EGF61 Polymorphism Predicts Complete Pathologic Response to Cetuximab-Based Chemoradiation Independent of KRAS Status in Locally Advanced Rectal Cancer Patients

Introduction: Administration of chemotherapeutic regimens such as FOLFOX or CAPEOX with chemoradiation in the neoadjuvant setting, termed total neoadjuvant treatment (TNT), was introduced in recent years. By increasing the complete pathologic and clinical responses, patients with locally advanced rectal cancer may have better oncologic outcomes and potentially abstain from undergoing a proctectomy. Methods: All patients who underwent TNT at a single National Accreditation Program for Rectal Cancer accredited referral center were included. A retrospective analysis was performed using a computerized Institutional Review Board-approved database. Patient demographics, diagnostic workup, treatment regimens, and surgical and pathological reports were reviewed. Complete pathological response was the primary outcome. Univariable and multivariable logistic regression analyses were performed to identify potential factors predisposing to complete pathological response. Results: Thirty patients met the inclusion criteria, 14(46.6%) of whom had complete pathologic response. There was no difference in baseline demographic characteristics between patients who achieved complete pathological response and those who did not. Pathology revealed a 92% intact mesorectum rate in the complete pathologic response group and a mean of 24 harvested lymph nodes in the entire study cohort. Both univariable and multivariable logistic regression analyses failed to demonstrate statistically significant factors predicting complete pathologic response, magnetic resonance imaging (MRI) tumor size, and posttreatment MRI lymph node positivity. Conclusion: TNT is safe and efficient for patients with locally advanced rectal cancer. It increases complete pathological and clinical response rates and may more widely evolve to be the treatment of choice in this group of patients in the near future.

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Rates of pathologic complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with or without regional pelvic hyperthermia for locally advanced rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.622 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 622-622

Author(s):

Cihan Gani ◽

Christopher Schroeder ◽

Ulf Lamprecht ◽

Michael Bamberg ◽

Bernhard Berger

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Pathologic Response ◽

Neoadjuvant Radiochemotherapy ◽

Complete Pathologic Response ◽

Regional Hyperthermia ◽

Significant Difference ◽

The Impact

622 Background: Regional pelvic hyperthermia is frequently added to neoadjuvant radiochemotherapy for locally advanced rectal cancer. The present retrospective study is the first to evaluate the impact of hyperthermia on rates of complete pathologic response and sphincter-sparing surgery in the context of a standard up-to-date neoadjuvant radiochemotherapy scheme. Methods: Between 2007 and 2010, 85 consecutive patients with locally advanced cancer (cT3, cT4, cN+) of the middle and lower rectum received neoadjuvant radiochemotherapy at our institution. 45 of 85 patients (“RCT group”) received standard treatment consisting of radiotherapy to the pelvis with 5040 cGy in 28 fractions of 180 cGy and 5-fluorouracil as a continuous infusion with 1000 mg/m² over 120 hours during the first and fifth week of treatment. 40 of 85 patients (“HRCT group”) received the same treatment with at least four treatments of weekly regional hyperthermia. Target temperature was 40.5°C for at least 60 minutes. Total mesorectal excision was routinely performed. Results: No significant difference in the distribution of age, gender, clinical stage and tumor grade was observed between both groups. Complete pathologic response was seen in 6.7% of patients in the RCT group and 22% of patients in the HRCT group (p=0.034). Overall rates of sphincter-sparing surgery were 64% in the RCT group and 65% in HRCT. However for deep seated tumors located within 4 cm of the anal verge (based on initial staging), sphincter sparing surgery was achieved in only 11.1% of patients in the RCT group but 35.7% of patients in the HRCT group (p = 0.19). Conclusions: The addition of regional hyperthermia to neoadjuvant radiochemotherapy significantly increases the rate of complete pathologic response, with a tendency towards higher rates of sphincter-sparing surgery for deep seated tumors.

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