Prognostic Significance of Neoadjuvant Rectal Score and Indication for Postoperative Adjuvant Therapy in Rectal Cancer Patients After Neoadjuvant Chemoradiotherapy

Maeda, Kiyoshi; Shibutani, Masatsune; Tachimori, Akiko; Nishii, Takafumi; Aomatsu, Naoki; Fukuoka, Tatsunari; Nagahara, Hisashi; Otani, Hiroshi; Inoue, Toru; Ohira, Masaichi

doi:10.21873/invivo.11772

Cited by 10 publications

(12 citation statements)

References 29 publications

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“…23 The role of adjuvant chemotherapy in poor responders has not been resolved either, with its administration in poor responders in the Italian study showing improved OS compared to those not treated with it, an observation supported by pooled and meta-analysis of other trials. 16,[24][25][26] Prospective (or retrospective) determination of the neoadjuvant rectal score in randomized trials might help to determine whether poor responders to CRT benefit from adjuvant chemotherapy. 26,27 Tailoring treatment according to response requires sensitive and specific methods to assess this, and appropriate endpoints for such studies.…”

Section: Prodige 23 and Rapido Both Reported Approximately 7%mentioning

confidence: 99%

“…16,[24][25][26] Prospective (or retrospective) determination of the neoadjuvant rectal score in randomized trials might help to determine whether poor responders to CRT benefit from adjuvant chemotherapy. 26,27 Tailoring treatment according to response requires sensitive and specific methods to assess this, and appropriate endpoints for such studies. 3,28 Magnetic resonance imaging (MRI) is the mainstay of nonpathological response assessment, with several methods, including MRI-based tumor regression grading, under evaluation in prospective trials to optimize its contribution.…”

Section: Prodige 23 and Rapido Both Reported Approximately 7%mentioning

confidence: 99%

“…While GRECCAR‐6 ( n = 265) showed no difference in oncological outcomes by treatment response when surgery was performed 7 or 11 weeks after CRT, 22 an ongoing RCT ( n = 340) comparing surgery 8 or 12 weeks after CRT may help to clarify this question 23 . The role of adjuvant chemotherapy in poor responders has not been resolved either, with its administration in poor responders in the Italian study showing improved OS compared to those not treated with it, an observation supported by pooled and meta‐analysis of other trials 16,24–26 . Prospective (or retrospective) determination of the neoadjuvant rectal score in randomized trials might help to determine whether poor responders to CRT benefit from adjuvant chemotherapy 26,27 …”

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TNT: Raising more questions than answers?

Jameson

Stevenson

Ngan

2022

Asia-Pac J Clncl Oncology

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Section: Prodige 23 and Rapido Both Reported Approximately 7%mentioning

confidence: 99%

Section: Prodige 23 and Rapido Both Reported Approximately 7%mentioning

confidence: 99%

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TNT: Raising more questions than answers?

Jameson

Stevenson

Ngan

2022

Asia-Pac J Clncl Oncology

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“…The relative prognostic significance of discordant TRG and ypTN stage is not well described (9,13,(24)(25)(26). Therefore, the present study assessed the prognostic value of ypTN to the AJCC TRG schema in patients with LARC treated with nCRT and TME.…”

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Rectal tumor fragmentation as a response pattern following chemoradiation

Mills

Naz

Sánchez

et al. 2022

J Gastrointest Oncol

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Background: Tumor response to neoadjuvant therapy is heterogenous and prognostically important for locally advanced rectal adenocarcinoma (LARC) patients. Commonly applied response classification approaches including tumor regression grading (TRG) and TN downstaging can be discordant. The aim of this study is to compare the prognostic value of discordant tumor response measurement categorized according to the AJCC/CAP TRG schema and ypTN stage. Methods: This is a single-center retrospective review of 90 consecutive patients with stage II-III rectal cancer receiving neoadjuvant chemoradiation (nCRT), total mesorectal excision (TME) and adjuvant chemotherapy (ACT) between 2007 and 2018. Two pathologists re-examined each case to assign a consensus AJCC TRG. A Cox proportional hazards ratio model assessed the effect of patient, tumor, and treatment factors on disease-free survival (DFS). Results: Median follow-up after surgery was 46 months (95% CI: 41-50 months). Median age at diagnosis was 55 years (range: 27-80). Most patients were male (58%) and Caucasian (92%) with clinical stage III disease (68%). Seventy-three patients (81%) underwent low anterior resection (LAR), 17 (19%) underwent abdominoperineal resection (APR). The median interval from completion of nCRT to surgery was 62 days (IQR: 56-70 days). The 4-year OS, DFS, and LC was 92.4%, 74.4%, and 90.2%, respectively. In the multivariate analysis, ypTN downstaging was not prognostically significant; however, AJCC TRG score 3 (minimal tumor response to treatment) was strongly predictive for inferior DFS (3-year DFS 79% vs. 25%, P<0.001). Patients with TRG 3 had a significantly higher risk of both local (75% vs. 5%) and distant failure (75% vs. 19%). Conclusions: Minimal tumor response to neoadjuvant therapy, AJCC TRG 3, irrespective of ypTN downstaging, is a pattern of residual disease that is at highest risk for recurrence. Response categorization discrepancies may be partly explained by alternative patterns of residual disease, including tumor fragmentation, and may be best reflected by TRG. The optimal tumor response categorization method requires further study to best stratify patient risk and management.

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“…По данным авторов, применение предоперационной лучевой терапии приводит к снижению в 2 раза 5-летней частоты безрецидивной выживаемости при раке прямой кишки -с 10,9% до 5,6% [8][9][10]. В последнее время установлено, что основным прогностическим признаком эффективности лучевой терапии при злокачественных опухолях является степень регресса опухоли.…”

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Molecular and Morphological Effects of Prolonged Radiotherapy in Rectal Cancer

Novikova¹,

Dzhenkova²,

Шапошников³

et al. 2020

СПНО (MPSE)

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Цель исследования: выявить молекулярные и морфологические эффекты предоперационной лучевой терапии при раке прямой кишки. В структуре нашего исследования проанализированы данные о 45 больных, которым в периоперационном периоде была проведена лучевая терапия. В ткани удаленной интраоперационно опухоли проводили анализ ДНК в опухолевых клетках (CycleTESTTMPLUS DNA ReagentKit), а также определяли лечебный патоморфоз и изменение размеров опухоли под действием предоперационной лучевой терапии. Нами были выявлены увеличение частоты опухолей с индексом ДНК до 1,5 в 1,5 раза, снижение частоты опухолей с индексом ДНК выше 1,5 в 2,6 раза, лечебный патоморфоз III степени в 70% случаев. Протяженность опухоли уменьшилась в 1,5 раза, а расстояние от ануса до нижнего края опухоли увеличилось в 1,2 раза (р<0,05). Молекулярно-морфологическим эффектом проводимой лучевой терапии рака прямой кишки было уменьшение потенциала злокачественности опухоли, проявляющееся лечебным патоморфозом различной степени. Пролонгированная лучевая терапия при раке прямой кишки снижает злокачественный потенциал опухоли и, несомненно, требует соблюдения сроков выполнения оперативного вмешательства. Ключевые слова: онкология, рак прямой кишки, лучевая терапия, ДНК. The study of molecular and morphological effects of prolonged preoperative radiotherapy for resectable rectal cancer. The data on 45 patients receiving preoperative radiotherapy with the Teratron system and the VarianUnique low-energy linear accelerator were studied. DNAs in tumor cells (CycleTESTTMPLUS DNA ReagentKit), therapeutic pathomorphosis and changes in the tumor sizes were analyzed in tumor tissues removed during surgery. The rate of tumors with the DNA index ˂1.5 increased by 1.5 times, the rate of tumors with the DNA index ˃1.5 decreased by 2.6 times, grade III therapeutic pathomorphosis was observed in 70% of cases. Tumor extension reduced by 1.5 times, the distance from the anus to the lower edge of tumor increased by 1.2 times (p<0.05). Molecular and morphological effects of prolonged preoperative radiotherapy for rectal cancer include the reduction of the malignant potential of tumors which was manifested in grade III therapeutic pathomorphosis in 70% of cases, an increased rate of tumors with the DNA index ˂1.5 by 1.5 times and a decreased rate of tumors with the DNA index ˃1.5 by 2.6 times. Prolonged radiotherapy for rectal cancer inhibits the malignant potential of tumors and requires compliance with surgery timing.Современная онкология достигла значительных успехов в лечении колоректального рака [1-3], а лучевая терапия давно входит в состав комбинированного лечения рака прямой кишки [4,5]. Многие исследования доказывают важную роль предоперационной лучевой терапии в комплексном лечении рака прямой кишки. Так, в США с 2004 по 2011 гг. доля больных, получивших неоадъювантную лучевую терапию, повысилась с 57% до 75%, а доля больных, получивших послеоперационную лучевую терапию, наоборот, снизилась с 39% до 18% [6,7].

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Prognostic Significance of Neoadjuvant Rectal Score and Indication for Postoperative Adjuvant Therapy in Rectal Cancer Patients After Neoadjuvant Chemoradiotherapy

Cited by 10 publications

References 29 publications

TNT: Raising more questions than answers?

TNT: Raising more questions than answers?

Rectal tumor fragmentation as a response pattern following chemoradiation

Molecular and Morphological Effects of Prolonged Radiotherapy in Rectal Cancer

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