scholarly journals Tumor Volume Reduction Rate Predicts Pathologic Tumor Response of Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemotherapy alone: Results from a Prospective Trial

2015 ◽  
Vol 6 (7) ◽  
pp. 636-642 ◽  
Author(s):  
Jian Xiao ◽  
Zerong Cai ◽  
Wenyun Li ◽  
Zuli Yang ◽  
Jiaying Gong ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Volume ◽  
Tumor Response ◽  
Locally Advanced ◽  
Prospective Trial ◽  
Reduction Rate ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Tumor Volume Reduction

Perioperative chemotherapy using FOLFOX with panitumumab for locally advanced rectal cancer: Phase II trial.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 502-502
Author(s):  
Mitsuyoshi Ota ◽  
Jun Watanabe ◽  
Atsushi Ishibe ◽  
Hirokazu Suwa ◽  
Masashi Momiyama ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Response Rate ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Reduction Rate ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Tumor Reduction

502 Background: Neoadjuvant chemotherapy for locally advanced rectal cancer is required to achieve tumor reduction when skipping routine use of preoperative radiation therapy. It is known that EGFR inhibitor has impact on early tumor shrinkage in metastatic colorectal cancer. We evaluated the effect of preoperative infusional fluorouracil, leucovolin, and oxaliplatin (FOLFOX) with panitumumab. Methods: Forty-three patients with clinical stage III rectal cancer without invasion to other organs were enrolled in this multicenter phase II trial. All patients had KRAS wild tumors confirmed by biopsy. Patients received six cycles of FOLFOX with panitumumab. Reduction rate of primary tumor was measured by T2 weighted sagittal image of magnetic resonance imaging. Excluding patients whose disease progressed after the six cycles, total mesorectal excision was performed two weeks after neoadjuvant chemotherapy. After surgery, adjuvant chemotherapy with six cycles of FOLFOX without panitumumab was planned before diverting stoma closure. The primary outcome was the response rate of the primary lesion. Results: Between January 2012 and December 2014, 42 out of 43 patients completed preoperative chemotherapy; one patient did not complete the regimen due to grade III neutropenia. There was no progressive disease in the 42 patients and response rate was 69.8% in this series. Average reduction rate of the primary lesion was 47.6%. All of the 43 participants had R0 resections without mortality or severe complications. Pathological complete response rate to chemotherapy was 7.0% (3 of 43). Thirty-eight out of 43 patients started adjuvant chemotherapy and 32 patients completed the regimen. Grade 3 or worse peripheral neuropathy was not seen during neoadjuvant chemotherapy and seen in 2.6% (1 of 38) during adjuvant chemotherapy. Conclusions: Periopative chemotherapy using FOLFOX with panitumumab seemed to have two advantages; one is tumor reduction which enables skipping neoadjuvant radiation therapy, the other is safely administering a larger dose of chemotherapy than adjuvant only in locally advanced rectal cancer. Additional impact of EGFR inhibitor should be followed in long term results. Clinical trial information: UMIN000006039.

Induction chemotherapy with mFOLFOXIRI in cT4N+ locally advanced rectal cancer: Subgroup analysis from a prospective trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16136-e16136
Author(s):  
Jianwei Zhang ◽  
Huabin Hu ◽  
Yue Cai ◽  
Xiaoyu Xie ◽  
Zehua Wu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Total Mesorectal Excision ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Prospective Trial ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Mesorectal Excision ◽  
Tumor Downstaging

e16136 Background: FOLFOXIRI had been recommended as induction treatment for patients with T4N+ rectal cancer in the latest NCCN guideline. However, no prospective study to support this recommendation in his population. Here, we tried to analyze the efficacy of FOLFOXIRI as induction chemotherapy in the subgroup of rectal cancer patients with T4N+ from a prospective trial. Methods: A phase II trial exploring the efficacy of mFOLFOXIRI as neoadjuvant chemotherapy in locally advanced rectal cancer had been conducted in our center recently. The subgroups of patients with clinical T4N+ rectal cancer were extracted for further analysis. All candidates were to receive 4 to 6 cycles of mFOLFOXIRI. MRI will be performed every two cycles to assess clinical responses. And then the patients would receive total mesorectal excision directly or proceed to chemoradiotherapy according to the result of restaging evaluation. Postoperative FOLFOX chemotherapy was recommended. The primary endpoint is the ratio of tumor downstaging to ypT0-2N0M0. Results: There were 27 patients with cT4N+. There were twenty male and 7 female, with the median age of 46 years old. MRF involved was observed in 14 patients. Neoadjuvant chemotherapy with mFOLFOXIRI was performed for at least 4 cycles. Six patients received radiotherapy before total mesorectal excision, including short-term radiation in 1 patient. R0 resection was achieved in all the patients (100%) and 24 (88.9%) of patients had received sphincter-saving operation. According to the pathologic result, all patients showed regression in the primary tumor (ypT0-3). The pCR rate was 22.2% (6/27) and the tumor downstaging (ypStage 0-I) rate was 29.6%. Another 13 (48.1%) patients showed downstaging to ypStage II. The main grade 3/4 adverse event was neutropenia (35.7%). With a median follow-up of 25 months, no local recurrence was observed. Only 3 patients developed distant metastasis. The 2-year survival rate for this group of population was 85.0%. Conclusions: mFOLFOXIRI showed high tumor downstaging rate in locally advanced rectal cancer. It could be reasonable to use mFOLFOXIRI as induction chemotherapy for cT4N+ rectal cancer patients. Clinical trial information: NCT02217020 . [Table: see text]

Effect of oxaliplatin-containing neoadjuvant chemotherapy on tumor volume in locally advanced rectal cancer and sensitivity of surviving tumor cells to radiotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3547-3547 ◽  
Author(s):  
Kjersti Flatmark ◽  
Knut Hakon Hole ◽  
Marie Gron Saelen ◽  
Torveig Weum Abrahamsen ◽  
Karianne Giller Fleten ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tumor Volume ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Volume Reduction ◽  
Median Volume ◽  
Tumor Volume Reduction ◽  
Additional Tumor

3547 Background: The use of oxaliplatin (OXA) is well established in adjuvant and palliative treatment of colorectal cancer (CRC), but its role in neoadjuvant treatment of locally advanced rectal cancer (LARC) is controversial. Data from the ACCORD 12/0405, STAR-01 and NSABBP R-04 trials suggest no additional clinical benefit of adding OXA to fluoropyrimidine-based preoperative chemoradiotherapy (CRT) in LARC. However, the possibility of reducing risk of systemic recurrence and the use of OXA-containing neoadjuvant chemotherapy (NACT) in liver metastasis warrant further clarification of the role of OXA in neoadjuvant treatment of LARC. Methods: We report results from a non-randomized phase II trial of neoadjuvant treatment of 72 LARC patients, receiving two courses of the Nordic FLOX regimen prior to CRT (25 x 2 Gy; weekly OXA; daily capecitabine). Tumor volumes were calculated from MRI scans taken before and after NACT and 4 weeks after CRT completion. Using OXA resistant human CRC cell lines, the impact of previous OXA exposure on radiosensitivity (1-5 Gy) was examined. Results: Median baseline tumor volume was 16.6 cm3 (1.1-293 cm3). All tumors, except one, responded to NACT, leaving a median tumor volume of 5.3 cm3 (0.2-157 cm3), representing a median volume reduction of 63%. In all but three patients, additional tumor volume reduction was observed following subsequent CRT (median tumor volume 5.3 cm3; 0.02-119 cm3; median volume reduction of 68%). Exposure of cell lines to increasing concentrations of OXA resulted in resistance towards the drug. OXA resistant models exhibited increased radiosensitivity compared to OXA sensitive counterparts. Conclusions: OXA-containing NACT led to substantial tumor volume reduction. Additional tumor volume reduction was observed in almost all cases, suggesting that pretreatment with OXA-containing NACT did not preclude tumor response to CRT. Results from experimental models rather suggest that pretreatment with OXA might enhance radiosensitivity of surviving OXA resistant cells. Taken together, our results are in favor of continued exploration of OXA-containing NACT in LARC. Clinical trial information: NCT00278694.

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