Impact of neoadjuvant chemoradiotherapy on the local recurrence and distant metastasis pattern of locally advanced rectal cancer

Introduction: The ?gold standard? for patients with locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. Aim: Evaluation of local recurrence after surgery for locally advanced rectal cancer. Methods and patients: Retrospective study included 189 patients, who were operated at Oncology Institute of Vojvodina from January 1st 2012 until December 31st 2017. Patients were divided into two groups. In the first group 73 patients who received chemoradiotherapy were included, while 116 patients without neoadjuvant treatment were in the second group. All patients were diagnosed with locally advanced rectal cancer. The existence of operable metastases in the liver and/or lungs did not exclude patients from the study. Patients who had undergone resection of the rectum by Miles, Hartmann or local tumor excision were excluded from the study. Results: The median follow-up period was 48 months (range 13-84). In total, 23 (12.2%) patients developed local recurrence. In the chemoradiotherapy group, 15.1% (11 of 73 patients) had a local recurrence, as compared with 10.3% (12 of 116 patients) in the group without neoadjuvant treatment. In both groups, there were no correlation between rate of local recurrence with other clinical and pathological parameters such as gender, tumor location, T and N stage, histological differentiation, or lymphovascular and perineural invasion (p>0.05). We confirmed significant association between circumferential resection margin with local recurrence in patients who were treated by preoperative chemoradiation (p=0.014). Conclusion: This study has not shown reduced risk of local recurrence after neoadjuvant therapy most likely due to small number of patients. Despite our results, neoadjuvant treatment followed by surgery remains the best treatment protocol for patients with locally advanced rectal cancer.

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Management of Clinically Involved Lateral Lymph Node Metastasis in Locally Advanced Rectal Cancer: A Radiation Dose Escalation Study

Frontiers in Oncology ◽

10.3389/fonc.2021.674253 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xiaolin Pang ◽

Liang Huang ◽

Yan Ma ◽

Zhanzhen Liu ◽

Peiyi Xie ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Neoadjuvant Chemotherapy ◽

Response Rate ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Short Axis ◽

Recurrence Rates

BackgroundPatients with lateral lymph nodes (LLNs) metastasis are not effectively treated with neoadjuvant chemoradiotherapy. This study aimed to compare the efficacy of three neoadjuvant therapeutic regimens, namely, chemotherapy, chemoradiotherapy, and chemoradiotherapy with a dose boost of LLNs, and to identify the optimal approach for treating LLNs metastasis of locally advanced rectal cancer.MethodsA total of 202 patients with baseline LLNs metastasis (short axis ≥5 mm) and treated with neoadjuvant treatment, followed by radical surgery from 2011 to 2019, were enrolled. The short axis of the LLNs on baseline and restaging MRI were recorded. Survival outcomes were compared.ResultsIn the booster subgroup, shrinkage of LLNs was significantly greater than in the neoadjuvant chemotherapy and chemoradiotherapy subgroups (P <0.001), without increasing radiation related side effects (P = 0.121). For patients with baseline LLNs of short axis ≥5 mm in the booster subgroup, the response rate (short axis <5 mm on restaging MRI) was 72.9%, significantly higher than patients in the neoadjuvant chemotherapy subgroup (48.9%, P = 0.007) and higher than for patients in the neoadjuvant chemoradiotherapy group (65.0%), but there was no statistical difference (P = 0.411). The 3-year local recurrence and lateral local recurrence rates were both 2.3% in the dose booster group, which were lower than those of the other two subgroups (local recurrence: P <0.001; lateral local recurrence: P <0.001). The short axis of lateral lymph nodes (≥5 and <5 mm) on restaging MRI was an independent risk factor for prognosis (P <0.05).ConclusionRadiation dose boost is an effective way of increasing the response rate and decreasing recurrence rates. The restaging LLNs with short axis ≥5 mm is a predictor of poor prognosis.

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Deep learning radiomics-based prediction of distant metastasis in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A multicentre study

EBioMedicine ◽

10.1016/j.ebiom.2021.103442 ◽

2021 ◽

Vol 69 ◽

pp. 103442

Author(s):

Xiangyu Liu ◽

Dafu Zhang ◽

Zhenyu Liu ◽

Zhenhui Li ◽

Peiyi Xie ◽

...

Keyword(s):

Rectal Cancer ◽

Deep Learning ◽

Multicentre Study ◽

Distant Metastasis ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer

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Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

World Journal of Gastrointestinal Oncology ◽

10.4251/wjgo.v13.i4.252 ◽

2021 ◽

Vol 13 (4) ◽

pp. 252-264

Author(s):

Hyojung Park

Keyword(s):

Rectal Cancer ◽

Predictive Factors ◽

Distant Metastasis ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Early Distant Metastasis

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768 The Role of MRI Texture Analysis in Predicting Outcomes in Locally Advanced Rectal Cancer After Chemoradiotherapy

British Journal of Surgery ◽

10.1093/bjs/znab134.024 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Alrahawy ◽

M Aker ◽

A Zeinaldin ◽

T Arulampalam

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Texture Analysis ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Distant Metastases ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Imaging Biomarker ◽

Imaging Biomarkers

Abstract Background Locally advanced rectal cancer (LARC) is treated by neoadjuvant chemoradiotherapy(NCRT) followed by surgery after restaging by magnetic resonance imaging(MRI). Texture analysis(TA) is a novel imaging biomarker that can assess heterogeneity in MRIs. This study hypothesizes that TA has the ability to predict the complete response(CR), survival, local recurrence, and distant metastasis. Method This is a retrospective analysis of all patients diagnosed with LARC who received NCRT and who have had MRI scans. Six parameters were systematically extracted from Textural histograms of post-treatment scans. Correlation between TA and CR was tested. These parameters were then examined to determine their ability in predicting local recurrence, distant metastases, and survival by means of Kaplan-Meier survival curves and log-rank tests. Results Four out of the six parameters extracted significantly identified CR. Utilising the same cut-off values across all parameters, three parameters significantly predicted local recurrence: Entropy(p = 0.033), mean of positive pixels(MPP)(p = 0.045), and Skewness(p = 0.018). Four parameters significantly predicted distant metastases: SD(p = 0.015), entropy(p = 0.017), MPP(p = 0.005), and skewness (p < 0.001). Four texture parameters significantly predicted survival: SD(p = 0.002), entropy(p = 0.001), MPP(p < 0.001), and skewness(p = 0.017). Conclusions MRI textural features are potentially significant imaging biomarkers in predicting survival, local recurrence, or liver metastases in LARC.

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Molecular and Dynamic Evaluation of Proteins Related to Resistance to Neoadjuvant Treatment with Chemoradiotherapy in Circulating Tumor Cells of Patients with Locally Advanced Rectal Cancer

Cells ◽

10.3390/cells10061539 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1539

Author(s):

Virgílio Souza e Silva ◽

Emne Ali Abdallah ◽

Bianca de Cássia Troncarelli Flores ◽

Alexcia Camila Braun ◽

Daniela de Jesus Ferreira Costa ◽

...

Keyword(s):

Rectal Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Transforming Growth Factor ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer

The heterogeneity of response to neoadjuvant chemoradiotherapy (NCRT) is still a challenge in locally advanced rectal cancer (LARC). The evaluation of thymidylate synthase (TYMS) and RAD23 homolog B (RAD23B) expression in circulating tumor cells (CTCs) provides complementary clinical information. CTCs were prospectively evaluated in 166 blood samples (63 patients) with LARC undergoing NCRT. The primary objective was to verify if the absence of RAD23B/TYMS in CTCs would correlate with pathological complete response (pCR). Secondary objectives were to correlate CTC kinetics before (C1)/after NCRT (C2), in addition to the expression of transforming growth factor-β receptor I (TGF-βRI) with survival rates. CTCs were isolated by ISET and evaluated by immunocytochemistry (protein expression). At C1, RAD23B was detected in 54.1% of patients with no pCR and its absence in 91.7% of patients with pCR (p = 0.014); TYMS− was observed in 90% of patients with pCR and TYMS+ in 51.7% without pCR (p = 0.057). Patients with CTC2 > CTC1 had worse disease-free survival (DFS) (p = 0.00025) and overall survival (OS) (p = 0.0036) compared with those with CTC2 ≤ CTC1. TGF-βRI expression in any time correlated with worse DFS (p = 0.059). To conclude, RAD23B/TYMS and CTC kinetics may facilitate the personalized treatment of LARC.

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