scholarly journals Prognoses in Pathologically Confirmed T1 Lower Rectal Cancer Patients with or without Preoperative Therapy: An Analysis Using the Surveillance, Epidemiology, and End Results Database

Oncology ◽  
2021 ◽  
Author(s):  
Tetsuro Taira ◽  
Hiroaki Nozawa ◽  
Kazushige Kawai ◽  
Kazuhito Sasaki ◽  
Koji Murono ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Preoperative Therapy ◽  
Lower Rectal Cancer ◽  
Cancer Specific Survival ◽  
Factors Associated ◽  
Significant Difference ◽  
Significant Factors ◽  
End Results

Introduction Preoperative chemoradiotherapy (CRT) is the standard therapy for downstaging in locally advanced lower rectal cancer. However, it remains unclear whether rectal cancers down-staged by preoperative therapy show similar prognoses to those of the same stage without preoperative therapy. We previously demonstrated that preoperative CRT did not affect prognosis of rectal cancer with pathological T1N0 (pT1N0) stage in a single institute. Here, using a larger dataset, we compared prognoses of (y)pT1 rectal cancer stratified by the use of preoperative therapy and analyzed prognostic factors. Methods Cases of pT1N0 rectal cancer, registered between 2004 and 2016, were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized as the ‘ypT1 group’ if they had undergone preoperative therapy before surgery or as the ‘pT1 group’ if they had undergone surgery alone. overall survival (OS) and cancer-specific survival (CSS) between these groups of patients was compared. Factors associated with CSS and OS were identified by univariate and multivariate analyses. Results Among 3,757 eligible patients, ypT1 and pT1 groups comprised 720 and 3,037 patients, respectively. While ypT1 patients showed poorer CSS than ypT1 patients, there was no significant difference in OS. Preoperative therapy was not an independent prognostic factor for CSS or OS. Multivariate analysis identified age and histological type as significant factors associated with CSS. Sex, age, race, and number of lymph nodes dissected were identified as significant factors associated with OS. Conclusions Prognosis among patients with (y)p T1N0 rectal cancer was similar irrespective of whether they underwent preoperative therapy, which is consistent with our previous observations.

scholarly journals A multicenter phase I study of preoperative chemoradiotherapy with S-1 and irinotecan for locally advanced lower rectal cancer (SAMRAI-1)

2016 ◽  
Vol 120 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Takeo Sato ◽  
Kazushige Hayakawa ◽  
Naohiro Tomita ◽  
Masafumi Noda ◽  
Norihiko Kamikonya ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Phase I ◽  
Phase I Study ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Multicenter Phase

scholarly journals Neutrophil-to-Lymphocyte Ratio is a Prognostic Predictive Factor for Local Advanced Lower Rectal Cancer Treated with Curative Surgical Treatment after Neoadjuvant Chemoradiotherapy: A Single-Center Retrospective Cohort Study

2021 ◽  
Author(s):  
Ryosuke Nakagawa ◽  
Shimpei Ogawa ◽  
Yuji Inoue ◽  
Takeshi Ohki ◽  
Yoshiko Bamba ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Operation Time ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lower Rectal Cancer ◽  
Curative Surgery ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) correlates with relapse-free survival (RFS) and may be a predictor of recurrence in patients after curative surgery for colorectal cancer. This study aimed to analyze the long-term oncological outcomes of locally advanced lower rectal cancer treated with curative surgery after neoadjuvant chemoradiotherapy (nCRT) to examine the prognostic value of the NLR and to evaluate the fluctuation of pre- and post-CRT NLR as recurrence risk factors.Methods: Fifty-two patients who underwent curative surgery were enrolled between 2009 and 2016. A cut-off pre-CRT NLR of 3.20 was used based on receiver-operating characteristic curve analysis. The primary outcome was RFS. Factors influencing recurrence after treatment according to fluctuations between the pre- and post-CRT NLR were also analyzed.Results: Univariate analysis was performed using 17 clinicopathological factors thought to affect RFS. A significant difference was found in the pre-CRT NLR (hazard ratio [HR]: 7.626, 95% confidence interval [CI]: 2.760-21.06, p<0.0001), operation time (HR: 2.949, 95% CI: 1.137-7.646, p=0.0261), and pathological T stage (HR: 8.342, 95% CI: 2.458-28.306 p=0.0007). RFS according to the pre-CRT NLR using Kaplan–Meier analysis showed that the group with pre-CRT ≥3.20 had a lower 5-year RFS (p=0.001). A lower pre-CRT NLR resulted in a significantly higher recurrence rate, regardless of the increase or decrease in the pre- and post-CRT NLR.Conclusions: The pre-CRT NLR may be a predictor of prognosis in patients with locally advanced lower rectal cancer after nCRT.

scholarly journals Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer

2017 ◽  
Vol 35 (23) ◽  
pp. 2631-2638 ◽  
Author(s):  
Naruhiko Ikoma ◽  
Y. Nancy You ◽  
Brian K. Bednarski ◽  
Miguel A. Rodriguez-Bigas ◽  
Cathy Eng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Salvage Surgery ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Mesorectal Excision ◽  
Time To Recurrence ◽  
The Impact

Purpose After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment. Patients and Methods Patients with locally advanced (cT3-4 or cN+) rectal cancer who were treated with preoperative chemoradiotherapy followed by total mesorectal excision at our institution during 1993 to 2008 were identified. We examined patterns of recurrence location, time to recurrence, treatment factors, and survival. Results A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-only recurrence (11.2 months) than in lung-only recurrence (18.2 months) or locoregional-only recurrence (24.7 months; P = .001). Salvage surgery was performed in 57% of patients with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence ( P < .001) but not in those with locoregional-only recurrence ( P = .353). Conclusion We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

Perioperative chemotherapy alone versus preoperative chemoradiotherapy for locally advanced distal esophageal and gastroesophageal junction cancer: A 10-year review of the British Columbia (BC) Cancer Registry.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4028-4028
Author(s):  
Shiru Lucy Liu ◽  
Irene S. Yu ◽  
Sally CM Lau ◽  
Yizhou Zhao ◽  
Devin Schellenberg ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Performance Status ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Pathologic Response ◽  
R0 Resection ◽  
Perioperative Chemotherapy ◽  
Cancer Specific Survival ◽  
Significant Difference

4028 Background: The optimal treatment strategy for resectable cancer of the distal esophagus (ESOPH) and gastroesophageal junction (GEJ) remains controversial. This study evaluates patterns of practice in BC, rates of complete surgical resection, and survival outcomes of patients treated with perioperative chemotherapy alone (CA), per MAGIC or FLOT4 protocol, versus preoperative chemoradiotherapy (CRT), per CROSS protocol. Methods: We undertook a provincial analysis of initially resectable, locally advanced, cancer of the ESOPH and/or GEJ who underwent surgery in BC, from 2008 to 2018. Baseline patient, tumor, treatment, and clinical outcome data were collected from the BC Cancer Registry. Kaplan-Meier survival and multivariate regression analyses were conducted. Results: Among 575 patients, 468 underwent surgery and were included (Table). More surgeries were aborted intraoperatively in the CA cohort compared to CRT (12% vs 2%, p<0.001). There was no difference in age, sex, or ECOG performance status among the cohorts, and 83% were adenocarcinoma. While 82% of ESOPH involving GEJ (N = 251, 54%) is treated with CRT, only 53% of GEJ alone (N=217, 46%) is treated with CRT (p<0.001). CRT is associated with a higher rate of complete or partial pathologic response compared to CA (59% vs 39%, p=0.002). R0 resection rate was 90% and 94% in the CA and CRT cohort, respectively (p=0.383). There is no statistically significant difference in overall survival, with medians of 29.6 and 26.0 months for patients treated with CA and CRT, respectively (p=0.723). Cancer-specific survival is also not significantly different (p=0.565). In the CA cohort, 37% of patients complete all 8 cycles of FLOT and 52% of patients complete all 6 cycles of MAGIC (p=0.396). Conclusions: Patients treated with CRT have higher rates of complete resection and pathologic response, but their survival is not significantly different compared to those treated with CA. [Table: see text]

scholarly journals Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Ming-Yii Huang ◽  
Hsin-Hua Lee ◽  
Hsiang-Lin Tsai ◽  
Ching-Wen Huang ◽  
Yung-Sung Yeh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Efficacy And Safety

A multicenter phase I study on preoperative chemoradiotherapy with S-1 and CPT-11 for locally advanced lower rectal cancer (SAMRAI-1).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 503-503
Author(s):  
Masafumi Noda ◽  
Takeo Sato ◽  
Kazushige Hayakawa ◽  
Naohiro Tomita ◽  
Norihiko Kamikonya ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Phase I ◽  
Phase I Study ◽  
Locally Advanced ◽  
Preoperative Chemoradiotherapy ◽  
Lower Rectal Cancer ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

503 Background: Preoperative chemoradiotherapy with 5-FU is a standard therapy for locally advanced lower rectal cancer. This therapy is useful for increasing local control rates and maintaining anal functions, but there is no evidence indicating that this therapy can extend survival. We performed a phase I study with the objective of developing a new chemoradiotherapy with irinotecan (CPT-11) and S-1, containing gimeracil, a dihydropyrimidine dehydrogenase inhibitor with radiosensitizing effect. Methods: Patients with locally advanced lower rectal cancer (T3-4, N0-2) of which the inferior border was located closer to the anal verge than to the peritoneal reflection were used for analysis. The radiation dose was 45 Gy in 25 fractions. The radiation field included the internal iliac, pararectal, and obturator lymph nodes in addition to the primary tumor and enlarged lymph nodes. S-1 was administered for five consecutive days and withdrawn for two consecutive days (administration: Days 1-5, 8-12, 22-26, and 29-33). The dose of S-1 (80, 100, 120 mg/day) was controlled in accordance with the body surface area. CPT-11 was administered on days 1, 8, 22, and 29. The initial dose of CPT-11 was 60 mg/m2 (Level 1), and the dose was increased gradually. Total mesorectal excision was performed 6-10 weeks after completion of the chemoradiotherapy. Results: 20 patients were enrolled. Excluding 2 patients who discontinued the study, 18 patients were subject to analysis. Dose-limiting toxicity (DLT) was not seen in 3 patients treated with CPT-11 at 80 mg/m2 (Level 2), but was seen in 3 of the 6 patients treated with CPT-11 at 90 mg/m2 (Level 3). DLT was seen in 3 other patients administered a Level 2 dose. At Level 2 or Level 3, DLTs, namely neutropenia, thrombocytopenia and diarrhea were seen. Level 2 was regarded as a maximum tolerated dose, and Level 1 as a recommended dose (RD). The pathological complete response rate was 28%, and the downstaging rate 56%. Conclusions: The results of the study suggest that the RD of CPT-11 is 60 mg/m2. We plan to perform a phase II study to evaluate the efficacy and safety of chemoradiotherapy with S-1 and CPT-11. Clinical trial information: UMIN000001639.

Preoperative chemoradiotherapy for advanced lower rectal cancer using SOX+Bev regimen.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 708-708
Author(s):  
Jun Higashijima ◽  
Mitsuo Shimada ◽  
Kozo Yoshikawa ◽  
Masaaki Nishi ◽  
Hideya Kashihara ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Predictive Factor ◽  
Response Rate ◽  
Preoperative Chemoradiotherapy ◽  
Pathological Response ◽  
Clinical Response Rate ◽  
Lower Rectal Cancer ◽  
Improve Response Rate ◽  
Significant Difference

708 Background: We have performed preoperative CRT for advanced lower rectal cancer patients using S-1 or UFT. To improve response rate, we are performing phase 2 trial of preoperative CRT using S-1/ Oxaliplatin /Bevacizumab (SOX+Bev) regimen. In this study, we show the results of the trial and the promising predictive factor. Methods: Twenty-five patients (SOX+Bev) and 59 patients (S-1 or UFT) were included in this study. S-1(80mg/m2), UFT(300mg/m2) were administered orally every day on radiation therapy, and S-1(80mg/m2,Oxaliplatin(40-60mg/m2),Bevacizumab(5mg/kg) were administered in SOX+Bev group. Total dose of radiation was 40Gy with four field technique. As a predictive factor, we measured miR-223 with real-time PCR using pre CRT biopsy specimens. Results: Clinical response by RECIST were as follows: SOX+Bev group: CR/PR/SD/PD = 1/21/3/0, S-1/UFT group: CR/PR/SD/PD = 1/32/26/0. Clinical response rate were 88% in SOX+Bev group, higher than 56.0% in S-1/UFT group. Pathological response grade were as follows: SOX+Bev group: 1a/1b/2/3 = 5/4/10/6,S-1/UFT group :1a/1b/2/3 = 13/16/27/3. Pathological response rate was 64% in SOX+Bev group, 51% in S-1/UFT group and there was no significant difference. The pCR rate was 24% in SOX+Bev group, significantly higher than 5% in S-1/UFT group (p < 0.05)B In S-1 group, miR-223 in responder group tended to be higher than non-responder group (p = 0.06). And in SOX+Bev group, miR-223 in Grade 3 group(8.89±9.41) was significantly higher than other group (3.19±4.64) (p = 0.05). Conclusions: Preoperative CRT with SOX+Bev regimen can improve response rate and bring high pCR rate. miR-223 may be promising predictive factor and useful to perform order made therapy. Clinical trial information: 13267.

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