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- Volume 35(2); April 2019
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Editorial
- From Total Mesorectal Excision to Organ Preservation for the Treatment of Rectal Cancer
- Seong Kyu Baek
- Ann Coloproctol. 2019;35(2):51-52. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2019.04.15
- 3,201 View
- 100 Download
- 1 Web of Science
- 1 Citations
Review
- Organ Preservation Strategies After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer
- Ri Na Yoo, Hyung Jin Kim
- Ann Coloproctol. 2019;35(2):53-64. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2019.04.15.1
- 4,976 View
- 186 Download
- 6 Web of Science
- 6 Citations
-
Abstract
PDF - Standard use of neoadjuvant chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemotherapy in locally advanced rectal cancer has tremendously improved oncologic outcomes over the past several decades. However, these improvements come with costs of significant morbidity and poor quality of life. Along with developments in imaging techniques, clinical experience and evidence have identified a certain subgroup of patients that have exceptionally good clinical outcomes while preserving quality of life. Driven by patient demand and interest in preserving quality of life, numerous organ preservation treatment strategies for managing rectal cancer are rapidly evolving. Herein, the flow of research in organ preservation strategies and counter arguments are discussed.
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Citations
Citations to this article as recorded by
- Efficacy and safety of MR-guided adaptive simultaneous integrated boost radiotherapy to primary lesions and positive lymph nodes in the neoadjuvant treatment of locally advanced rectal cancer: a randomized controlled phase III trial
Haohua Wang, Xiang Zhang, Boyu Leng, Kunli Zhu, Shumei Jiang, Rui Feng, Xue Dou, Fang Shi, Lei Xu, Jinbo Yue
Radiation Oncology.2024;[Epub] CrossRef - Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef - Komplette Response nach neoadjuvanter Therapie beim Rektumkarzinom: Implikationen für die Chirurgie
Carolin Kastner, Bernhard Petritsch, Joachim Reibetanz, Christoph-Thomas Germer, Armin Wiegering
Der Chirurg.2022; 93(2): 144. CrossRef - Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy
Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim
World Journal of Gastrointestinal Surgery.2021; 13(9): 1000. CrossRef - Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
Min Chul Kim, Jae Hwan Oh
Annals of Coloproctology.2021; 37(6): 382. CrossRef - The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer
Mayra Evelia Jiménez de los Santos, Juan Armando Reyes-Pérez, Rosa Martha Sandoval-Nava, José Luis Villalobos-Juárez, Yolanda Villaseñor-Navarro, Itzel Vela-Sarmiento, Isabel Sollozo-Dupont
Acta Radiologica Open.2020; 9(9): 205846012095729. CrossRef
- Efficacy and safety of MR-guided adaptive simultaneous integrated boost radiotherapy to primary lesions and positive lymph nodes in the neoadjuvant treatment of locally advanced rectal cancer: a randomized controlled phase III trial
Original Articles
- Oncologic Outcomes of Organ Preserving Approaches in Patients With Rectal Cancer Treated With Preoperative Chemoradiotherapy
- In Ja Park, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
- Ann Coloproctol. 2019;35(2):65-71. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2019.03.17
- 3,871 View
- 120 Download
- 12 Web of Science
- 12 Citations
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Abstract
PDF
- Purpose
We evaluated the oncologic outcomes of organ-preserving strategies in patients with rectal cancer treated with preoperative chemoradiotherapy (PCRT).
Methods
Between January 2008 and January 2013, 74 patients who underwent wait-and-watch (WW) (n = 42) and local excision (LE) (n = 32) were enrolled. Organ-preserving strategies were determined based on a combination of magnetic resonance imaging, sigmoidoscopy, and physical examination 4–6 weeks after completion of PCRT. The rectum sparing rate, 5-year recurrence-free survival (RFS), and overall survival (OS) were evaluated.
Results
The rectum was more frequently spared in the LE (100% vs. 87.5%, P = 0.018) at last follow-up. Recurrence occurred in 9 (28.1%) WW and 7 (16.7%) LE (P = 0.169). In the WW, 7 patients had only luminal regrowth and 2 had combined lung metastasis. In the LE, 2 (4.8%) had local recurrence only, 4 patients had distant metastasis, and 1 patient had local and distant metastasis. Among 13 patients who indicated salvage surgery (WW, n = 7; LE, n = 11), all in the WW received but all of LE refused salvage surgery (P = 0.048). The 5-year OS and 5-year RFS in overall patients was 92.7% and 76.9%, respectively, and were not different between WW and LE (P = 0.725, P = 0.129).
Conclusion
WW and LE were comparable in terms of 5-year OS and RFS. In the LE group, salvage treatment was performed much less among indicated patients. Therefore, methods to improve the oncologic outcomes of patients indicated for salvage treatment should be considered before local excision. -
Citations
Citations to this article as recorded by- Rectal Sparing Approaches after Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-Analysis Comparing Local Excision and Watch and Wait
Quoc Riccardo Bao, Stefania Ferrari, Giulia Capelli, Cesare Ruffolo, Marco Scarpa, Amedea Agnes, Giuditta Chiloiro, Elisa Palazzari, Emanuele Damiano Luca Urso, Salvatore Pucciarelli, Gaya Spolverato
Cancers.2023; 15(2): 465. CrossRef - Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef - Can pretreatment platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios predict long-term oncologic outcomes after preoperative chemoradiation followed by surgery for locally advanced rectal cancer?
Sang Hyun An, Ik Yong Kim
Annals of Coloproctology.2022; 38(3): 253. CrossRef - Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef - Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef - Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef - The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef - Improvement in the Assessment of Response to Preoperative Chemoradiotherapy for Rectal Cancer Using Magnetic Resonance Imaging and a Multigene Biomarker
Eunhae Cho, Sung Woo Jung, In Ja Park, Jong Keon Jang, Seong Ho Park, Seung-Mo Hong, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(14): 3480. CrossRef - Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef - Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef - The risk of distant metastases in rectal cancer managed by a watch-and-wait strategy – A systematic review and meta-analysis
Joanna Socha, Lucyna Kępka, Wojciech Michalski, Karol Paciorek, Krzysztof Bujko
Radiotherapy and Oncology.2020; 144: 1. CrossRef - From Total Mesorectal Excision to Organ Preservation for the Treatment of Rectal Cancer
Seong Kyu Baek
Annals of Coloproctology.2019; 35(2): 51. CrossRef
- Rectal Sparing Approaches after Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-Analysis Comparing Local Excision and Watch and Wait
- Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy
- Chang Hyun Kim, Seung-Seop Yeom, Hand-Duk Kwak, Soo Young Lee, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim
- Ann Coloproctol. 2019;35(2):72-82. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2019.04.22
- 4,372 View
- 112 Download
- 14 Web of Science
- 14 Citations
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Abstract
PDF
- Purpose
Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap.
Methods
From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed.
Results
Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively.
Conclusion
Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality. -
Citations
Citations to this article as recorded by- Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis
Nerea Becerra‐Tomás, Georgios Markozannes, Margarita Cariolou, Katia Balducci, Rita Vieira, Sonia Kiss, Dagfinn Aune, Darren C. Greenwood, Laure Dossus, Ellen Copson, Andrew G. Renehan, Martijn Bours, Wendy Demark‐Wahnefried, Melissa M. Hudson, Anne M. Ma
International Journal of Cancer.2024; 155(3): 400. CrossRef - A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
Cureus.2024;[Epub] CrossRef - A Predictive Model to Evaluate Pathologic Complete Response in Rectal Adenocarcinoma
Shuiwang Qing, Lei Gu, Tingting Du, Xiaolan Yin, Ke-jia Zhang, Huo-jun Zhang
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef - Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer
François Rouleau Fournier, Mohammad Ali K. Motamedi, Carl J. Brown, Terry Phang, Manoj J. Raval, Cameron J. Hague, Ahmer A. Karimuddin
Annals of Surgery.2022; 275(2): 303. CrossRef - Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef - Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?
M. Finochi, B. Menahem, G. Lebreton, J. Lubrano, Y. Eid, A. Alves
Techniques in Coloproctology.2021; 25(1): 91. CrossRef - Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Philippe Rouanet, Michel Rivoire, Sophie Gourgou, Bernard Lelong, Eric Rullier, Merhdad Jafari, Laurent Mineur, Marc Pocard, Jean Luc Faucheron, François Dravet, Denis Pezet, Jean Michel Fabre, Laurent Bresler, Jacques Balosso, Christophe Taoum, Claire Le
Journal of Surgical Oncology.2021; 123(1): 299. CrossRef - The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis
Silin Chen, Ning Li, Yuan Tang, Jinming Shi, Ying Zhao, Huiying Ma, Shulian Wang, Ye-xiong Li, Jing Jin
European Radiology.2021; 31(12): 8827. CrossRef - Predictors of Positive Circumferential Resection Margin in Rectal Cancer: A Current Audit of the National Cancer Database
Hillary L. Simon, Thais Reif de Paula, Magda M. Profeta da Luz, Ravi P. Kiran, Deborah S. Keller
Diseases of the Colon & Rectum.2021; 64(9): 1096. CrossRef - MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy
Akitoshi Inoue, Shannon P. Sheedy, Jay P. Heiken, Payam Mohammadinejad, Rondell P. Graham, Hee Eun Lee, Scott R. Kelley, Stephanie L. Hansel, David H. Bruining, Jeff L. Fidler, Joel G. Fletcher
Insights into Imaging.2021;[Epub] CrossRef - Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef - Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef - Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef - Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
Gyung Mo Son, Bong-Hyeon Kye, Min Ki Kim, Jun-Gi Kim
Annals of Coloproctology.2019; 35(5): 229. CrossRef
- Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis
- Oncologic Outcomes in Patients Who Undergo Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision for Locally Advanced Rectal Cancer: A 14-Year Experience in a Single Institution
- Min Jung Kim, Seung-Yong Jeong, Ji Won Park, Seung-Bum Ryoo, Sang Sik Cho, Ki Young Lee, Kyu Joo Park
- Ann Coloproctol. 2019;35(2):83-93. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2019.04.22.1
- 4,287 View
- 95 Download
- 18 Web of Science
- 16 Citations
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Abstract
PDF
- Purpose
This study evaluated the oncologic outcomes of locally advanced rectal cancer patients who underwent preoperative neoadjuvant chemoradiotherapy (CRT) followed by surgery and determined the prognostic significance of pathologic complete response (pCR).
Methods
Between January 2002 and December 2015, 580 patients with rectal cancer who underwent surgery after neoadjuvant CRT were identified. Survival according to tumor response to CRT and pathologic stage was analyzed using the Kaplan-Meier method, and the Cox proportional hazard model was used to identify factors associated with survival outcomes.
Results
A total of 111 patients (23.7%) achieved pCR while the other 469 patients showed residual disease. Patients with pCR had a lower pretreatment carcinoembryonic antigen level and earlier cT classification than those with residual disease. With a median follow-up of 78 months, disease-free survival (DFS) and overall survival (OS) were significantly better in the pCR group than in the residual disease group. The 5-year DFS and 5-year OS for patients with ypStage 0, I, II, or III were 92.5%, 85.1%, 72.2%, 54.3% (P < 0.001) and 94.5%, 91.0%, 83.1%, 69.3%, respectively (P < 0.001). Pathologic AJCC stage after CRT was the most statistically significant independent predictor of OS (HR, 6.97 [95% confidence interval, 3.16–15.39] for stage III vs. stage 0) and DFS (HR, 7.30 [95% confidence interval, 3.63–14.67] for stage III vs. stage 0).
Conclusion
Rectal cancer patients who achieved pCR showed improved survival compared to those with residual disease after preoperative CRT. Moreover, pCR was an independent indicator of OS and DFS, and pathologic AJCC stage was correlated with survival after preoperative CRT. -
Citations
Citations to this article as recorded by- Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better?
Anurima Patra, Aisha Lakhani, Antony Augustine, Priyanka Mohapatra, Anu Eapen, Ashish Singh, Dipti Masih, Thomas S. Ram, Mark R. Jesudason, Rohin Mittal, Anuradha Chandramohan
Indian Journal of Radiology and Imaging.2024; 34(01): 85. CrossRef - A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
Cureus.2024;[Epub] CrossRef - Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef - Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef - Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef - Patient Survival With ypT0N+ Following Neoadjuvant Therapy in Rectal Cancer
Mohamedraed Elshami, Robert N. Goldstone, Lawrence S. Blaszkowsky, James C. Cusack, Theodore S. Hong, Jennifer Y. Wo, Motaz Qadan
Diseases of the Colon & Rectum.2022; 65(10): 1224. CrossRef - Neoadjuvant Radiotherapy Dose Escalation in Locally Advanced Rectal Cancer: a Systematic Review and Meta-analysis of Modern Treatment Approaches and Outcomes
N. Hearn, D. Atwell, K. Cahill, J. Elks, D. Vignarajah, J. Lagopoulos, M. Min
Clinical Oncology.2021; 33(1): e1. CrossRef - Can normalized carcinoembryonic antigen following neoadjuvant chemoradiation predict tumour recurrence after curative resection for locally advanced rectal cancer?
Youngki Hong, Amandeep Ghuman, Keat Seong Poh, Dimitri Krizzuk, Arun Nagarajan, Sudha Amarnath, Juan J. Nogueras, Steven D. Wexner, Giovanna DaSilva
Colorectal Disease.2021; 23(6): 1346. CrossRef - Omission of or Poor Response to Preoperative Chemoradiotherapy Impacts Radial Margin Positivity Rates in Locally Advanced Rectal Cancer
Ana Sofia Ore, Gabrielle E. Dombek, Carlos A. Cordova-Cassia, Jeanne F. Quinn, Thomas E. Cataldo, Benjamin L. Schlechter, Matthew J. Abrams, Evangelos Messaris
Diseases of the Colon & Rectum.2021; 64(6): 669. CrossRef - Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study
Min-Young Park, In-Ja Park, Hyo-Seon Ryu, Jay Jung, Min-Sung Kim, Seok-Byung Lim, Chang-Sik Yu, Jin-Cheon Kim
Cancers.2021; 13(14): 3502. CrossRef - Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy
Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim
World Journal of Gastrointestinal Surgery.2021; 13(9): 1000. CrossRef - Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef - Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature
Durim Delishaj, Ilaria Costanza Fumagalli, Stefano Ursino, Agostino Cristaudo, Francesco Colangelo, Antonio Stefanelli, Alessandro Alghisi, Giuseppe De Nobili, Romerai D’Amico, Alessandra Cocchi, Antonio Ardizzoia, Carlo Pietro Soatti
World Journal of Clinical Cases.2021; 9(30): 9077. CrossRef - Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
Min Chul Kim, Jae Hwan Oh
Annals of Coloproctology.2021; 37(6): 382. CrossRef - Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef - From Total Mesorectal Excision to Organ Preservation for the Treatment of Rectal Cancer
Seong Kyu Baek
Annals of Coloproctology.2019; 35(2): 51. CrossRef
- Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better?
- Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer
- Taesun Choi, Se-Jin Baek, Jung Myun Kwak, Jin Kim, Seon-Hahn Kim
- Ann Coloproctol. 2019;35(2):94-99. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2018.08.28
- 3,668 View
- 72 Download
- 2 Web of Science
- 2 Citations
-
Abstract
PDF
- Purpose
Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure.
Methods
The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group.
Results
Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively).
Conclusion
Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes. -
Citations
Citations to this article as recorded by- Characteristics of Patients Presented With Metastases During or After Completion of Chemoradiation Therapy for Locally Advanced Rectal Cancer: A Case Series
Radwan Torky, Mohammed Alessa, Ho Seung Kim, Ahmed Sakr, Eman Zakarneh, Fozan Sauri, Heejin Bae, Nam Kyu Kim
Annals of Coloproctology.2021; 37(3): 186. CrossRef - Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer
Ho Seung Kim, Nam Kyu Kim
Annals of Gastroenterological Surgery.2020; 4(4): 379. CrossRef
- Characteristics of Patients Presented With Metastases During or After Completion of Chemoradiation Therapy for Locally Advanced Rectal Cancer: A Case Series
- Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery
- Byong Ho Jeon, Ui Sup Shin, Sun Mi Moon, Jung Il Choi, Mi-Sook Kim, Kie Hwan Kim, Se-Jin Sung
- Ann Coloproctol. 2019;35(2):100-106. Published online April 30, 2019
- DOI: https://doi.org/10.3393/ac.2018.10.01
- 4,371 View
- 128 Download
- 13 Web of Science
- 15 Citations
-
Abstract
PDF
- Purpose
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
Methods
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
Results
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985).
Conclusion
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed. -
Citations
Citations to this article as recorded by- Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis
Giuseppe Portale, Patrizia Bartolotta, Danila Azzolina, Dario Gregori, Valentino Fiscon
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef - NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND LYMPHOPENIAAS PROGNOSTIC FACTORS OF OVERALL SURVIVAL IN LOCALADVANCED RECTAL CANCER
Ocanto A, Morera R, Rodríguez I, Cantero R
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2023; : 11. CrossRef - Neutrophil-to-lymphocyte ratio predicts survival of patients with rectal cancer receiving neo-adjuvant chemoradiation followed by radical resection: a meta-analysis
Giuseppe Colloca, Antonella Venturino, Domenico Guarneri
Expert Review of Anticancer Therapy.2023; 23(4): 421. CrossRef - Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy
Tzu-Chieh Yin, Po-Jung Chen, Yung-Sung Yeh, Ching-Chun Li, Yen-Cheng Chen, Wei-Chih Su, Tsung-Kun Chang, Ching-Wen Huang, Chun-Ming Huang, Hsiang-Lin Tsai, Jaw-Yuan Wang
Frontiers in Oncology.2023;[Epub] CrossRef - The Crying Need for a Better Response Assessment in Rectal Cancer
Samuel Amintas, Nicolas Giraud, Benjamin Fernandez, Charles Dupin, Quentin Denost, Aurelie Garant, Nora Frulio, Denis Smith, Anne Rullier, Eric Rullier, Te Vuong, Sandrine Dabernat, Véronique Vendrely
Current Treatment Options in Oncology.2023; 24(11): 1507. CrossRef - Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy
Şefika Arzu Ergen, Ceren Barlas, Cumhur Yıldırım, Didem Çolpan Öksüz
Journal of Gastrointestinal Cancer.2022; 53(1): 151. CrossRef - Deep regional hyperthermia combined with modern concurrent chemoradiotherapy increases T-downstaging rate in locally advanced rectal cancer
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Annals of Coloproctology.2022; 38(2): 97. CrossRef - Watch and wait strategies for rectal cancer: A systematic review
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Precision and Future Medicine.2022; 6(2): 91. CrossRef - Histopathological and Haemogram Features Correlate with Prognosis in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation without Pathological Complete Response
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Journal of Clinical Medicine.2022; 11(17): 4947. CrossRef - Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis
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Cancer Medicine.2021; 10(17): 5983. CrossRef - Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer
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Cureus.2021;[Epub] CrossRef - An inflammation index-based prediction of treatment response to neoadjuvant chemoradiotherapy for rectal mucinous adenocarcinoma
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International Journal of Clinical Oncology.2020; 25(7): 1299. CrossRef
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