Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer

Janjan, Nora A.; Abbruzzese, James L.; Pazdur, Richard; Khoo, Vincent; Cleary, Karen R.; DuBrow, Ronelle A.; Ajani, Jaffer A.; Rich, Tyvin A.; Goswitz, Mary S.; Evetts, P.A.; Allen, Pamela K.; Lynch, Patrick M.; Skibber, John M.

doi:10.1016/s0167-8140(99)00054-7

Cited by 134 publications

(93 citation statements)

References 21 publications

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“…We found that patients with pCR had better disease-specific survival than those with either post-treatment stage I or stage IIA disease. Our data is consistent with the previous findings from other carcinoma sites that pCR is associated with better prognosis [24][25][26][27][28][29]. Given the rarity and the limited number of patients with PDA who received neoadjvant CRT had pCR in pancreatectomy reported in this study, future collaborative studies of a larger patient population is needed to confirm the prognostic values of pCR in patients with PDA.…”

Section: Discussionsupporting

confidence: 92%

“…The extent of residual invasive adenocarcinoma in post-therapy specimens has been shown to correlate with the prognosis in patients with several types of carcinomas, including PDA, esophageal cancer, and rectal cancer [24][25][26][27][28][29]. In our previous study of 240 patients with PDA who received neoadjuvant CRT and pancreaticoduodenectomy, we showed that posttherapy tumor stage (ypT), lymph node status (ypN), and the post therapy AJCC pathologic stage were independent prognostic factors of both disease-free and overall survivals in this group of patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…In other tumor sites, patients who achieved pCR after neoadjuvant therapy have better prognosis. Patients with pCR in rectal specimens who received neoadjuvant chemoradiation have better disease-free and overall survival than patients with residual rectal adenocarcinoma [24][25][26][27][28][29]. Similarly, patients with pCR in esophagectomy specimens after neoadjuvant therapy also had better prognosis than those with residual disease [12,14].…”

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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In patients with pancreatic ductal adenocarcinoma (PDA) who received neoadjuvant therapy and pancreatectomy, pathologic complete response (pCR) is rarely observed and the prognostic significance of pCR is not clear. In this study, we reported 11 patients with pCR (2.5%) from 442 patients with PDA who received neoadjuvant treatment and pancreatectomy from 1995 to 2010. There were 6 men and 5 women with median age of 61 years. Four patients had either synchronous or prior history of extra-pancreatic cancer. Five patients received neoadjuvant chemotherapy followed by chemoradiation, and 6 received chemoradiation alone. Ten patients had pancreaticoduodenectomy and one had distal pancreatectomy. Scar and chronic pancreatitis consistent with therapy effect were present in all cases (100%). Pancreatic intraepithelial neoplasia 3 (Pan IN3)/carcinoma in situ was present in 5 cases, PanIN1 and PanIN2 in 5 cases. However, no residual invasive carcinoma or lymph node metastasis was identified in all cases. Follow-up information was available in 10 patients. Follow-up time ranges from 6 to 194 months (median, 63 months). During follow-up, three patients died of other causes and one developed a second primary PDA in the tail of pancreas at 84 months after initial pancreaticoduodenectomy and died at 105 months after the initial diagnosis of PDA. The other 6 patients were alive with no evidence of disease. Patients with pCR had better survival than those who had post-therapy stage I or IIA

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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“…An understanding of predictors of tumor response is particularly important for rectal cancer, because the response to preoperative chemoradiation, in turn, predicts long-term outcome. [16][17][18][19] Predictive factors can be useful in the design of clinical trials on new therapies. Patients can be stratified on the basis of known predictive factors in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer

Das

Skibber

Rodrı́guez-Bigas

et al. 2007

Cancer

305

208

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BACKGROUNDThe objective of this study was to identify predictive factors for pathologic complete response and tumor downstaging after preoperative chemoradiation for rectal cancer.METHODSBetween 1989 and 2004, 562 patients with nonmetastatic rectal adenocarcinoma received preoperative chemoradiation and underwent mesorectal excision. The median radiation dose was 45 Gray (Gy) (range, 19.8–58.6 Gy), 77% of patients received concurrent infusional 5‐fluorouracil, 20% of patients received concurrent capecitabine, and 3% of patients received other regimens.RESULTSNineteen percent of patients achieved a pathologic complete response (CR), whereas 20% of patients had only microscopic residual disease at surgery, and 61% of patients had macroscopic residual disease at surgery. Downstaging of the tumor stage occurred in 57% of patients. The results from a univariate analysis indicated that tumor circumferential extent >60% (P = .033) and pretreatment carcinoembryonic antigen (CEA) level >2.5 ng/mL (P = .015) were associated significantly with lower pathologic CR rates. The univariate analysis also indicated that tumor circumferential extent >60% (P = .001), pretreatment CEA level >2.5 ng/mL (P = .006), and distance from the anal verge >5 cm (P = .035) were associated significantly with lower downstaging rates. The results from a multivariate logistic regression analysis indicated that greater circumferential extent of tumor (odds ratio [OR], 0.43; P = .033) independently predicted a lower pathologic CR rate. The multivariate logistic regression analysis also indicated that greater circumferential extent of tumor (OR, 0.49; P = .020) and greater distance from the anal verge (OR, 0.46; P = .010) independently predicted a lower downstaging rate.CONCLUSIONSCircumferential extent of tumor, CEA level, and distance from the anal verge predicted for the pathologic response to preoperative chemoradiation for patients with rectal cancer. Therefore, these factors may be used to predict outcomes for patients, to develop risk‐adapted treatment strategies, and to target patients who participate in trials of newer therapies. Cancer 2007. © 2007 American Cancer Society.

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“…Clinical factors include performance status, tumor stage, tumor mobility and circumference of the rectal wall involved by tumor (11). Treatment factors include radiation dose and time elapsed from radiation to surgery (12,13).…”

mentioning

confidence: 99%

Genomic predictor of complete response after chemoradiotherapy in rectal cancer

Noh¹,

Kim²

2016

Ann. Transl. Med.

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Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer

Cited by 134 publications

References 21 publications

Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer

Genomic predictor of complete response after chemoradiotherapy in rectal cancer

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