Incidence of Pathological Complete Response after Neoadjuvant Treatment in Current Vajira Hospital Rectal Cancer Practice
Keywords:
Locally advanced rectal cancer, pathological complete response, prognostic factor', neoadjuvant concurrent chemoradiation therapyAbstract
Background and Objective: Colorectal cancer is the third most common cancer worldwide. The current standard treatment for locally advanced rectal cancer is neoadjuvant concurrent chemoradiation therapy (CCRT) followed by total mesorectal excision (TME). The responses to CCRT differ significantly in each study, and approximately 15-30% of patients have pathological complete response(pCR). This research aims to investigate the pCR rate and the factors affecting the pCR after neoadjuvant CCRT in rectal cancer.
Method: A retrospective study of locally advanced rectal cancer, diagnosed with cT3-4, N0 or any cT, cN1-2, who underwent neoadjuvant CCRT during 2014-2020.
Results: A total of 234 rectal cancer patients, there were 101 (43.1%) patients treated with neoadjuvant CCRT, with 68 (67.3%) male patients and a mean age of 58.5 years (+/- 11.5). The most common cancer location was the lower rectum, 60 (59.4%). For clinical staging, 76 patients had cT3 (75.2%) and 54 patients had cN1-2 (53.5%). A total of 14 patients (13.9%) had pCR. When univariate analysis and multivariate analysis were calculated, it was found that CEA> 2.5, cN1-2 and capecitabine as a radiosensitizing agent affected pCR with OR 0.23 P = 0.04 (95% CI 0.59-0.93), OR 0.15 P = 0.02 (95% CI 0.03-0.79) and OR 9.89 P = 0.01 (95% CI 1.62-60.25), respectively.
Conclusion: The pCR rate was 13.9%, with factors affecting pCR were CEA> 2.5, cN1-2 and capecitabine as a radiosensitizing agent.
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25. Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22(1): 29-42.
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27. Petrelli F, Trevisan F, Cabiddu M, Sgroi G, Bruschieri L, Rausa E, et al. Total neoadjuvant therapy in rectal cancer: A systematic review and meta-analysis of treatment outcomes. Ann Surg 2020; 271(3): 440-8.
28. Zhu S, Brodin NP, English K, Ohri N, Chuy JW, Rajdev LN, et al. Comparing outcomes following total neoadjuvant therapy and following neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer. E Clinical Medicine 2019; 16: 23-9.
29. Kalady MF, de Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 2009; 250(4): 582-9.
2. Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 1999; 17(8): 2396.
3. Du D, Su Z, Wang D, Liu W, Wei Z. Optimal Interval to Surgery After Neoadjuvant Chemoradiotherapy in Rectal Cancer: A Systematic Review and Meta-analysis. Clin Colorectal Cancer 2018; 17(1): 13-24.
4. Lefevre JH, Mineur L, Kotti S, Rullier E, Rouanet P, de Chaisemartin C, et al. Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: A multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol 2016; 34(31): 3773-80.
5. Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336(14):980-7.
6. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345(9): 638-46.
7. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351(17): 1731-40.
8. O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol 2014; 32(18): 1927-34.
9. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr., Silva e Sousa AH Jr., et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240(4): 711-7.
10. Dattani M, Heald RJ, Goussous G, Broadhurst J, São Julião GP, Habr-Gama A, et al. Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer: A systematic review and pooled analysis. Ann Surg 2018; 268(6): 955-67.
11. Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 2013; 56(10): 1109-17.
12. Appelt AL, Pløen J, Harling H, Jensen FS, Jensen LH, Jørgensen JC, et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. Lancet Oncol 2015; 16(8): 919-27.
13. Lu Z, Cheng P, Yang F, Zheng Z, Wang X. Long-term outcomes in patients with ypT0 rectal cancer after neoadjuvant chemoradiotherapy and curative resection. Chin J Cancer Res 2018; 30(2): 272-81.
14. Letaief F, Nasri M, Ayadi M, Meddeb K, Mokrani A, Yahyaoui Y, et al. Potential predictive factors for pathologic complete response after the neoadjuvant treatment of rectal adenocarcinoma: a single center experience. Cancer Biol Med 2017; 14(3): 327-34.
15. Peng J, Lin J, Qiu M, Wu X, Lu Z, Chen G, et al. Clinical factors of post-chemoradiotherapy as valuable indicators for pathological complete response in locally advanced rectal cancer. Clinics (Sao Paulo) 2016; 71(8): 449-54.
16. Ryan JE, Warrier SK, Lynch AC, Heriot AG. Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review. Colorectal Dis 2015; 17(10): 849-61.
17. Hartley A, Ho KF, McConkey C, Geh JI. Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. Br J Radiol 2005; 78(934): 934-8.
18. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 2012; 99(7): 918-28.
19. Huang Y, Lee D, Young C. Predictors for complete pathological response for stage II and III rectal cancer following neoadjuvant therapy - A systematic review and meta-analysis. Am J Surg 2020; 220(2): 300-8.
20. Burbach JP, den Harder AM, Intven M, van Vulpen M, Verkooijen HM, Reerink O. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol 2014; 113(1): 1-9.
21. Song JH, Park YH, Seo SH, Lee A, Kim KH, An MS, et al. Difference in tumor area as a predictor of a pathological complete response for patients with locally advanced rectal cancer. Ann Coloproctol 2017; 33(6): 219-26.
22. Tan Y, Fu D, Li D, Kong X, Jiang K, Chen L, et al. Predictors and risk factors of pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer: A population-based analysis. Front Oncol 2019; 9: 497.
23. Garcia-Aguilar J, Chow OS, Smith DD, Marcet JE, Cataldo PA, Varma MG, et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol 2015; 16(8): 957-66.
24. Marco MR, Zhou L, Patil S, Marcet JE, Varma MG, Oommen S, et al. Consolidation mFOLFOX6 chemotherapy after chemoradiotherapy improves survival in patients with locally advanced rectal cancer: Final results of a multicenter phase II trial. Dis Colon Rectum 2018; 61(10): 1146-55.
25. Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22(1): 29-42.
26. Fernandez-Martos C, Garcia-Albeniz X, Pericay C, Maurel J, Aparicio J, Montagut C, et al. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial†. Ann Oncol 2015; 26(8): 1722-8.
27. Petrelli F, Trevisan F, Cabiddu M, Sgroi G, Bruschieri L, Rausa E, et al. Total neoadjuvant therapy in rectal cancer: A systematic review and meta-analysis of treatment outcomes. Ann Surg 2020; 271(3): 440-8.
28. Zhu S, Brodin NP, English K, Ohri N, Chuy JW, Rajdev LN, et al. Comparing outcomes following total neoadjuvant therapy and following neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer. E Clinical Medicine 2019; 16: 23-9.
29. Kalady MF, de Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 2009; 250(4): 582-9.
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2022-02-28
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Chandrachamnong P, Bhatanaprabhabhan K, Chongthanakorn M, Ngamsirimas B. Incidence of Pathological Complete Response after Neoadjuvant Treatment in Current Vajira Hospital Rectal Cancer Practice. SRIMEDJ [Internet]. 2022 Feb. 28 [cited 2024 Nov. 5];37(1):1-6. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/253898
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