Neoadjuvant Radiochemotherapy for Patients With Locally Advanced Rectal Cancer Leads to Impairment of the Anal Sphincter

2006 ◽  
Vol 10 (2) ◽  
pp. 309-314 ◽  
Author(s):  
J THEISEN ◽  
W KAUER ◽  
H NEKARDA ◽  
L SCHMID ◽  
H STEIN ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Sphincter ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Radiochemotherapy

A nomogram based on clinical factors to predict locally advanced stage of rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 376-376
Author(s):  
Guoxiang Cai ◽  
Baorong Song ◽  
Liyong Huang ◽  
Ye Xu ◽  
Zuqing Guan ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Preoperative Staging ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Radiochemotherapy ◽  
Advanced Stage ◽  
Serum Cea ◽  
Magnetic Resonance Imaging Mri

376 Background: Preoperative staging of rectal cancer is important for designing treatment strategy. The standard treatment for locally advanced rectal cancer is neoadjuvant radiochemotherapy followed by surgery. Magnetic resonance imaging (MRI) and transrectal ultrasonography are major staging approaches with a prediction accuracy of about 70-80% but not widely available in hospitals in China. We sought to define possible clinicopathological predictors and establish a simple nomogram as a reference tool for patients and clinicians to predict stage of rectal cancer and make decisions about neoadjuvant therapy. Methods: Preoperative staging of rectal cancer is important for designing treatment strategy. The standard treatment for locally advanced rectal cancer is neoadjuvant radiochemotherapy followed by surgery. Magnetic resonance imaging (MRI) and transrectal ultrasonography are major staging approaches with a prediction accuracy of about 70-80% but not widely available in hospitals in China. We sought to define possible clinicopathological predictors and establish a simple nomogram as a reference tool for patients and clinicians to predict stage of rectal cancer and make decisions about neoadjuvant therapy. Results: In the training set, 77.1% of patients had locally advanced stage by pathology. The multivariate analysis indicated that tumor size (Odds ratio (OR)=1.55, p< 0.001), differentiation (OR =0.38, p< 0.001), location (OR =1.06, p=0.038), serum CEA (OR =0.24, p< 0.001) and CA19-9 level (OR =0.13, p< 0.001) were associated with tumor stage. A nomogram consisting of these 5 factors was developed and predicted locally advanced stage with a concordance index of 0.756. The concordance index of this nomogram was 0.800 in the validation set. Conclusions: Large tumor size, far from anal verge, poor differentiation, elevated serum CEA and CA19-9 level were high-risk factors of locally advanced stage of rectal cancer. The nomogram based on these clinical factors can predicte locally advanced rectal cancer with a considerable accuracy and thus helpful for making neoadjuvant therapy recommendations.

scholarly journals 8-Oxoguanine DNA Glycosylase (OGG1) Cys326 Variant: Increased Risk for Worse Outcome of Patients with Locally Advanced Rectal Cancer after Multimodal Therapy

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2805
Author(s):  
Martin Leu ◽  
Theresa Riebeling ◽  
Leif Hendrik Dröge ◽  
Laura Hubert ◽  
Manuel Guhlich ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Outcome ◽  
Cox Regression ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Rank Test ◽  
Neoadjuvant Radiochemotherapy ◽  
Increased Risk

Despite excellent loco-regional control by multimodal treatment of locally advanced rectal cancer, a substantial portion of patients succumb to this disease. As many treatment effects are mediated via reactive oxygen species (ROS), we evaluated the effect of single nucleotide polymorphisms (SNPs) in ROS-related genes on clinical outcome. Based on the literature, eight SNPs in seven ROS-related genes were assayed. Eligible patients (n = 287) diagnosed with UICC stage II/III rectal cancer were treated multimodally starting with neoadjuvant radiochemotherapy (N-RCT) according to the clinical trial protocols of CAO/ARO/AIO-94, CAO/ARO/AIO-04, TransValid-A, and TransValid-B. The median follow-up was 64.4 months. The Ser326Cys polymorphism in the human OGG1 gene affected clinical outcome, in particular cancer-specific survival (CSS). This effect was comparable in extent to the ypN status, an already established strong prognosticator for patient outcome. Homozygous and heterozygous carriers of the Cys326 variant (n = 105) encountered a significantly worse CSS (p = 0.0004 according to the log-rank test, p = 0.01 upon multiple testing adjustment). Cox regression elicited a hazard ratio for CSS of 3.64 (95% confidence interval 1.70–7.78) for patients harboring the Cys326 allele. In a multivariable analysis, the effect of Cys326 on CSS was preserved. We propose the genetic polymorphism Ser326Cys as a promising biomarker for outcome in rectal cancer.

Nuclear factor-kB (NF-kB), p53, survivin, Ki-67, and Bcl-2 as prognostic factors in locally advanced rectal cancer patients receiving radiochemotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22062-e22062
Author(s):  
R. Berardi ◽  
A. Mandolesi ◽  
A. Onofri ◽  
E. Maccaroni ◽  
G. Mantello ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Radiochemotherapy ◽  
Ki 67 ◽  
Female Ratio

e22062 Background: NF-kB, p53, Survivin, Ki-67 and Bcl-2 expressions have been demonstrated to be prognostic factors in solid tumors. The aim of our analysis was to investigate the importance of their expression, as prognostic factors in patients with locally advanced rectal cancer patients receiving receiving neoadjuvant radiochemotherapy Methods: We analyzed the expression of NF-kB, p53, Survivin, Ki-67 and Bcl-2 in patients with locally advanced rectal cancer who underwent neoadjuvant treatment (radiotherapy ± chemotherapy) at our Department Results: Seventy-four patients were eligible for our analysis. Median age at diagnosis was 66 years (range 36–85). Male/female ratio was 47/37; 37 patients (90%) were diagnosed with adenocarcinoma, whilst 4/41 (10%) with mucinous adenocarcinoma. All the patients received radiotherapy ± 5-fuorouracil/capecitabile-based chemotherapy. Median follow up was 28 months (range 6,7–56,6 months). At univariate and multivariate analysis of the above mentioned parameters, NF-kB, Ki67 and bcl-2 showed an impact on outcome.In particular, in NF-kB-strongly positive patients time to progression (TTP) and overall survival were significantly shorter (p=0,011 and p=0,018 respectively). Moreover a high expression of Ki-67 and a low expression of bcl-2 were associated with a better TTP Conclusions: Our results suggest that NF-kB, bcl-2 and Ki-67 could represent important parameters able to predict the outcome in patients receiving neoadjuvant treatment for rectal cancer. Further prospective studies are warranted in order to confirm the prognostic role of the above mentioned factors in this setting. This could be useful in order to select patients to receive adjuvant chemotherapy after neoadjuvant treatment and surgery for locally advanced rectal cancer, intensifying the adjuvant therapy in some groups of patients and obviating the use of the some drugs (i.e. those involving NF-kB in their mechanism of action) in selected patients No significant financial relationships to disclose.

Predictive value of circulating tumor DNA in locally advanced rectal cancer patients receiving neoadjuvant radiochemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15125-e15125 ◽  
Author(s):  
Min Li ◽  
WeiWei Xiao ◽  
Grace Q. Zhao ◽  
Zhiwei Guo ◽  
Xuexi Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Predictive Value ◽  
Tumor Response ◽  
Predictive Accuracy ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Circulating Tumor Dna ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Radiochemotherapy ◽  
Tumor Dna

e15125 Background: Neoadjuvant radiochemotherapy (RCT) is rapidly becoming the preferred treatment for patients diagnosed with late-stage locally advanced rectal cancer (LARC). Presently, tumor regression grades (TRG) is used to characterize treatment responsiveness; patients with low TRG scores have been shown to receive no benefit from surgery. To-date, however, there exists no reliable method for identifying low TRG-scoring patients without surgery. Here we propose the use of circulating tumor DNA (ctDNA) to identify low TRG-scoring patients to reduce overtreatment and improve quality of life. Methods: 30 LARC patients undergoing neoadjuvant RCT were prospectively enrolled in our study. Plasma was collected before treatment, immediately preceding cycle 3 chemotherapy, and 2 weeks following cycle 4 chemotherapy. Tumor tissue was also collected before treatment start. CtDNA and tumor DNA were sequenced using Accu-Act, a 61-gene NGS panel. Tumor response was classified as TRG1-5 according to Mandard classification system. Somatic mutation profiles were correlated with tumor response. The accuracy of ctDNA and tumor DNA in predicting TRG scores was calculated using the change of allele frequency. The predictive value of ctDNA was also compared to that of standard CEA and CA199 assays. Patients with CEA and CA199 scores below threshold were also considered for evaluation. Results: 18 of the 30 LARC patients enrolled had complete ctDNA profiling test among whom 13 had already undergone surgery. 17 somatic mutations were identified from the 10 patients with TRG scores of either 1, 2, or 3. Predictive accuracy of pretreatment ctDNA profiling was 70%, compared to that of CEA analysis (66%) and CA199 analysis (50%). TRG prediction using ctDNA successfully evaluated half of patients for whom CEA analysis failed to predict the change in tumor burden. Conclusions: Our findings suggest ctDNA mutation profiling may be a powerful tool for predicting TRG in LARC patients undergoing RCT. Further studies are needed to validate the utility of ctDNA in identifying patients who can be spared from unnecessary surgical treatment in LARC. Clinical trial information: NCT02031939.

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