Pelvic side wall nodes in locally advanced rectal cancer as a prognostic indicator.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 613-613
Author(s):  
Kirsten Elizabeth Jean Laws ◽  
Christina Wilson ◽  
Stephen Harrow
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Side Wall ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Pre Treatment ◽  
Long Course ◽  
Patterns Of Recurrence

613 Background: Neoadjuvant long course chemoradiotherapy is a well recognised treatment in locally advanced rectal cancer. Patients with pelvic side wall nodes are often considered for neoadjuvant treatment. We investigated whether pelvic side wall nodes identified on pre-treatment imaging is a poor prognostic factor and whether there are different patterns of recurrence compared to patients without pelvic side wall node involvement. Methods: All patients treated with long course chemoradiotherapy between January 2008 and December 2009 were identified. Patients were excluded if treatment indication was for inoperable disease, postoperative, recurrence, or palliative intent. 231 patients were identified and a retrospective analysis performed investigating patterns of recurrence and survival for patients with pelvic side wall nodes identified on pre-treatment imaging. Results: Kaplan Meier curves are presented showing patients with pelvic side wall nodes identified on pre-treatment imaging appear to have poorer outcomes and overall survival compared with those with only mesorectal nodes or no nodes. Patterns of recurrence are presented, showing patients with pelvic side wall nodes identified on pre-treatment imaging have a non significant trend to increased rates of disease recurrence (local and distal recurrence combined, 45.7% versus 27.9% for pelvic side wall nodes versus no pelvic side wall nodes). Patients with pelvic side wall nodes identified on pre-treatment imaging appear to be more likely to develop distant metastases compared to those patients who have mesorectal nodes or no nodal involvement (37% versus 23%). Conclusions: Our study highlights that patients with pelvic side wall nodes identified on pre-treatment imaging appear to have a trend to poorer overall survival, are more likely to recur and develop distant metastases. These results were not statistically significant, due to the small number of patients, and the data is consequently limited. We intend to further investigate current management strategies for this subgroup of patients, with assessment of radiotherapy treatment plans, current use of integral boosts, and surgical procedures for this subgroup of patients.

scholarly journals Correlation of Outcome of Neo adjuvant Concurrent Chemo radiotherapy with Clinico-epidemiological characteristics in locally advanced rectal cancer patients: retrospective study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Abdelaziz ◽  
R R Ghali ◽  
N A Mosalam ◽  
W A Elnemrawy
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Retrospective Study ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Concurrent Chemotherapy ◽  
Significant Difference ◽  
Long Course

Abstract Background The treatment of (LARC) is subject to continuous change due to better diagnostic tools, radio therapeutic techniques and chemotherapeutic agents. It is clear, that a multimodality approach is the only way to achieve satisfactory local recurrence and survival rates in this type of cancer. Widespread use of neoadjuvant therapy have all contributed to decrease the rate of local recurrence, raise the quality of life and the probability of overall survival. Aim of the Work to correlate clinico-epdemiological factors of locally advanced rectal cancer patients with outcomes of neoadjuvant concurrent chemo radiotherapy (NACRT) regarding disease -free survival (DFS) and overall survival (OS). Patients and Methods In this retrospective study, data were collected from files of 100 patients with locally advanced rectal cancer patients with cT3-4 or any cT/cN+ disease assessed using colonoscopy, enhanced computed tomography. and or magnetic resonance imaging, between Jan 2010 and December 2016 in oncology department of Ain Shams faculty of medicine and Nasser institute of treatment and research. The patients received long course radiotherapy (45-50.4 Gy/1.8-2 Gy) combined with concurrent chemotherapy. Surgery was done after NACCRT. Results This study is no statistically significant difference between patient’s demographic characteristics with DFS and OS. This study shows there was no statistically difference between doses of long course radiation on DFS of the study and so type of concurrent chemotherapy on DFS while type of surgery had impact and statistically significant difference on DFS and OS. The study also showed that Types of surgery, y-pathological nodal staging had statistically significance with DFS and OS. Conclusion assessment of LARC patients before selection type of therapy is very important. Neoadjuvant concurrent chemo-radiotherapy is only stander of cure in high-risk group of LARC patients.

Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years

2012 ◽  
Vol 30 (16) ◽  
pp. 1926-1933 ◽  
Author(s):  
Rolf Sauer ◽  
Torsten Liersch ◽  
Susanne Merkel ◽  
Rainer Fietkau ◽  
Werner Hohenberger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Cumulative Incidence ◽  
Working Group ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Purpose Preoperative chemoradiotherapy (CRT) has been established as standard treatment for locally advanced rectal cancer after first results of the CAO/ARO/AIO-94 [Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society] trial, published in 2004, showed an improved local control rate. However, after a median follow-up of 46 months, no survival benefit could be shown. Here, we report long-term results with a median follow-up of 134 months. Patients and Methods A total of 823 patients with stage II to III rectal cancer were randomly assigned to preoperative CRT with fluorouracil (FU), total mesorectal excision surgery, and adjuvant FU chemotherapy, or the same schedule of CRT used postoperatively. The study was designed to have 80% power to detect a difference of 10% in 5-year overall survival as the primary end point. Secondary end points included the cumulative incidence of local and distant relapses and disease-free survival. Results Of 799 eligible patients, 404 were randomly assigned to preoperative and 395 to postoperative CRT. According to intention-to-treat analysis, overall survival at 10 years was 59.6% in the preoperative arm and 59.9% in the postoperative arm (P = .85). The 10-year cumulative incidence of local relapse was 7.1% and 10.1% in the pre- and postoperative arms, respectively (P = .048). No significant differences were detected for 10-year cumulative incidence of distant metastases (29.8% and 29.6%; P = .9) and disease-free survival. Conclusion There is a persisting significant improvement of pre- versus postoperative CRT on local control; however, there was no effect on overall survival. Integrating more effective systemic treatment into the multimodal therapy has been adopted in the CAO/ARO/AIO-04 trial to possibly reduce distant metastases and improve survival.

scholarly journals The Elevated Pre-Treatment C-Reactive Protein Predicts Poor Prognosis in Patients with Locally Advanced Rectal Cancer Treated with Neo-Adjuvant Radiochemotherapy

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 780
Author(s):  
Richard Partl ◽  
Katarzyna Lukasiak ◽  
Eva-Maria Thurner ◽  
Wilfried Renner ◽  
Heidi Stranzl-Lawatsch ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
C Reactive Protein ◽  
Adjuvant Radiochemotherapy ◽  
Free Survival ◽  
Reactive Protein ◽  
Pre Treatment

The aim of the present study was to investigate the association of the pre-treatment C-reactive protein (CRP) plasma level with survival outcomes in a cohort of 423 consecutive patients with locally advanced rectal cancer treated with neo-adjuvant radiochemotherapy followed by surgical resection. To evaluate the prognostic value of the CRP level for clinical endpoints recurrence-free survival (RFS), local-regional control (LC), metastases-free survival (MFS), and overall survival (OS), uni- and multivariate Cox regression analyses were applied, and survival rates were calculated using Kaplan–Meier analysis. The median follow-up time was 73 months. In univariate analyses, the pre-treatment CRP level was a significant predictor of RFS (hazard ratio (HR) 1.015, 95% CI 1.006–1.023; p < 0.001), LC (HR 1.015, 95% CI 1.004–1.027; p = 0.009), MFS (HR 1.014, 95% CI 1.004–1.023; p = 0.004), and OS (HR 1.016, 95% CI 1.007–1.024; p < 0.001). Additionally, univariate analysis identified the MRI circumferential resection margin (mrCRM) and pre-treatment carcinoembryonic antigen (CEA) as significant predictor of RFS (HR 2.082, 95% CI 1.106–3.919; p = 0.023 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). Univariate analysis also revealed a significant association of the mrCRM (HR 2.089, 95% CI 1.052–4.147; p = 0.035) and CEA (HR 1.006, 95% CI 1.003–1.008; p < 0.001) with MFS. Age and CEA were prognostic factors for OS (HR 1.039, 95% CI 1.013–1.066; p = 0.003 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). In multivariate analysis that included parameters with a p-level < 0.20 in univariate analysis, the pre-treatment CRP remained a significant prognostic factor for RFS (HR 1.013, 95%CI 1.001–1.025; p = 0.036), LC (HR 1.014, 95% CI 1.001–1.027; p = 0.031), and MFS (HR 1.013, 95% CI 1.000–1.027; p = 0.046). The results support the hypothesis that an elevated pre-treatment CRP level is a predictor of poor outcome. If confirmed by additional studies, this easily measurable biomarker could contribute to the identification of patients who might be candidates for more aggressive local or systemic treatment approaches or the administration of anti-inflammatory drugs.

Induction chemotherapy followed by chemoradiotherapy and total mesenteric excision for locally advanced rectal cancer with resectable metastases.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 526-526 ◽  
Author(s):  
Carla Hajj ◽  
Andrea Cercek ◽  
Leonard Saltz ◽  
Neil Howard Segal ◽  
Diane Lauren Reidy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Induction Chemotherapy ◽  
Primary Tumor ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

526 Background: Optimal management of patients with locally advanced rectal cancer (LARC) and synchronous, resectable metastases remains controversial and treatment decisions benefit from a multidisciplinary approach. To better characterize the role of induction chemotherapy followed by chemoradiation and surgery, we evaluated patterns of distal progression and overall survival in this subset of patients. Methods: We reviewed records of 25 LARC patients with synchronous resectable metastases treated with induction chemotherapy (ICT) followed by 5-fluorouracil-based concurrent chemoradiation (CRT) at our institution between December 2006 and December 2010. Radiation was delivered using a standardized three-field technique or IMRT. The incidence and sites of failure were analyzed. Overall survival (OS) and progression-free survival (PFS) were calculated from the completion of CRT using the Kaplan-Meier method. Results: Of the 25 patients who received ICT followed by CRT, 21 (84%) underwent total mesorectal excision and metastectomy. Eleven patients (44%) had liver metastases. The median ICT duration was 2.4 months. Twenty patients (80%) received a FOLFOX-based ICT regimen and 5 patients (20%) received irinotecan-based chemotherapy. Two patients had unresectable disease, one was medically inoperable, and surgery was aborted due to intra-operative complications in one patient. Eighteen of the 21 were NED after surgery and metastatectomy (86%) with 24% pathologic complete response rate in the primary tumor; 10 (56%) received adjuvant chemotherapy. None of the patients recurred locally. Six of the 18 (33%) progressed distally, four of whom had received adjuvant chemotherapy. Four distal recurrences were in the lungs. With a median follow-up of 29.6 months, the 3-year OS was 50.4%. Median OS and PFS were 25.1 months and 13.5 months, respectively. Conclusions: ICT prior to CRT is associated with acceptable toxicity, substantial primary tumor regression, and promising clinical outcomes in patients with high-risk LARC with synchronous, resectable metastatic disease.

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