scholarly journals P-175 Total neoadjuvant treatment versus standard therapy (neoadjuvant radiochemotherapy and adjuvant chemotherapy) of rectal cancer with high-risk factors for local or systemic recurrence

2020 ◽  
Vol 31 ◽  
pp. S147
Author(s):  
M. Tuta ◽  
N. Boc ◽  
M. Peternel ◽  
F. Anderluh ◽  
I. Oblak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Standard Therapy ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Radiochemotherapy ◽  
Systemic Recurrence ◽  
High Risk Factors

scholarly journals Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia

2019 ◽  
Vol 53 (4) ◽  
pp. 465-472
Author(s):  
Mojca Tuta ◽  
Nina Boc ◽  
Erik Brecelj ◽  
Mirko Omejc ◽  
Franc Anderluh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
High Risk ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Distant Recurrence ◽  
High Risk Factors ◽  
Grade 3

Abstract Background In the light of a high rate of distant recurrence and poor compliance of adjuvant chemotherapy in high risk rectal cancer patients the total neoadjuvant treatment was logical approach to gaining acceptance. We aimed to evaluate toxicity and efficiency of this treatment in patients with rectal cancer and high risk factors for local or distant recurrence. Patients and methods Patients with rectal cancer stage II and III and with at least one high risk factor: T4, presence of extramural vein invasion (EMVI), positive extramesorectal lymph nodes or mesorectal fascia (MRF) involvement were treated with four cycles of induction CAPOX/FOLFOX, followed by capecitabine-based radiochemotherapy (CRT) and two consolidation cycles of CAPOX/FOLFOX before the operation. Surgery was scheduled 8–10 weeks after completition of CRT. Results From November 2016 to July 2018 66 patients were evaluable. All patients had stage III disease, 24 (36.4%) had T4 tumors, in 46 (69.7%) EMVI was present and in 47 (71.2%) MRF was involved. After induction chemotherapy, which was completed by 61 (92.4%) of patients, radiologic downstaging of T, N, stage, absence of EMVI or MRF involvement was observed in 42.4%, 62.1%, 36.4%, 69.7% and 68.2%, respectively. All patients completed radiation and 54 (81.8%) patients received both cycles of consolidation chemotherapy. Grade 3 adverse events of neoadjuvant treatment was observed in 4 (6%) patients. Five patients rejected surgery, 3 of them with radiologic complete clinical remissions. One patient did not have definitive surgery of primary tumor due to unexpected cardiac arrest few days after sigmoid colostomy formation. Among 60 operated patients pathological complete response rate was 23.3%, the rate of near complete response was 20% and in 96.7% radical resection was achieved. Pathological T, N and stage downstaging was 65%, 96.7% and 83.4%, respectively. Grade ≥ 3 perioperative complications were anastomotic leakage in 3, pelvic abscess in 1 and paralytic ileus in 2 patients. The rate of pathologic complete response (pCR) in patients irradiated with 3D conformal technique was 12.1% while with IMRT and VMAT it was 37% (p < 0.05). Hypofractionation with larger dose per fraction and simultaneous integrated boost used in the latest two was the only factor associated with pCR. ConclusionsTotal neoadjuvant treatment of high risk rectal cancer is well tolerated and highly effective with excellent tumor and node regression rate and with low toxicity rate. Longer follow up will show if this strategy will improve distant disease control and survival.

A phase II trial of total neoadjuvant treatment (TNT) (Capox plus radiotherapy) for local advanced rectal cancer patients with high risk factors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15025-e15025
Author(s):  
Xin Wang ◽  
Yongyang Yu ◽  
Xiangbing Deng ◽  
Wenjian Meng ◽  
Hong Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
R0 Resection ◽  
High Risk Factors ◽  
Common Grade ◽  
Grade 3

e15025 Background: Standard neoadjuvant concurrent chemoradiotherapy didn't achieve improved overall survival in stage II-III rectal cancer. Total neoadjuvant treatment (TNT) might be a proper treatment option for patients with high risk factors. Therefore, this phase II trial was conducted to evaluate the safety and efficacy of TNT (Capox and IMRT/VMAT) in rectal cancer patients with high risk factors. Methods:Patients who were diagnosed stage II-III rectal cancer with at least one of the following high risk factors were recruited: cT4b, cN2, EMVI +, MRF+, lateral LN +. Three cycles of induction Capox were followed by pelvic IMRT/VMAT and two cycles of concurrent Capox. Three cycles of consolidation Capox were delivered after radiotherapy. Primary endpoints were pathological complete response (pCR) and R0 resection rate. Secondary endpoints were DFS, OS, toxicities and QOL. Here we present the initial results of this study. Results: From Jun 2015 to Jan 2017, 42 patients were evaluable. One patient (2.4%) who had acute intestinal obstruction after the first cycle of chemotheraoy underwent emergency TME. A total of 27 patients (64.3%) completed 8 cycles of chemotherapy. Forty-one patients (97.6%) completed the planned radiotherapy. 15 of 42 patients (35.7%) achieved a pCR or cCR, in which 12 patients (80%) completed 8 cycles of chemotherapy. Five patients refused the operation and selected Watch & Wait. R0 resection rate of patients who underwent TME were 100%. The mean time of operation was 207 minutes (120-370 minutes). And the mean estimated blood loss was 89ml (10-500ml). The most common grade 3 or higher adverse events associated with the neoadjuvant administration were leucopenia (9.5%), diarrhea (4.8%), radiation dermatitis (4.8%) and thrombocytopenia (2.4%). The most common grade 3 or worse surgery-related complications were pelvic abscesses, anastomotic leaks and hemorrhage which were observed in one patient, respectively. Conclusions: Total neoadjuvant treatment (TNT) is effective and safe for local advanced rectal cancer patients with high risk factors. Long-term efficacies of TNT need to be evaluated.

Neoadjuvant Radiotherapy Versus Surgery Alone for Stage II/III Mid-low Rectal Cancer With or Without High-risk Factors

2019 ◽  
Vol 272 (6) ◽  
pp. 1060-1069 ◽  
Author(s):  
Xiangbing Deng ◽  
Ping Liu ◽  
Dan Jiang ◽  
Mingtian Wei ◽  
Xin Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
High Risk ◽  
Low Rectal Cancer ◽  
Stage Ii ◽  
Neoadjuvant Radiotherapy ◽  
High Risk Factors

Adjuvant chemotherapy for pathological stage I non-small cell lung cancer with high-risk factors for recurrence: A multicenter study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8500-8500 ◽  
Author(s):  
Yasuhiro Tsutani ◽  
Kentaro Imai ◽  
Hiroyuki Ito ◽  
Takahiro Mimae ◽  
Yoshihiro Miyata ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage I ◽  
Pathological Stage ◽  
Component Size ◽  
High Risk Factors ◽  
Invasive Component ◽  
Risk Factors For Recurrence ◽  
Lymphatic Permeation

8500 Background: The role of adjuvant chemotherapy for pathological stage I non-small cell lung cancer (NSCLC) is controversial. The purpose of this study was to investigate the effect of adjuvant chemotherapy for pathological stage I NSCLC with high-risk factors for recurrence. Methods: Prospectively collected data from 1,278 patients with pathological stage I (8th edition) NSCLC undergoing lobectomy were retrospectively analyzed. High-risk factors for recurrence were determined by multivariable Cox proportional hazards model for recurrence-free survival (RFS). RFS, overall survival (OS), and cancer-specific survival (CSS) were compared between patients who received adjuvant chemotherapy and those who did not. Results: In multivariable analysis, age (≥70 y; hazard ratio [HR], 2.14), invasive component size ( > 2 cm; HR, 1.60), visceral pleural invasion (HR, 1.81), lymphatic permeation (HR, 1.67), and vascular invasion (HR, 2.78) were identified as independent factors for RFS. In patients with high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion (high-risk group; n = 641), RFS was significantly different between patients who received adjuvant chemotherapy (n = 222; 5-y RFS, 81.4%) and those who did not (n = 418; 5-y RFS, 73.8%; P = 0.023). OS and CSS were also significantly better in patients who received adjuvant chemotherapy (5-y OS, 92.7%; 5-y CSS, 95.0%) than in those who did not (5-y OS, 81.7%; P < 0.0001; 5-y CSS, 89.5%; P = 0.012). In patients without any high-risk factors for recurrence (low-risk group; n = 637), RFS was not significantly different between patients who received adjuvant chemotherapy (n = 83; 5-y RFS, 98.1%) and those who did not (n = 554; 5-y RFS, 95.7%; P = 0.30). OS and CSS were also not significantly different between patients who received adjuvant chemotherapy (5-y OS, 98.0%; 5-y CSS, 100%) and those who did not (5-y OS, 95.6%; P = 0.35; 5-y CSS, 99.4%; P = 0.52). Conclusions: Adjuvant chemotherapy may improve survival in patients with pathological stage I NSCLC who have high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion.

Tumor-associated macrophages as predictive biomarkers for postoperative adjuvant chemotherapy in patients with stage II colon cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 620-620
Author(s):  
Jianmin Xu ◽  
Qingyang Feng ◽  
Wenju Chang ◽  
Ye Wei ◽  
Li Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Tumor Associated Macrophages ◽  
Postoperative Adjuvant Chemotherapy ◽  
Patient Counselling ◽  
High Risk Factors ◽  
Stage Ii Colon Cancer

620 Background: For stage II colon cancer, the effect of postoperative adjuvant chemotherapy is still controversial. It is well known that tumor-associated macrophages (TAMs) play an important role in tumor progression. The aim of this study is to determine the effect of TAMs as predictor for adjuvant chemotherapy for stage II colon cancer. Methods: From July 2009 to June 2012, 521 patients with pathological stage II colon cancer were included. TAMs were detected using tissue microarray and immunohistochemistry (all TAMs detected by CD68; M2 subtype detected by CD206). The density of CD68+ TAMs, CD206+ TAMs and the ratio of CD206+ TAMs / CD68+ TAMs (CD206 / CD68 ratio) were calculated. The cut-off values were defined using X-Tile software. Results: High CD206+ TAMs density and high CD206 / CD68 ratio were significantly associated with reduced disease-free survival (DFS, P < 0.001 and P < 0.001, respectively) and overall survival (OS, P < 0.001 and P < 0.001, respectively). And CD206 / CD68 ratio had a better prognostic power. Furthermore, for patients with low CD206 / CD68 ratio, adjuvant chemotherapy made no benefit. But for high CD206 / CD68 ratio, adjuvant chemotherapy significantly improved DFS and OS (as shown in Table 1). In subgroup analysis, for T3 with high-risk factors or T4 tumors, CD206 / CD68 ratio was also a significant predictor for adjuvant chemotherapy (interaction P = 0.024 in DFS). Conclusions: For stage II colon cancer, CD206 / CD68 ratio was a good prognostic and predictive biomarker for adjuvant chemotherapy. Together with clinicopathological high-risk factors, it might facilitate patient counselling and individualise management. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document