Preoperative chemoradiotherapy (QT-RT) with capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14628-e14628
Author(s):  
Aintzane Sancho ◽  
Ines Marrodan ◽  
Begoña Calvo ◽  
Alberto Muñoz ◽  
Joan Manel Mane ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Sphincter Preservation ◽  
High Rate ◽  
R0 Resection ◽  
Pelvic Mri

e14628 Background: Locally advanced rectal carcinoma is associated with high rate of abdomino-perineal amputation. We analyzed a cohort of patients (pts) diagnosed of locally advanced rectal cancer, treated with neoadjuvant QT-RT with CAPOX followed by four cycles of adjuvant CAPOX after surgery. Methods: Pts with locally advanced rectal cancer (T3-T4 and/or N+) were treated with oxaliplatin (50mg/m2 day 1, 8, 22 and 29) and capecitabine (1650mg/m2 on days 1 to 14 and 22 to 35) combined with pelvic radiotherapy (180cGy/day; 45Gy in 25 fractions). Surgery was scheduled 4 to 6 weeks after completion QT-RT. Four cycles of adjuvant XELOX were administered (capecitabine 2000mg/m2 on days 1 to 14) and oxaliplatin (130mg/m2 day 1) every 3 weeks. The main end points assessed were: rate of sphincter preservation, pathological complete response (pCR) rate, toxicity and feasibility of postoperative chemotherapy. Local staging was done with pelvic MRI and/or EUS. Results: From Sept 2005 to Nov 2012, 201 pts with locally advanced rectal cancer were included. Pts characteristics: M/F 135/66; ECOG 0/1/2: 48/149/4; median age 65 (28-81); upper/mid/distal rectum 29/105/67; stage cT3/N- 21, cT2-T3/N+ 140, cT4/N- 6, cT4/N+ 34. Full dose preoperative QT-RT was administered in 192 (95%). The main toxicities were diarrhea grade 2/3: 42/24 and neurotoxicity grade 1/2: 94/7. After treatment 198 pts underwent surgery. Sphincter preservation and R0 resections were achieved in 125 and 184 respectively. pCR was achieved in 35 pts (17.4%). 145 pts (72%) received all 4 cycles of adjuvant XELOX. Grade 3/4 toxicities included vomiting 3/0, diarrhea 7/0, skin-foot syndrome 2/0, mucositis 1/0, neurotoxicity 6/0, neutropenia 10/1 and thromopenia 6/1. Downstaging in T/N was achieved in 108/144 pts (53.7/71.6%) respectively. 3-year progression-free and overall survival were 75% and 83% respectively. No toxic deaths were reported. Conclusions: Combination QT-RT based in capecitabine and oxaliplatin is a well tolerated regimen and achieved encouring rates of pCR, R0 resection, sphincter preservation and tumor downstaging in patients with locally advanced rectal cancer.

Preoperative chemoradiotherapy with capecitabine and oxaliplatin in patients with locally advanced rectal cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 548-548
Author(s):  
I. Marrodan ◽  
E. Azkona ◽  
S. Carrera ◽  
U. Aresti ◽  
B. Calvo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Sphincter Preservation ◽  
High Rate ◽  
R0 Resection

548 Background: Locally advanced rectal carcinoma is associated with high rate of abdomino-perineal amputation. We analyzed a cohort of patients (pts) diagnosed of locally advanced rectal cancer, treated with neoadjuvant chemoradiotherapy (QT-RT) with capecitabine and oxaliplatin (XELOX) followed by four cycles of adjuvant XELOX after surgery. Methods: Patients with locally advanced rectal cancer (T3-T4 and/or N+) were treated with oxaliplatin (50mg/m2 day 1, 8, 22 and 29) and capecitabine (1,650mg/m2 on days 1 to 14 and 22 to 35) combined with pelvic radiotherapy (180 cGy/day; 45Gy in 25 fractions). Surgery was scheduled 4 to 6 weeks after completion QT-RT. Four cycles of adjuvant XELOX were administered (capecitabine 2,000mg/m2 on days 1 to 14 and oxaliplatin 130mg/m2 on day 1) every 3 weeks. Main end points assessed were: rate of sphincter preservation, pathologic complete response (pCR) rate and the feasibility of postoperative chemotherapy. Results: From March 2007 to April 2010, 98 pts with locally advanced rectal cancer were included. M/F: 66/32; ECOG 0/1: 19/79; median age: 64 (38-81); upper/mid/distal rectum: 13/50/35; clinical stage: cT3/N- 9, cT2-T3/N+ 72, cT4/N- 4, cT4/N+ 13. Full dose of preoperative QT-RT was administered in 93 pts (95%). Main toxicities were grade 1/2 neurotoxicity (56/4) and grade 2/3 diarrhea (23/10). After treatment 96 pts underwent surgery. Sphincter preservation, R0 resections and pCR were achieved in 57, 93 pts and 17 (18%) patients, respectively, and 65 pts (66%) received all 4 cycles of adjuvant XELOX. Grade 3/4 toxicities included diarrhea 3/0, vomiting 2/0, neurotoxicity 5/0, hand-foot syndrome 1/0, neutropenia 4/0 and thrombopenia 0/4. 3-year progression-free and overall survival were 66% and 72%, respectively. No toxic deaths were reported. Downstaging in T/N stage was achieved in 53/71 pts (55/74%) respectively. Conclusions: Combination preoperative QT-RT with capecitabine and oxaliplatin is a well tolerated regimen and achieves encouraging rates of pCR, R0 resection, sphincter preservation and tumor downstaging in patients with locally advanced rectal cancer. No significant financial relationships to disclose.

Exosomal microRNA-199b-5p as a potential circulating biomarker to predict response of preoperative chemoradiotherapy for locally advanced rectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15161-e15161 ◽  
Author(s):  
Dong Won Baek ◽  
Kyung Hwa Kim ◽  
Byung Woog Kang ◽  
Hye Jin Kim ◽  
Soo Yeon Park ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Serum Samples ◽  
Pathologic Stage ◽  
Tissue Specimens ◽  
Response Group

e15161 Background: Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision has become the standard treatment for locally advanced rectal cancer (LARC). However, the effect of CRT varies from complete response to complete resistance, and predicting response to CRT have not been well characterized yet. Previous studies have shown the potential of micro-RNA (miRNA) based approaches to enhance tumor radiation response. Accordingly, the present study attempted to identify biomarkers to predict response for preoperative CRT using comprehensive miRNA analysis in patients with LARC. Methods: This study included 65 rectal cancer tissues and 90 serum samples from patients who diagnosed with LACR and received preoperative CRT at Kyungpook National University Chilgok Hospital. Tissue specimens and serum samples were collected before CRT to evaluate the biologic differences between the good CRT response group and the poor CRT response group. For discovery of specific miRNAs, 800 miRNAs were analyzed using NanoString in 30 rectal cancer tissues. Thereafter, a total of 65 tissues, and 90 serum samples were investigated using real-time PCR for validation. Results: The median age was 59 years (range, 30-82), and the ratio of male to female was 3.05 to 1. The pathologic stages after preoperative CRT were as follows: pathologic complete response (n=13, 14.4%), pathologic stage I (n=13, 14.4%), pathologic stage II (n=27, 30.0%), pathologic stage III (n=28, 31.1%), and pathologic stage IV (n=9, 10.0%). In the discovery set, 16 target miRNAs were detected. In the validation set with tissue specimens, expression of 3 miRNAs (miR-199a/b-3p ( p=0.032), miR-199a-5p ( p=0.023), miR-199b-5p ( p=0.005)) was significantly upregulated which was associated with better response of CRT. Moreover, among the 3 candidate miRNAs, miR-199b-5p level was significantly upregulated in serum, and it was also found to be related with better response of CRT in LARC (pathologic stage 0/I versus II/III/IV, p=0.027). Conclusions: In the present study, high level of exosomal miR-199b-5p was associated with better response, suggesting it to be a promising non-invasive biomarker to predict response of CRT in patients with LARC. Accordingly, specific miRNAs can be predictive biomarker or therapeutic target to overcome radiotherapy resistance in LARC with a functional study.

scholarly journals Road to organ preservation in locally advanced rectal cancer

2017 ◽  
Vol 145 (7-8) ◽  
pp. 415-420
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Branko Brankovic
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Operative Management ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Pathological Examination ◽  
Diagnostic Tools ◽  
Non Operative Management

Introduction. In the past 20 years there has been significant change in the treatment of rectal cancer, especially in terms of multimodal approach. Surgery is, at least for now, the mainstay treatment for resectable rectal cancer. Preoperative chemoradiotherapy is, regardless of its modality, short or long course, different chemotherapeutic regiments, widely recommended for locally advanced rectal cancer. After neoadjuvant treatment, 15?27% of patients experience pathological complete response (pCR). These patients could benefit from non-operative management, thus avoiding potential surgical complications and possible reduction in the quality of life. Unfortunately, one cannot precisely define, while omitting surgery, which patients have pCR. For this reason Habr-Gama, a pioneer in the ?watch-and-wait? strategy, developed a new endpoint for non-operative management ? clinical complete response. To measure the response, in the absence of pathological examination, same diagnostic tools are used as in initial staging, but none is reliable enough to be used alone. This article is focusing on critical points in the reassessment of response to preoperative chemoradiotherapy for advanced rectal cancer, which is mandatory for appropriate selection of patients who might benefit from non-operative management.

Phase I trial of neoadjuvant concurrent chemoradiotherapy with S-1 and weekly irinotecan in locally advanced rectal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14543-14543
Author(s):  
J. Ahn ◽  
H. Choi ◽  
S. Cheon ◽  
S. Shin ◽  
K. Keum ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Phase I ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
R0 Resection ◽  
Dose Levels

14543 Background: S-1 is a novel, orally administered 5-FU analogue and is known of radiosensitizer. The aim of this study was to establish the feasibility and efficacy of S-1 in combination with weekly irionotecan with concurrent pelvic radiotherapy (RT) in patients with locally advanced rectal cancer. Methods: Clinical stage T3–4 or N+(on MRI) rectal adenocarcinoma patients received weekly irinotecan 40mg/m2(day1,8,15,22,29) and S-1 at dose levels of 40, 50, 60 and 70mg/m2 (5days a week from day 1 to 38) according to phase I methodology. Concurrently conventional RT was given at daily fractions of 1.8 Gy on 5 days a week for a total dose of 50.4 (45 + 5.4)Gy. Surgery was performed 4–8 weeks following completion of chemoradiation. Results: A total 16 patients (10M/7F, median age 46 years, ECOG PS0–1) were enrolled between August 2005 and July 2006. One pt withdrew the consent during CCRT. Dose-limiting toxicity (DLT) occurred at 50mg/m2 of S-1 in one of six pts (G4 cerebral infarction). At dose of 60, 70mg/m2 of S-1, no DLT occurred. G3/4 toxicties were rare. Fifthteen pts underwent surgery and R0 resection was achieved in 13 pts. Four pts (25.0%) had a pathological complete response. Conclusions: The recommended dose (RD) for further study is S-1 70mg/m2 with irinotecan and radiotherapy. Neoadjuvant S-1/irinotecan/RT is feasible and well tolerated. Phase II trial is being conducted. No significant financial relationships to disclose.

scholarly journals Prognostic impact of acellular mucin pools towards the patients with locally advanced rectal cancer achieving pathological complete response after preoperative chemoradiotherapy

2020 ◽  
Vol 13 ◽  
pp. 175628482091125
Author(s):  
Lin Zhang ◽  
Huajie Guan ◽  
Qiuyun Luo ◽  
Lifang Yuan ◽  
Yulan Mao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Prognostic Impact

Background: To date, the prognostic significance of acellular mucin pools in tumors from patients with locally advanced rectal cancer (LARC) undergoing preoperative chemoradiotherapy (CRT) and subsequently obtaining pathological complete response (pCR) has not been well determined. Our current study aimed to explore the prognostic impact on these patients of acellular mucin pools. Methods: We collected clinical data from 117 consecutive LARC patients who achieved pCR after preoperative CRT and then underwent radical resection. Two groups of patients were generated, according to the presence or absence of acellular mucin pools. The 5-year disease-free survival (DFS) and overall survival (OS) rates were compared between the two groups of patients. Results: A total of 27 (23.1%) patients presented with acellular mucin pools. At a median follow-up period of 64 months, patients with acellular mucin pool showed a 5-year DFS rate (96.3% versus 83.7%, p = 0.110) and 5-year OS rate (100% versus 87.5%, p = 0.054) statistically similar to those of patients without acellular mucin pools. In univariable and multivariable Cox regression analyses, the presence of acellular mucin pools was not determined as an independent risk factor for DFS [hazard ratio (HR): 0.222; 95% confidence interval (CI): 0.029–1.864; p = 0.145] or OS (HR: 0.033; 95% CI: 0.000–9.620; p = 0.238). Conclusions: Acellular mucin pools had no significant prognostic impact on LARC patients showing pCR after preoperative CRT.

Sign in / Sign up

Export Citation Format

Share Document