Molecular Markers Aid Prediction of Treatment Failure After Surgical Resection and Adjuvant Chemoradiation for Locally Advanced Rectal Cancer

2012 ◽  
Vol 84 (3) ◽  
pp. S350
Author(s):  
J. Kim ◽  
Y. Kim ◽  
H. Kim ◽  
N. Kim ◽  
S.J. Shin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Molecular Markers ◽  
Treatment Failure ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Adjuvant Chemoradiation

Early detection to neoadjuvant chemotherapy response in locally advanced rectal cancer using 18F-FDG PET.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 440-440
Author(s):  
Junichi Hasegawa ◽  
Junichi Nishimura ◽  
Yoji Ogawa ◽  
Ho Min Kim ◽  
Toshiki Hitora ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Early Detection ◽  
Surgical Resection ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinicopathological Parameters ◽  
Tumor Diameter

440 Background: Early detection of treatment response of neoadjuvant chemotherapy (CTx) for locally advanced rectal cancer may spare patients the toxicity of ineffective CTx. We evaluated prospectively tumor response with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in the early course of preoperative CTx. Methods: A total of 15 patients with locally advanced rectal cancer (T3 or T4 and N0-N2) received neoadjuvant CTx (XELOX or XELOX+bevacizumab). Patients underwent 18F-FDG PET before CTx, at the end of first cycle of CTx (12-38 days: median 15days), and before surgical resection. Scans were interpreted using SUVmax parameter. Magnetic resonance imaging (MRI) was undergone before CTx, at the end of 2 cycles of CTx (25-54 days: median 38 days), and before resection. The tumor longest diameter was measured by MRI T2-weighted images. After resection, SUVmax and diameter were compared with the Tumor Regression Grade (TRG). Results: Of 15 patients, TRG1 was in 1 patient, TRG2 was in 5 patients, and TRG3 was in 9 patients. We divided into 2 groups, non-responder (NR) group was TRG1 and TRG2, and responder (R) group was TRG3. There was no significant difference as for clinicopathological parameters before CTx including tumor diameter and SUVmax. The tumor size before surgery was significantly smaller in R group than NR group (22.2 mm vs. 35.0 mm; p = 0.017). SUVmax in R group was significantly lower at the end of first cycle of CTx (4.9 vs. 9.3; p = 0.023), and before surgical resection (3.2 vs. 10.3; p = 0.007) than that in NR group. Conclusions: In this study, 18F-FDG PET at the end of first neoadjuvant CTx successfully predict pathological response of locally advanced rectal cancer.

Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 489-489 ◽  
Author(s):  
S. K. Yu ◽  
G. Brown ◽  
R. J. Heald ◽  
S. Chua ◽  
G. Cook ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinical Staging ◽  
Pet Ct

489 Background: Neoadjuvant chemoradiotherapy (CRT) and surgical resection are standard components of therapy for patients locally advanced rectal cancer (T3,T4 or N+) in UK. In 15%-30% of patients treated pre-operatively with CRT will develop pathological complete response (CR). The time from completion of CRT to maximal tumour response is as yet unknown. This study is the first prospective study to attempt to identify the percentage of patients who can safely omit surgery and the safety of deferred surgery in patients who achieve clinical complete response post CRT. Of the 59 patients required for the study, this provides an update on 19 patients entered. Methods: Patients with locally advanced rectal cancer requiring neoadjuvant treatment are identified in the multidisciplinary meet (MDT). Patients undergo CRT using a minimum of 50.4Gy in 28 # daily conformal CT planned CRT with concomitant Capecitabine at 825mg/m2 BD. MRI pelvis and body CT are repeated 4 weeks post CRT and rediscussed at MDT. If there is a good partial response or CR, patients are considered for Deferral of Surgery Study. Based on the pre treatment clinical staging, patients are considered for adjuvant chemotherapy as per NICE guidance. At any point of the study, if there is histology proven tumour regrowth or progression, patient undergo surgery. Results: 10 (53%) patients remain in CR. 6 (32%) patients underwent surgical resection with clear margin after detection of tumour regrowth at from 2-23 months post CRT. 5 out of 6 of the patients with tumour regrowth underwent PET CT as per protocol, and all tumour regrowth in those 5 patients were detected by PET CT, i.e. FDG avid disease. The pathological stages on these 6 patients were ypT2N0 CRM negative in 5 and ypT3N0 CRM negative in 1. 3 (15%) patients with tumour regrowth refused surgery. Conclusions: In the 19 recruited patients, all the patients with tumour regrowth underwent surgical resection with clear margins. PET CT appears a useful tool for detecting tumour regrowth. The median time for tumour regrowth is 17.5 months post CRT. The trial will be successful if at least 11/59 patients are able to safely omit surgery. Accrual of patients continues. No significant financial relationships to disclose.

Combined modality therapy of locally advanced adenocarcinoma of the rectum: Update of a phase I trial of preoperative radiation (RT) with concurrent capecitabine (Cap) and irinotecan (Ir)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13547-13547
Author(s):  
E. P. Mitchell ◽  
P. Anne ◽  
S. Goldstein ◽  
G. Isenberg ◽  
J. Fitzgerald ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Phase I ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Hematologic Toxicity ◽  
Preoperative Radiation ◽  
Dose Limiting Toxicity

13547 Background: We previously reported the combination of preoperative radiation (RT) with concurrent Irinotecan and 5-FU in locally advanced rectal cancer, was well tolerated and had an excellent pathologic complete response rate (CR) of 25%, but with catheter related infections and thromboses as major toxicities (Proc Am Soc Clin Onc 22: 2003). With the potential benefits of capecitabine (Cap) and no need for an implanted catheter, a phase I study was initiated to determine the toxicity and maximum tolerated dose (MTD) of Cap with concurrent Ir and RT. Methods: Eligible patients (pts) had primary or recurrent Stage II or III rectal adenocarcinoma, without a history of prior RT or chemotherapy. The treatment regimen was as follows: external beam RT at 1.8Gy daily M-F, to a total dose of 50.4 or 54 Gy; Ir 50 mg/m2 IV, d 1, 8, 15, 22; dose escalating Cap starting at 825 mg/m2 PO divided in 2 doses, Q 12h. Surgical resection occurred at 6–10 weeks. Dose limiting toxicity is defined as Gr4 heme or non-heme Gr3. Results: A total of 16 pts have enrolled on the study, 10 male and 6 female;the median age was 57 (range 44–77). All are evaluable for toxicity. The Table reviews the maximum toxicities. Grade three diarrhea is the only dose-limiting toxicity to date. There has also been 3 pts with Gr 3 hematologic toxicity. There has been no Gr 4 toxicity. Patients are currently accruing on the 4th dose level of capecitabine. A total of 13 pts have completed the preoperative phase and three are currently on treatment. Eleven pts have had surgical resection. One pt refused surgery due to a biopsy proven CR to chemoradiation. One pt refused surgery and died of disease. Of the 11 pts undergoing surgical resection, there have been 3 pathologic CR. Conclusions: The preoperative combination of capecitabine, irinotecan and radiation in locally advanced rectal cancer pts is feasible and well tolerated. The study continues to accrue, and the MTD has not been achieved. [Table: see text] [Table: see text]

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