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International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 287–297 | Cite as

Selecting patients for hyperthermia combined with preoperative chemoradiotherapy for locally advanced rectal cancer

  • Sang-Won Kim
  • Ji Woon Yea
  • Jae Hwang Kim
  • Mi Jin Gu
  • Min Kyu Kang
Original Article

Abstract

Background

This study investigated the role of hyperthermia combined with preoperative concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer (LARC) according to hypoxic marker expression.

Methods

One hundred and nine LARC patients with tissue blocks available for immunohistochemical assessment of carbonic anhydrase 9 (CA9) expression were reviewed. CA9 expression was considered positive when the staining percentage of tumor cells was >25% (n = 31). Pelvic radiotherapy with a total dose of 39.6–45 Gy was delivered concurrently with fluorouracil-based chemotherapy. Hyperthermia was administered to 52 patients twice a week during CCRT. Treatment response and outcomes were compared between hyperthermochemoradiotherapy (HCRT) and CCRT groups.

Results

In patients with positive CA9 expression, the rates of downstaging (p = 0.060) and pathologic complete response (p = 0.064) tended to be higher in the HCRT group than in the CCRT group. Distant metastasis-free survival (p = 0.029) and cancer-specific survival (p = 0.020) were significantly worse in tumors with both positive CA9 expression and poor tumor response. Negative CA9 expression, presence of major tumor response, and the use of hyperthermia were significant favorable prognostic factors for cancer-specific survival after the first recurrence in multivariate analysis.

Conclusions

Hyperthermia might selectively enhance the preoperative treatment response in LARC with positive CA9 expression and offset the negative effect of hypoxia on prognosis. Pretreatment evaluation of hypoxia could aid in the selection of patients who might benefit from hyperthermia.

Keywords

Rectal cancer Concurrent chemoradiotherapy Hyperthermia Carbonic anhydrase 9 Treatment response 

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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Department of Radiation OncologyKonyang University College of MedicineDaejeonRepublic of Korea
  2. 2.Department of Radiation OncologyYeungnam University College of MedicineDaeguRepublic of Korea
  3. 3.Department of SurgeryYeungnam University College of MedicineDaeguRepublic of Korea
  4. 4.Department of PathologyYeungnam University College of MedicineDaeguRepublic of Korea
  5. 5.Department of Radiation OncologyKyungpook National University School of MedicineDaeguRepublic of Korea

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