Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies

Valentini, Vincenzo; Coco, Claudio; Cellini, Numa; Picciocchi, Aurelio; Fares, Mina; Rosetto, M.E.; Mantini, Giovanna; Morganti, Alessio Giuseppe; Barbaro, Brunella; Cogliandolo, S; Nuzzo, Gennaro; Tedesco, Manfredo; Ambesi-Impiombato, Fabrizio; Cosimelli, Maurizio; Rotman, Marvin

doi:10.1016/s0360-3016(01)01618-2

Cited by 115 publications

(69 citation statements)

References 27 publications

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“…In our study, over 40% of patients had T4 tumours representing a group of patients with truly locally advanced disease. This may account for the low pathological complete response rate seen in our study compared with 10 -30% achieved in other studies (Janjan et al, 1999;Bosset et al, 2000;Chan et al, 2000;Grann et al, 2001;Onaitis et al, 2001;Valentini et al, 2001). Two studies included only patients with clinically staged T4 tumours (Videtic et al, 1998;Rodel et al, 2000).…”

Section: Discussionmentioning

confidence: 54%

“…Many recent studies included T3 tumours staged by endoscopic ultrasound which are often less bulky than clinically staged T3 tumours. Very few patients with T4 tumours were recruited (o5% of total enrolled) in these studies (Janjan et al, 1999;Bosset et al, 2000;Chan et al, 2000;Grann et al, 2001;Onaitis et al, 2001;Valentini et al, 2001). In our study, over 40% of patients had T4 tumours representing a group of patients with truly locally advanced disease.…”

Section: Discussionmentioning

confidence: 99%

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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: 54%

Section: Discussionmentioning

confidence: 99%

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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“…As in other studies, we noticed that rectal cancer survival varies, in an inversely way (Jessup et al, 1998;Gunderson et al, 2004) with the stage of the cancer (Harling et al, 2004;Rerink et al, 2004). Survival and disease relapse after surgery alone (Quirke et al, 1986;Adam et al, 1994) or combined with adjuvant treatment (Mohiuddin et al, 2000;Grann et al, 2001;Greene et al, 2001;Kapiteijn et al, 2001;Valentini et al, 2001;Tepper et al, 2002;Mohiuddin et al, 2006;Gunderson & Tepper, 2007) for rectal cancer patients are a function of both degree of bowel wall penetration of the primary lesion and nodal status. However nodal involvement alone is inadequate as the sole pathologic factor to predict survival and relapse rates (Quirke et al, 1986;Adam et al, 1994).…”

Section: Resultsmentioning

confidence: 99%

Rectal Cancer Epidemiology

Abreu¹,

Matos²,

Poças³

et al. 2011

Rectal Cancer - A Multidisciplinary Approach to Management

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“…Tumor regression grade (TRG) is a semi-quantitative parameter describing a relative proportion of residual tumor and stromal fibrosis. It is regarded a useful parameter for the assessment of histopathological changes in tumor following neoadjuvant therapy [14,18,19,21,22,29,[34][35][36][37][38] . There are five grades of cancer response to treatment in TRG staging, ranging from TRG 1-no residual cancer cells in the intestinal wall, replaced by fibrous tissue, through TRG 2-presence of occasional residual cancer cells, scattered in fibrous stroma, TRG 3-fibrosis dominating over residual cancer, TRG 4-residual cancer outgrowing fibrosis, to TRG 5-no tumor response or regression, no fibrosis with extensive residual cancer [29] .…”

Section: Colorectal Cancermentioning

confidence: 99%

“…Reports on the relationship between "T-downstaging" or ypT and TRG are not numerous, and are with regard to preoperative longterm radiotherapy and chemoradiotherapy [21,22,35,36] . The relationship between TRG and the probability of lymph nodes involvement has been described in detail only in patients with rectal cancer submitted to long-term radiochemotherapy [22,41] .…”

Section: Colorectal Cancermentioning

confidence: 99%

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Lukasz¹,

Liszka²,

Ewa³

et al. 2007

WJG

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INTRODUCTIONColorectal cancer is the third most common malignancy diagnosed in the USA [1] . The estimated colorectal cancer mortality in the USA in 2006 is 55 170 [2] . The primary treatment method for rectal cancer is surgery, namely anterior rectal resection, abdomino-perineal resection or local excision [3][4][5][6] . Preoperative radiotherapy and radiochemotherapy play an increasing role in the treatment of rectal cancer [7][8][9][10][11][12][13] . The effectiveness of neo-adjuvant therapy may be assessed and monitored by means of longterm survival follow up, incidence of local recurrence, estimation of the percentage of patients with primary high stage tumor suitable for radical surgery, estimation of the percentage of patients suitable for sphincter-saving surgery or by monitoring the tumor stage using visualizing diagnostic methods [14,15] . Transrectal ultrasound (TRUS) is a useful method for the assessment of the local tumor stage and the regional lymph node status prior to neo-adjuvant therapy [3,4,6,16] . Basing on TRUS and histopathological examination one can define the tumor reg ression parameter "T-downstaging". Lower ypT parameter value (local tumor stage assessed by the pathologist in surgical specimen following neo-adjuvant therapy) than uT (local Abstract AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS:Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS:Complete regression (ypT0, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging" and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5.No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION:Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients

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Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies

Cited by 115 publications

References 27 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

Rectal Cancer Epidemiology

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

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