Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence‐free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy

Agarwal, Atin; Chang, George J.; Hu, Chung Yuan; Taggart, Melissa W.; Rashid, Asif; Park, In J.; You, Yong; Das, Prajnan; Krishnan, Sunil; Crane, Christopher H.; Rodrı́guez-Bigas, Miguel A.; Skibber, John M.; Ellis, Lee M.; Eng, Cathy; Kopetz, Scott; Maru, Dipen M.

doi:10.1002/cncr.28331

Cited by 53 publications

(42 citation statements)

References 25 publications

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“…Many studies have shown dramatic survival advantages by surgically minimizing the volume of cancers, including melanoma (1), brain (2), breast (3), and lung cancers (4). Otherwise, precancerous, cancerous, or normal tissue invaded by cancer cells remain (5)(6)(7). When these residual cells are not eradicated by adjuvant treatments, they give rise to recurrences.…”

Section: Introductionmentioning

confidence: 99%

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

et al. 2017

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Effectiveness of surgery as a cancer treatment is reduced when all cancer cells are not detected during surgery, leading to recurrences that negatively impact survival. To maximize cancer cell detection during cancer surgery, we designed an in situ intraoperative, label-free, optical cancer detection system that combines intrinsic fluorescence spectroscopy, diffuse reflectance spectroscopy, and Raman spectroscopy. Using this multimodal optical cancer detection system, we found that brain, lung, colon, and skin cancers could be detected in situ during surgery with an accuracy, sensitivity, and specificity of 97%, 100%, and 93%, respectively. This highly sensitive optical molecular imaging approach can profoundly impact a wide range of surgical and noninvasive interventional oncology procedures by improving cancer detection capabilities, thereby reducing cancer burden and improving survival and quality of life.

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Section: Introductionmentioning

confidence: 99%

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

et al. 2017

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“…Agarwal et al [28] studied 251 patients with locally advanced rectal adenocarcinoma who received preoperative CRT and found that recurrence-free survival did not differ between patients with pCR and those with nearly complete response (residual cancer cells ≤ 5%). Guillem et al [8] studied 297 patients with rectal cancer who received preoperative CRT and reported that the survival rate was significantly higher in patients with pCR or nearly pCR ( ≥ 95% tumor response) than in patients with other responses.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with pCR [6,8,16,18,[26][27][28] and those with good tumor regression even in the absence of pCR [8,16,17,21,26,[28][29][30][31] have been reported to have good outcomes. Agarwal et al [28] studied 251 patients with locally advanced rectal adenocarcinoma who received preoperative CRT and found that recurrence-free survival did not differ between patients with pCR and those with nearly complete response (residual cancer cells ≤ 5%).…”

Section: Discussionmentioning

confidence: 99%

A Modified Classification of Prognostic Factors Based on Pathological Stage and Tumor Regression Grade in Patients with Rectal Cancer Who Receive Preoperative Chemoradiotherapy

Suzuki

Sadahiro²,

Okada³

et al. 2017

Oncology

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Objective: The histologic response to neoadjuvant chemoradiotherapy (CRT) has been intimately related to outcomes in locally advanced rectal cancer. However, reliable prognostic factors have yet to be established. Subjects and Methods: The study group comprised 198 patients with locally advanced rectal cancer who received CRT. A modified classification based on the combination of ypStage and tumor regression grade (TRG) was developed. ypStage II with TRG 2 was classified as ypTRGstage IIA, and ypStage II with TRG 3 or 4 was classified as ypTRGstage IIB. ypStage 0 and ypStage I were classified as ypTRGstage I, and ypStage III was classified as ypTRGstage III. Results: The 5-year disease-free survival (DFS) was 83% in ypTRGstage I, 86% in ypTRGstage IIA, 57% in ypTRGstage IIB, and 60% in ypTRGstage III (p = 0.0001). The 5-year DFS in ypTRGstage IIA did not differ significantly from that in ypStage 0 (p = 0.865) or ypStage I (p = 0.585). The 5-year DFS in ypStage IIB did not differ from that in ypStage III (p = 0.912). Multivariate analysis showed that ypTRGstage was an independent risk factor for DFS. Conclusion: A modified classification allows patients with ypStage II locally advanced rectal cancer to be clearly divided into two groups: responders and nonresponders.

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“…The feasibility of curative resection and sphincter-sparing surgery depending on the reduction in tumour size has been reported to increase with neoadjuvant chemoradiation (CRT) in patients with locally advanced rectal cancer (5). Preoperative radiotherapy (RT) is said to be more effective than postoperative RT (6).…”

Section: Abant Med J 2015;4(4):338-350mentioning

confidence: 99%

Effect of neoadjuvant chemoradiation on local control and disease-free survival in locally advanced rectal neoplasms

Kurt¹,

Karğı²,

Tiryaki³

et al. 2015

Turk J Bioch

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Amaç: Lokal ileri rektum kanserlerinde tedavinin temelini cerrahi oluştuşturmakla beraber neoadjuvan kemoradyoterapi (KRT) ile lokal ileri rektum kanserlerinde tümör boyutunda küçülmeye bağlı küratif rezeksiyon ve sfinkter koruyucu cerrahi yapılabilirliğinin arttığı bildirilmiştir. Bu çalışmanın amacı, neoadjuvan KRT aldıktan sonra cerrahi tedavi yapılan hastalarda rekürrens, hastalıksız /hastalıklı sağkalım ve buna etki eden faktörlerin araştırılmasıdır. Sonuç: Hiperfraksiyone RT mezorektumun sınırlarını sterilize eder ve tümör hücre kalıntılarının gelişmesini engeller. Bu durum lokal nüks ihtimalini azaltır ve muhtemelen tümör hücrelerinin uzak organlara giderek metastaz yapmasını da engellemiş olur. Neoadjuvan KRT sonrası yapılacak ideal ameliyat tekniği Total mezorektal eksizyon' dur. Cevaplanması gereken önemli soru ise KRT sonrası ideal ameliyat zamanlamasının ne olduğudurÇalışmamızda olgu sayısının az olması ve takip süresinin kısa olması nedeni ile uzun dönem neoadjuvan kemoradyoterapi uygulanan lokal ileri rektum kanserli hastalarda nüks, sağkalım/ hastalıksız sağkalımın uzun dönem takip sonuçlarının anlaşılması için başka çalışmalara ihtiyaç vardır.Objective: Although surgery comprises the basis for the treatment of locally advanced rectal cancer, the feasibility of curative resection and sphincter-sparing surgery depending on the reduction in tumour size has been reported to increase with neoadjuvant chemoradiation (CRT) in patients with locally advanced rectal cancer. The aim of this study was to investigate recurrence, survival with disease/disease-free survival and factors affecting them in patients who underwent surgery after receiving neoadjuvant CRT. Method: The files of 79 patients aged older than 18 years who were diagnosed with locally advanced rectal cancer and underwent surgery after receiving neoadjuvant CRT between January 2007 and May 2012 were retrospectively analysed in terms of demographics and clinical, radiological and pathological data. Results: A total of 79 patients, among whom 27 (34.2%) were females and 52 (65.8%) were males, were included in the study, and the mean age was 60.82±5 years. The complete regression rate after neoadjuvant CRT was 15.18%. The average follow-up period of the patients was 26 months (range: 3-59 months). During the follow up, tumour recurrence was detected in 28 (35.44%) patients, among whom 12 had local recurrence and 17 had systemic recurrence; the survival rate of the patients was 83.54%. The disease-free survival rate was 72.15%. In most of the patients, stage regression and the reduction of tumour size were achieved. Conclusion: In summary, hyperfractionated radiotherapy sterilises the margins of the mesorectum and prevents the development of tumour cell remnants, thus reducing the likelihood of local recurrence and preventing tumour cells from metastasising to remote organs. The ideal surgical technique after neoadjuvant CRT is total mesorectal excision. The important question is the optimum time for surgery after CRT. Thus, further studi...

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Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence‐free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy

Cited by 53 publications

References 25 publications

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

Highly Accurate Detection of Cancer In Situ with Intraoperative, Label-Free, Multimodal Optical Spectroscopy

A Modified Classification of Prognostic Factors Based on Pathological Stage and Tumor Regression Grade in Patients with Rectal Cancer Who Receive Preoperative Chemoradiotherapy

Effect of neoadjuvant chemoradiation on local control and disease-free survival in locally advanced rectal neoplasms

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