Current possibilities of predicting the therapeutic response to neoadjuvant chemoradiotherapy in rectal cancer

Neoadjuvant chemotherapy in combination with radiation is currently the standard of care for patients with locally advanced rectal cancer. The main purpose of the treatment is to reduce the risk of recurrence, however at the same time it may be accompanied by severe adverse effects due to post-radiation pelvic damage. An effort towards finding markers allowing the prediction of the therapy response has been undertaken by many groups. In this review we have performed a literature search to identify the main studies directed at the use of clinical, radiological, immunological and molecular (protein, DNA and RNA) markers. We present a summary for each group with an overall conclusion that a certain level of ambiguity and disunity in interpretation of the results currently exists among the reported findings. Apparently, even in the most promising direction of circulating molecular biomarkers further work is needed before a clinical utility can be established.

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MRI features and texture analysis for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy and tumor recurrence of locally advanced rectal cancer

European Radiology ◽

10.1007/s00330-020-06835-4 ◽

2020 ◽

Vol 30 (8) ◽

pp. 4201-4211 ◽

Cited By ~ 2

Author(s):

Hayeong Park ◽

Kyung Ah Kim ◽

Ji-Han Jung ◽

Jeongbae Rhie ◽

Sun Young Choi

Keyword(s):

Rectal Cancer ◽

Texture Analysis ◽

Tumor Recurrence ◽

Therapeutic Response ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Early Prediction ◽

Mri Features

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PROGNOSTIC VALUE OF POST-RADIATION REGRESSION OF LOCALLY ADVANCED RECTAL CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-1-135-141 ◽

2019 ◽

Vol 65 (1) ◽

pp. 135-141

Author(s):

Denis Samsonov ◽

Aleksey Karachun ◽

Igor Pravosudov ◽

Olga Ivko ◽

Pavel Grishko ◽

...

Keyword(s):

Rectal Cancer ◽

Prognostic Value ◽

Tumor Regression ◽

Locally Advanced ◽

Therapy Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Tumor Regression Grade ◽

Preoperative Irradiation ◽

Post Radiation

Currently, combination therapy, including preoperative irradiation of the tumor and areas of regional lymphatic drainage, has become the standard for the treatment of patients with locally advanced rectal cancer. Methods for evaluating neoadjuvant therapy response are increasingly being introduced into the practice of specialized medical centers. However, the prognostic value of tumor regression grade remains unclear. The results of numerous studies presented in modern literature are contradictory, and their comparative analysis is extremely difficult because of the abundance of post-radiation regression classifications used. This review article reflects the current views on the role and ways of assessing the therapeutic pathomorphosis of rectal cancer after radiotherapy/chemoradiotherapy.

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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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