scholarly journals Response to neoadjuvant treatment among rectal cancer patients in a population-based cohort

2020 ◽  
Vol 36 (1) ◽  
pp. 177-185
Author(s):  
Elizabeth Alwers ◽  
Lina Jansen ◽  
Jakob Kather ◽  
Efrat Amitay ◽  
Hendrik Bläker ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Tumor Response ◽  
Patient Survival ◽  
Neoadjuvant Treatment ◽  
Population Based ◽  
Pathological Examination ◽  
Study Patient ◽  
Molecular Characteristics ◽  
Tumor Characteristics

Abstract Background In rectal cancer, prediction of tumor response and pathological complete response (pCR) to neoadjuvant treatment could contribute to refine selection of patients who might benefit from a delayed- or no-surgery approach. The aim of this study was to explore the association of clinical and molecular characteristics of rectal cancer with response to neoadjuvant treatment and to compare patient survival according to level of response. Methods Resected rectal cancer patients were selected from a population-based cohort study. Molecular tumor markers were determined from the surgical specimen. Tumor response and pCR were defined as downstaging in T or N stage and absence of tumor cells upon pathological examination, respectively. The associations of patient and tumor characteristics with tumor response and pCR were explored, and patient survival was determined by degree of response to neoadjuvant treatment. Results Among 1536 patients with rectal cancer, 602 (39%) received neoadjuvant treatment. Fifty-five (9%) patients presented pCR, and 239 (49%) and 250 (53%) patients showed downstaging of the T and N stages, respectively. No statistically significant associations were observed between patient or tumor characteristics and tumor response or pCR. Patients who presented any type of response to neoadjuvant treatment had significantly better cancer-specific and overall survival compared with non-responders. Conclusion In this study, patient characteristics were not associated with response to neoadjuvant treatment, and molecular characteristics determined after surgical resection of the tumor were not predictive of pCR or tumor downstaging. Future studies should include molecular biomarkers from biopsy samples before neoadjuvant treatment.

scholarly journals Influence of incorrect staging of colorectal carcinoma on oncological outcome: are we playing safely?

2021 ◽  
Author(s):  
Claudia Reali ◽  
Gabriele Bocca ◽  
Ian Lindsey ◽  
Oliver Jones ◽  
Chris Cunningham ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Preoperative Staging ◽  
Neoadjuvant Treatment ◽  
Preoperative Imaging ◽  
Resection Margins ◽  
Colorectal Cancers ◽  
Radiological Staging ◽  
N Stage

AbstractAccurate preoperative staging of colorectal cancers is critical in selecting patients for neoadjuvant therapy prior to resection. Inaccurate staging, particularly understaging, may lead to involved resection margins and poor oncological outcomes. Our aim is to determine preoperative imaging accuracy of colorectal cancers compared to histopathology and define the effect of inaccurate staging on patient selection for neoadjuvant treatment(NT). Staging and treatment were determined for patients undergoing colorectal resections for adenocarcinomas in a single tertiary centre(2016–2020). Data were obtained for 948 patients. The staging was correct for both T and N stage in 19.68% of colon cancer patients. T stage was under-staged in 18.58%. At resection, 23 patients (3.36%) had involved pathological margins; only 7 of which had been predicted by pre-operative staging. However, the staging was correct for both T and N stage in 53.85% of rectal cancer patients. T stage was understaged in 26.89%. Thirteen patients had involved(R1)margins; T4 had been accurately predicted in all of these cases. There was a general trend in understaging both the tumor and lymphonodal involvement (T p < 0.00001 N p < 0.00001) causing a failure in administrating NT in 0.1% of patients with colon tumor, but not with rectal cancer. Preoperative radiological staging tended to understage both colonic and rectal cancers. In colonic tumours this may lead to a misled opportunity to treat with neoadjuvant therapy, resulting in involved margins at resection.

scholarly journals CEA, EpCAM, αvβ6 and uPAR Expression in Rectal Cancer Patients with a Pathological Complete Response after Neoadjuvant Therapy

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 516
Author(s):  
Daan Linders ◽  
Marion Deken ◽  
Maxime van der Valk ◽  
Willemieke Tummers ◽  
Shadhvi Bhairosingh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Response Evaluation ◽  
Tumor Bed ◽  
Upar Expression ◽  
Diagnostic Biopsy

Rectal cancer patients with a complete response after neoadjuvant therapy can be monitored with a watch-and-wait strategy. However, regrowth rates indicate that identification of patients with a pathological complete response (pCR) remains challenging. Targeted near-infrared fluorescence endoscopy is a potential tool to improve response evaluation. Promising tumor targets include carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (EpCAM), integrin αvβ6, and urokinase-type plasminogen activator receptor (uPAR). To investigate the applicability of these targets, we analyzed protein expression by immunohistochemistry and quantified these by a total immunostaining score (TIS) in tissue of rectal cancer patients with a pCR. CEA, EpCAM, αvβ6, and uPAR expression in the diagnostic biopsy was high (TIS > 6) in, respectively, 100%, 100%, 33%, and 46% of cases. CEA and EpCAM expressions were significantly higher in the diagnostic biopsy compared with the corresponding tumor bed (p < 0.01). CEA, EpCAM, αvβ6, and uPAR expressions were low (TIS < 6) in the tumor bed in, respectively, 93%, 95%, 85%, and 62.5% of cases. Immunohistochemical evaluation shows that CEA and EpCAM could be suitable targets for response evaluation after neoadjuvant treatment, since expression of these targets in the primary tumor bed is low compared with the diagnostic biopsy and adjacent pre-existent rectal mucosa in more than 90% of patients with a pCR.

scholarly journals Circulating tumor cells: A promising marker of predicting tumor response in rectal cancer patients receiving neoadjuvant chemo-radiation therapy

Oncotarget ◽  
2016 ◽  
Vol 7 (43) ◽  
pp. 69507-69517 ◽  
Author(s):  
Wenjie Sun ◽  
Guichao Li ◽  
Juefeng Wan ◽  
Ji Zhu ◽  
Weiqi Shen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Tumor Response

scholarly journals MRI Radiomics for Prediction of Tumor Response and Downstaging in Rectal Cancer Patients after Preoperative Chemoradiation

2020 ◽  
Vol 5 (6) ◽  
pp. 1286-1295
Author(s):  
Haihui Chen ◽  
Liting Shi ◽  
Ky Nam Bao Nguyen ◽  
Arta M. Monjazeb ◽  
Karen E. Matsukuma ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Tumor Response ◽  
Preoperative Chemoradiation

scholarly journals Reduction of circulating lymphocyte count is a predictor of good tumor response after neoadjuvant treatment for rectal cancer

Medicine ◽  
2018 ◽  
Vol 97 (38) ◽  
pp. e11435 ◽  
Author(s):  
Zehua Wu ◽  
Jianwei Zhang ◽  
Yue Cai ◽  
Ru Deng ◽  
Liu Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymphocyte Count ◽  
Tumor Response ◽  
Neoadjuvant Treatment

Prognostic Relevance of Mucinous Subtype in a Population-based Propensity Score Analysis of 40,083 Rectal Cancer Patients

2015 ◽  
Vol 23 (5) ◽  
pp. 1576-1586 ◽  
Author(s):  
Ignazio Tarantino ◽  
Felix J. Hüttner ◽  
Rene Warschkow ◽  
Bruno M. Schmied ◽  
Markus K. Diener ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Cancer Patients ◽  
Propensity Score Analysis ◽  
Population Based ◽  
Prognostic Relevance ◽  
Score Analysis

Patient versus clinician symptom reporting during chemoradiation for rectal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 646-646 ◽  
Author(s):  
Libertad T. Flores ◽  
Antonia V Bennett ◽  
Ethel B Law ◽  
Carla Hajj ◽  
Mindy P Griffith ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Group Versus ◽  
Intensity Modulated Radiotherapy ◽  
Study Patient ◽  
Cohen’S Kappa ◽  
Paired Group ◽  
Cohen's Kappa ◽  
Patient Reported ◽  
Clinician Assessment

646 Background: Pelvic radiotherapy with concurrent 5-fluorouracil based chemotherapy (chemoradiation) is a component of standard therapy for patients with T3/T4 or node-positive rectal cancer. Chemoradiation can be associated with significant acute gastrointestinal toxicity. This study sought to retrospectively compare patient and clinician reports of acute symptoms experienced by rectal cancer patients receiving chemoradiation. Methods: The charts of 199 rectal cancer patients who received chemoradiation from 11/06 to 2/11 were reviewed. Clinicians assessed toxicity weekly using Common Terminology for Clinical Adverse Event (CTCAE) version 3.0. Patient-reported outcomes (PROs) were collected weekly, in clinic, beginning 9/09 using the 7-item Bowel Problems Scale. 197 patients had at least one clinician assessment or PRO and were eligible for this study. Patient and clinician assessments were compared among a subgroup of 65 patients (paired group) who had at least one patient and clinician assessment on the same date using descriptive statistics. Agreement between patient and clinician assessments was evaluated by Cohen’s kappa coefficient. Results: Characteristics were well-balanced between all rectal patients and the paired group, with the exception of the use of intensity modulated radiotherapy (IMRT). IMRT has been used increasingly over time, and IMRT was therefore used in a larger proportion of the paired group versus all patients (77% vs. 51%, respectively). Diarrhea and proctitis were reported more often by patients than clinicians throughout treatment. Uncorrected agreement for diarrhea and proctitis was 82% and 72%, respectively. Corrected for chance, Cohen’s kappa was .64 for diarrhea, indicating moderate agreement, and .22 for proctitis, indicating only slight agreement. Conclusions: Our findings suggest a discrepancy between clinician and patient symptom reports. Further study is warranted to discern potential benefits of including PROs in prospective studies, and to find whether PROs can help clinicians set patient expectations, and/or enhance communication for optimal symptom management.

Sign in / Sign up

Export Citation Format

Share Document