incidence of KRAS mutation decreased significantly after chemoradiotherapy in both good and poor response groups. Higher MGMT promoter methylation status at baseline DNA was associated with a better tumor response. Therefore, cell-free DNA detection may be useful in evaluating the effect of preoperative chemoradiotherapy in patients with rectal cancer.

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“…This treatment is associated with fewer local recurrences [1] and may also result in improved long-term survival [2]. Post-operative histopathological results are important indicators of prognosis in rectal cancer after CRT [3,4]. Therefore, pre-operative and non-invasive assessment of response to CRT of rectal cancer, and the identification of viable tumours after CRT, are crucial for planning the most beneficial strategies for each individual patient.…”

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confidence: 99%

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging

Song¹,

Kim²,

Lee³

et al. 2012

BJR

111

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Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients

Cited by 304 publications

References 34 publications

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

The role of plasma cell-free DNA detection in predicting preoperative chemoradiotherapy response in rectal cancer patients

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging

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Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients

Cited by 304 publications

References 34 publications

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

The role of plasma cell-free DNA detection in predicting preoperative chemoradiotherapy response in rectal cancer patients

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT2weighted and PET/CT imaging

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Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging