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Prognostic significance of pathological response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer

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Abstract

Background

Preoperative chemoradiotherapy (CRT) is widely used in the treatment of locally advanced rectal cancer (LARC). Pathological response to CRT has been shown to be a potential prognostic predictor in rectal cancer patients. The aim of this study was to determine the prognostic significance of pathological response to preoperative CRT in LARC patients.

Methods

Thirty-two patients with LARC were retrospectively analyzed to determine the relationships of pathological response and clinicopathological characteristics to survival outcomes. Patients received CRT with tegafur/uracil and leucovorin. Radiotherapy was administered in fractions of 1.8 Gy/day and 5 days per week. The total dose of radiation delivered was 45 Gy.

Results

All patients underwent total mesorectal excision with lymph node dissections after CRT, and resected specimens were examined pathologically. Four patients showed pathological complete response, 14 showed good response, and 14 showed poor response. Pathological complete or good response was associated with longer survival (P = 0.041). Clinicopathological factors excluding gender were not correlated with outcome. No factor was associated with recurrence.

Conclusion

Pathological response to preoperative CRT may be a useful prognostic predictor in patients with LARC.

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References

  1. Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933

    Article  CAS  PubMed  Google Scholar 

  2. Govindarajan A, Reidy D, Weiser MR et al (2011) Recurrence rates and prognostic factors in ypN0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision. Ann Surg Oncol 18:3666–3672

    Article  PubMed  Google Scholar 

  3. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123

    Article  CAS  PubMed  Google Scholar 

  4. Valentini V, Coco C, Picciocchi A et al (2002) Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 53:664–674

    Article  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network (2014) Rectal cancer ver2.2015. NCCN Clinical Practice Guideline in Oncology. Available via DIALOG. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed 14 Dec 2014

  6. Jwa E, Kim JH, Han S et al (2014) Nomogram to predict ypN status after chemoradiation in patients with locally advanced rectal cancer. Br J Cancer 111:249–254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Huh JW, Lee JH, Kim HR (2014) Pretreatment expression of 13 molecular markers as a predictor of tumor responses after neoadjuvant chemoradiation in rectal cancer. Ann Surg 259:508–515

    Article  PubMed  Google Scholar 

  8. Shindoh J, Chun YS, Loyer EM et al (2013) Non-size-based response criteria to preoperative chemotherapy in patients with colorectal liver metastases: the morphologic response criteria. Curr Colorectal Cancer Rep 9:198–202

    Article  PubMed  PubMed Central  Google Scholar 

  9. Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844

    Article  PubMed  Google Scholar 

  10. Janjan NA, Crane C, Feig BW et al (2001) Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 24:107–112

    Article  CAS  PubMed  Google Scholar 

  11. Sobin LH, Gospodarowicz MK, Wittekind (2009) TNM classification of malignant tumours, 7th edn. Wiley–Blackwell, Oxford

  12. Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255:1129–1134

    Article  PubMed  Google Scholar 

  13. Chang HH, Leeper WR, Chan G et al (2012) Infarct-like necrosis: a distinct form of necrosis seen in colorectal carcinoma liver metastases treated with perioperative chemotherapy. Am J Surg Pathol 36:570–576

    Article  PubMed  Google Scholar 

  14. National Cancer Institute (2009) Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Available via DIALOG. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcae_4_with_lay_terms.pdf. Accessed 12 Mar 2015

  15. Debove C, Maggiori L, Chau A, et al (2015) What happens after R1 resection in patients undergoing laparoscopic total mesorectal excision for rectal cancer? A study in 333 consecutive patients. Colorectal Dis 17:197–204. doi:10.1111/codi.12849

  16. Shirao K, Hoff PM, Ohtsu A et al (2004) Comparison of the efficacy, toxicity, and pharmacokinetics of a uracil/tegafur (UFT) plus oral leucovorin (LV) regimen between Japanese and American patients with advanced colorectal cancer: joint United States and Japan study of UFT/LV. J Clin Oncol 22:3466–3474

    Article  CAS  PubMed  Google Scholar 

  17. Ozgen Z, Ozden S, Dane F et al (2013) Health-related quality of life during postoperative chemoradiotherapy with oral uracil-tegafur and leucovorin in rectal cancer patients. Hepatogastroenterology 60:533–537

    CAS  PubMed  Google Scholar 

  18. Shirao K, Hoff PM, Ohtsu A et al (2004) Comparison of the efficacy, toxicity, and pharmacokinetics of a uracil/tegafur (UFT) plus oral leucovorin (LV) regimen between Japanese and American patients with advanced colorectal cancer: joint United States and Japan study of UFT/LV. J Clin Oncol 22:3466–3474

    Article  CAS  PubMed  Google Scholar 

  19. Uzcudun AE, Batlle JF, Velasco JC et al (2004) Efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase II study. Dis Colon Rectum 45:1349–1358

    Article  Google Scholar 

  20. Cellier P, Leduc B, Martin L et al (2011) Phase II study of preoperative radiation plus concurrent daily tegafur-uracil (UFT) with leucovorin for locally advanced rectal cancer. BMC Cancer 11:98. doi:10.1186/1471-2407-11-98

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ishihara S, Hayama T, Yamada H et al (2011) Benefit of tegafur-uracil and leucovorin in chemoradiotherapy for rectal cancer. Hepatogastroenterology 58:756–762

    CAS  PubMed  Google Scholar 

  22. Selvaggi F, Fucini C, Pellino G, et al (2015) Outcome and prognostic factors of local recurrent rectal cancer: a pooled analysis of 150 patients. Tech Coloproctol 19:135–144. doi:10.1007/s10151-014-1241-x

  23. Sourrouille I, Mordant P, Maggiori L et al (2013) Long-term survival after hepatic and pulmonary resection of colorectal cancer metastases. J Surg Oncol 108:220–224

    Article  PubMed  Google Scholar 

  24. Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 237:502–508

    PubMed  PubMed Central  Google Scholar 

  25. Tanis PJ, Doeksen A, van Lanschot JJ (2013) Intentionally curative treatment of locally recurrent rectal cancer: a systematic review. Can J Surg 56:135–144

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rödel C, Grabenbauer GG, Papadopoulos T et al (2002) Apoptosis as a cellular predictor for histopathologic response to neoadjuvant radiochemotherapy in patients with rectal cancer. Int J Radiat Oncol Biol Phys 52:294–303

    Article  PubMed  Google Scholar 

  27. Bosset JF, Calais G, Mineur L et al (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15:184–190

    Article  CAS  PubMed  Google Scholar 

  28. Collette L, Bosset JF, den Dulk M et al (2007) Patients with curative resection of cT3–4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 25:4379–4386

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Ayako Tomono, Kimihiro Yamashita, Kiyonori Kanemitsu, Yasuo Sumi, Masashi Yamamoto, Shingo Kanaji, Tatsuya Imanishi, Tetsu Nakamura, Satoshi Suzuki, Kenichi Tanaka & Yoshihiro Kakeji

Authors
  1. Ayako Tomono
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  2. Kimihiro Yamashita
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  3. Kiyonori Kanemitsu
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  4. Yasuo Sumi
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  5. Masashi Yamamoto
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  6. Shingo Kanaji
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  7. Tatsuya Imanishi
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  8. Tetsu Nakamura
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  9. Satoshi Suzuki
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  10. Kenichi Tanaka
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  11. Yoshihiro Kakeji
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Corresponding author

Correspondence to Ayako Tomono.

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The authors declare that they have no conflict of interest.

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Tomono, A., Yamashita, K., Kanemitsu, K. et al. Prognostic significance of pathological response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Int J Clin Oncol 21, 344–349 (2016). https://doi.org/10.1007/s10147-015-0900-x

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  • DOI: https://doi.org/10.1007/s10147-015-0900-x

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