Prognostic Significance of Partial Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer

Lee, Yen-Chien; Hsieh, Chung-Cheng; Chuang, Jih Ing

doi:10.1097/dcr.0b013e318298e36b

Cited by 79 publications

(74 citation statements)

References 45 publications

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“…For example, none of the patients in our study showed a complete TRG response; 82.4% showed a poor response and 17.6% showed a minimal to moderate response. However, a meta-analysis performed by Lee et al indicated that even partial tumor regression after preoperative chemoradiotherapy improves DFS, and should be considered as a favorable prognostic factor [21]. …”

Section: Discussionmentioning

confidence: 99%

MRE11 and ATM Expression Levels Predict Rectal Cancer Survival and Their Association with Radiotherapy Response

Chung

Revoltar

et al. 2016

PLoS ONE

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BackgroundAberrant expression of DNA repair proteins is associated with poor survival in cancer patients. We investigated the combined expression of MRE11 and ATM as a predictive marker of response to radiotherapy in rectal cancer.MethodsMRE11 and ATM expression were examined in tumor samples from 262 rectal cancer patients who underwent surgery for rectal cancer, including a sub-cohort of 54 patients who were treated with neoadjuvant radiotherapy. The relationship between expression of the two-protein panel and tumor regression grade (TRG) was assessed by Mann–Whitney U test and receiver operating characteristics area under curve (ROC-AUC) analysis. The association between expression of the two-protein panel and clinicopathologic variables and survival was examined by Kaplan-Meier methods and Cox regression analysis.ResultsA high score for two-protein combined expression in the tumor center (TC) was significantly associated with worse disease-free survival (DFS) (P = 0.035) and overall survival (OS) (P = 0.003) in the whole cohort, and with DFS (P = 0.028) and OS (P = 0.024) in the neoadjuvant subgroup (n = 54). In multivariate analysis, the two-protein combination panel (HR = 2.178, 95% CI 1.115–4.256, P = 0.023) and perineural invasion (HR = 2.183, 95% CI 1.222–3.899, P = 0.008) were significantly associated with DFS. Using ROC-AUC analysis of good versus poor histological tumor response among patients treated preoperatively with radiotherapy, the average ROC-AUC was 0.745 for the combined panel, 0.618 for ATM alone, and 0.711 for MRE11 alone.ConclusionsThe MRE11/ATM two-protein panel developed in this study may have clinical value as a predictive marker of tumor response to neoadjuvant radiotherapy, and a prognostic marker for disease-free and overall survival.

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Section: Discussionmentioning

confidence: 99%

MRE11 and ATM Expression Levels Predict Rectal Cancer Survival and Their Association with Radiotherapy Response

Chung

Revoltar

et al. 2016

PLoS ONE

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“…A number of recent trials of long-course chemoradiotherapy optimization (including this one) have had tumor regression at the time of surgery as the primary endpoint (7, 9, 31, 32). However, while tumor regression is a prognostic marker (26–28) this does not imply that it is a valid surrogate of a relevant clinical endpoint in rectal cancer (28, 30, 33). Although there was no difference between the treatment arms for the primary trial endpoint (pCR), we found a significant increase in the rate of major response in the brachytherapy boost arm (41% vs 28%).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of a Randomized Trial in Locally Advanced Rectal Cancer: No Benefit From Adding a Brachytherapy Boost

Appelt

Vogelius

Pløen

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objective(s) Mature data on tumor control and survival are presented from a randomized trial of the addition of a brachytherapy boost to long-course neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer. Methods and Materials Between March 2005 and November 2008, 248 patients withT3-4N0-2M0 rectal cancer were prospectively randomized to either long-course preoperative CRT (50.4Gy in 28 fractions, peroral UFT and L-leucovorin) alone or the same CRT schedule plus a brachytherapy boost (10Gy in 2 fractions). Primary trial endpoint was pathological complete response (pCR) at time of surgery; secondary endpoints included overall survival (OS), progression-free survival (PFS) and freedom from locoregional failure. Results Results for the primary endpoint have previously been reported. This analysis presents survival data for the 224 patients in the Danish part of the trial. 221 patients (111 control arm, 110 brachytherapy boost arm) had data available for analysis, with a median follow-up of 5.4 years. Despite a significant increase in tumor response at the time of surgery, no differences in 5-year OS (70.6% vs 63.6%, HR=1.24, p=0.34) and PFS (63.9% vs 52.0%, HR=1.22, p=0.32) were observed. Freedom from locoregional failure at 5 years were 93.9% and 85.7% (HR=2.60, 1.00–6.73, p=0.06) in the standard and in the brachytherapy arm, respectively. There was no difference in the prevalence of stoma. Explorative analysis based on stratification for tumor regression grade and resection margin status indicated the presence of response migration. Conclusions Despite increased pathological tumor regression at the time of surgery, we observed no benefit on late outcome. Improved tumor regression does not necessarily lead to a relevant clinical benefit when the neoadjuvant treatment is followed by high-quality surgery.

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“…Rectal cancers account for 30% -35% of patients with colorectal cancers (2). Various tumor markers and clinical risk factors were reported to be associated with the overall prognosis of rectal cancers, including pre-treatment levels of carcinoembryonic antigen (CEA), pathological T and N stage, tumor differentiation grade, and presence of lymphovascular invasion (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Diffusion MR Imaging and Clinical-Pathologic Factors in Patients with Rectal Cancer

et al. 2018

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Background: Apparent diffusion coefficient (ADC) value measured from diffusion-weighted magnetic resonance (MR) images are highly correlated with pathological T or N stage, tumor differentiation grade, and extramural depth of tumor in patients with rectal cancer. Objectives: To assess the prognostic value of diffusion MR imaging and clinical-pathologic risk factors in patients with rectal cancer. Methods: This retrospective study was approved by our institutional review board and written informed consent was waived. Sixty-

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Prognostic Significance of Partial Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer

Abstract: Partial tumor response is associated with a 50% improvement in disease-free survival and should be considered as a favorable prognostic factor.

Cited by 79 publications

References 45 publications

MRE11 and ATM Expression Levels Predict Rectal Cancer Survival and Their Association with Radiotherapy Response

MRE11 and ATM Expression Levels Predict Rectal Cancer Survival and Their Association with Radiotherapy Response

Long-Term Results of a Randomized Trial in Locally Advanced Rectal Cancer: No Benefit From Adding a Brachytherapy Boost

Prognostic Value of Diffusion MR Imaging and Clinical-Pathologic Factors in Patients with Rectal Cancer

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