| William H. Ward, et al. |
2018 |
Cohort study |
Patients with incomplete laboratory data, staging information, survival, or recurrence status. |
Patients with AJCC stage II or III disease who underwent neoadjuvant chemoradiation and subsequent surgical resection. |
146 |
58.6 |
LMR |
Low LMR: OS 68.7% DFS 73.3%. |
A query was completed for clinical stage II-III rectal adenocarcinoma patients treated from 2002 to 2016. |
| |
|
|
|
|
Men: 89 |
|
NLR |
High LMR: OS 86.3% DFS 87.4%. |
Patients who had a complete blood count collected before neoadjuvant chemoradiation and again before surgery were included. |
| |
|
|
|
|
Female: 57 |
|
PLR |
Low NLR: OS 83% DFS 84.6%. |
|
| |
|
|
Patients who didn't receive neoadjuvant chemotherapy or chemoradiation. |
Patients with a CBC within 60 days of chemoradiation initiation or definitive surgery. |
|
|
|
High NLR: OS 41.5% DFS 40.4%. |
|
| |
|
|
Patients who had an AJCC clinical stage other than II-III. |
|
|
|
|
Low PLR: OS 83.6% DFS 83.6%. |
The LMR, NLR, and PLR were calculated for the pre-CRT and post-CRT time points. |
| |
|
|
Patients without a CBC result within 60 days of chemoradiation start. |
|
|
|
|
High PLR: OS 65.7% DFS 75.1% |
Potential cut points associated with OS differences were determined using maximally selected rank statistics. Survival curves were compared using log-rank tests and were adjusted for age and stage using Cox regression. |
| |
|
|
Patients without a CBC result within 60 days of TME. |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
Within the pretreatment group, a "low" (<2.86) LMR was associated with decreased OS. In the same group, a "high" (>4.47) NLR and "high" PLR (>203.6) were associated with decreased OS. With covariate adjustment for age, and separately for final pathologic stage, the associations between OS and LMR, NLR, and PLR each retained statistical significance. |
| Tseng M., et al. |
2018 |
Cohort study |
Patients who received cetuximab with 5-FU. |
Patients who were diagnosed with clinically staged T3/4, N0/+, M0 rectal cancer according to TNM classification of malignant tumors. |
117 |
60 |
Age at diagnosis |
5-year local recurrence: 4.5%; 5-year DFS: 65.7%; OS: 80.6%. |
From April 2002 to December 2014, 117 patients with LARC received neoadjuvant CRT followed by TME surgery. The treatment regimen compromised a total radiotherapy dose of 50.4 Gy in 28 daily fractions delivered concurrently with 5-FU and capecitabine chemotherapy over 5.5 weeks. All patients were planned for TME surgery. Local control, disease-free survival, overall survival and treatment toxicities were analyzed. Median follow-up was 34 months. 11.5% of patients achieved pCR and 72.6% had either tumor or nodal downstaging following neoadjuvant QRT. |
| |
|
|
|
|
Men: 78 |
|
Gender |
|
|
| |
|
|
Patients who received intensity-modulated radiotherapy instead of conventional radiotherapy. |
|
Female: 39 |
|
Chemotherapy regimen |
|
|
| |
|
|
|
|
|
|
Margin positivity |
Patients with LARC who achieved pCR after preoperative CRT had an improved 5-year disease survival rate of 83.3% versus 65.6% for patients who did not achieve pCR. |
|
| |
|
|
|
|
|
|
Tumor downstaging |
|
|
| |
|
|
Patients who declined neoadjuvant CRT. |
Patients who received neoadjuvant CRT followed by TME surgery at Nacional University Hospital, Singapore, from April 2002 to December 2014. |
|
|
Nodal positivity |
|
|
| |
|
|
|
|
|
|
Pathological response |
|
|
| |
|
|
|
|
|
|
|
|
Multivariate analysis showed that nodal positivity was a predictor of poor disease-free survival and poor overall survival. Tumor downstaging and pCR did not improve outcomes. |
| Sun Y., et al. |
2019 |
Cohort study |
Patients with distant metastasis at diagnosis. |
Patients who had histologically proven rectal adenocarcinomas, rectal tumors located <12 cm from anal verge, clinically staged as cT3-4 and/or N+ rectal tumors. |
118 |
54.3 |
Acellular mucin pools |
Patients with acellular mucin pools had a similar 5-year OS but a decreased DFS rate. |
A retrospective analysis of 118 LARC patients who achieved pCR following nCRT and TME from 2008 to 2015. |
| |
|
|
|
|
Men: 63 |
|
MUC1immunostaining |
|
|
| |
|
|
Patients with synchronous malignancy or a history of other malignant tumors. |
|
Female: 55 |
|
Serum post-CRT CEA levels |
Patients with positive MUC1 staining had a similar 5-year OS but a lower DFS rate. |
Clinicopathological and therapeutic parameters were evaluated as possible predictors of distant metastasis-free survival, and COX regression analysis was performed. After a median follow-up of 57 months, the 5-year OS and disease free survival rates were 94.7% and 88.1%, respectively. |
| |
|
|
Patients with emergency surgery or palliative surgical resection, local excision or a "Watch-and-Wait" strategy. |
|
|
|
Tumor distance from the anal verge |
|
|
| |
|
|
|
Patients treated with nCRT and radical surgery and pathological staged as T0N0M0 (ypCR). |
|
|
|
|
On univariate analysis, tumor distance from the anal verge (HR = 0.706; p = 0.039), acellular mucin pools (HR = 6687; p = 0.002) and MUC1 expression (HR = 8280; p < 0.001) were independently associated with DMFS. COX regression demonstrated that MUC1 expression (HR = 3812; p = 0.041) remained to be an independent predictor of DMFS in pCR patients. Tumor distance from anal verge, acellular mucin pools, and MUC1 expression were associated with distant metastasis in patients with pCR. MUC1 staining remained to be an independent risk factor for DMFS. Such information could facilitate treatment decision in this patient. |
| Nakamura T., et al. |
2019 |
Cohort study |
No info |
Patients with a histopathologically confirmed diagnosis of previously untreated rectal adenocarcinoma. |
105 |
64 |
Sex |
Male patients had a decreased 5r-DFS. |
105 patients with LARC who received NCRT followed by radical surgery. NCRT consisted of pelvic radiotherapy (45 Gy in 25 fractions over a period of 5 weeks), S-1 (80 mg/m2) given concurrently for 25 days, and irinotecan (60 mg/m2), given once a week as a continuous intravenous infusion. Radical surgery was performed 8 weeks after treatment. |
| |
|
|
|
|
|
|
Age |
|
|
| |
|
|
|
|
|
|
Preoperative tumor diameter |
|
|
| |
|
|
|
|
|
|
cStage |
|
|
| |
|
|
|
|
|
|
Preoperative CEA, CA19-9 |
|
|
| |
|
|
|
|
|
|
Tumor site |
|
|
| |
|
|
|
Eastern Cooperative Oncology Group performance status of 0-3. |
Men: 64 |
|
CRT treatment completion |
Patients with tumors with a pre-treatment diameter <40 mm or histopathological treatment response grade 0/1 or ypN1 and ypN2 had a decreased 5DFS. |
A pathological complete response was confirmed in 23.8%. The 5-year recurrence-free survival rate was 79.3%, and the 5-year overall survival rate was 87.1%. Multivariate analysis showed that the following 4 variables were independent predictors of recurrence-free survival: sex (male: p = 0.0172), pre-treatment tumor diameter (<40 mm: p = 0.0223), histopathological treatment response (grade 0/1: p = 0.0169), and ypN (ypN1: p = 0.1995; ypN2: p = 0.0007). Only ypN was an independent predictor of overall survival (ypN1: p = 0.0009; ypN2: p = 0.0012). |
| |
|
|
|
|
|
|
Perioperative transfusion |
|
|
| |
|
|
|
Age 20-82 years at the time of enrollment. |
Female: 41 |
|
Surgical procedure |
|
|
| |
|
|
|
|
|
|
Histological grade |
|
|
| |
|
|
|
Patients without dysfunction of major organs (bone marrow, heart, lung, liver and kidneys). |
|
|
ypN |
Patients with ypN1 ou ypN2 had also a decreased 5-year-OS. |
|
| |
|
|
|
|
|
|
ypCR |
|
|
| Runau F., et al. |
2016 |
Cohort study |
No info |
Patients with locally advanced disease (T3/4 ± nodal disease) and deemed medically fit for long-course neoadjuvant CRT followed by an aim of curative surgical resection of tumor. |
277 |
65.3 |
Length |
Patients with a pCR have a significantly improved OS and DFS compared to a non-pCR |
Retrospective study (2000-2012). 380 patients diagnosed with primary rectal adenocarcinoma were identified, 277 received neoadjuvant chemoradiotherapy followed by curative ressection. 46 patients obtained a pCR (ypT0N0) with no local recurrence and two metastatic recurrences on follow-up. Patiens with a pCR have a significantly improved OS and DFS compared to a non-pCR. On univariate analysis, increased tumor height above anal verge, low lymph node yield, high pre-operative hemoglobin and a low neutrophil-lymphocyte ratio are significant factors identifying a pCR. Multivariable analysis of the above factors confirmed tumor height above anal verge as significant in obtaining a pCR. |
| |
|
|
|
|
|
|
Tumor width |
|
|
| |
|
|
|
|
Men: 190 |
|
Distance from closest margin |
|
|
| |
|
|
|
|
|
|
Tumor height above anal verge |
|
|
| |
|
|
|
|
Female: 87 |
|
Examined lymph nodes |
|
|
| |
|
|
|
|
|
|
Involved lymph nodes |
|
|
| |
|
|
|
|
|
|
Pre-operative hemoglobin |
|
|
| |
|
|
|
|
|
|
Pre-operative neutrophil |
|
|
| |
|
|
|
|
|
|
Pre-operative platelets |
|
|
| |
|
|
|
|
|
|
Pre-operative lymphocytes |
|
|
| |
|
|
|
|
|
|
NLR |
|
|
| |
|
|
|
|
|
|
PLR |
|
|
| Yanwu Sun, et al. |
2017 |
Cohort study |
Patients with previous or concurrent malignancies. |
Patients with LARC undergoing nCRT and curative resection between 2008 and 2014. |
522 |
53.9 |
Age |
5-year OS (pCR vs. non-pCR: 92.0% vs. 76.1%) |
A total of 522 locally advanced rectal cancer patients undergoing nCRT and curative resection between 2008 and 2014 were included. A uni and multivariate analysis was developed to identify predictors of pCR. |
| |
|
|
|
|
Men: 334 |
|
Sex |
|
|
| |
|
|
Patients treated with emergent surgery, palliative resection. |
|
Female: 188 |
|
ASA scores |
DFS (pCR vs. non-pCR: 92.7% vs. 66.5%) |
|
| |
|
|
|
|
|
|
Distance from the anal verge |
|
|
| |
|
|
Patients treated with local excision or "watch and wait" strategy. |
|
|
|
Gross type |
|
These post-CRT clinicopathologic and treatment-related factors were identified and used to develop a predictive nomogram for pCR. Logistic regression showed that post-CRT distance from the anal verge, post-CRT tumor, post-CRT circumferential extent of tumor, pre-CRT CEA level, and post-CRT CEA level were independently associated with pCR. Then, with a median follow-up of 55 months, pCR was associated with better 5-y OS and DFS. |
| |
|
|
|
|
|
|
Histopathology |
|
|
| |
|
|
|
|
|
|
Tumor differentiation |
|
|
| |
|
|
|
|
|
|
Clinical T and N stage |
|
|
| |
|
|
|
|
|
|
Pretreatment CEA levels |
|
|
| |
|
|
|
|
|
|
Surgical approach |
|
|
| |
|
|
|
|
|
|
Post-CRT distance from the anal verge |
|
|
| |
|
|
|
|
|
|
Post-CRT tumor size |
|
|
| |
|
|
|
|
|
|
Post-CRT circumferential extent of tumor |
|
|
| |
|
|
|
|
|
|
Tumor pathology |
|
|
| |
|
|
|
|
|
|
Post-CRT CEA level |
|
|
| Braun L., et al. |
2019 |
Cohort study |
No info |
Patients with LARC treated with preoperative long-course 5-fluorouracil based RCT between 2006 and 2013 |
220 |
65.5 |
Primary tumor location |
DFS was significantly worse in patients with larger primary tumors (p = 0.003), an elevated NLR (>4.06) (p = 0.001), an elevated neutrophil count (p = 0.019), and an elevated leukocyte count (p = 0.023). |
A retrospective analysis of patients with locally advanced rectal cancer treated with preoperative long-course 5-fluorouracil-based RCT was performed. Potential clinical and hematological prognostic factors for disease free survival (DFS) were studied using uni- and multivariate analysis. A total of 220 patients were included in the analysis. Median follow-up was 67 months. Five-year DFS and overall survival (OS) were 70% and 85%, respectively. NLR with a cut-off value of 4.06 was identified as optimal to predict DFS events. In multivariate analysis, only tumor volume (HR 0.33, 95% CI (0.14-0.83), p = 0.017) and NLR (HR 0.3, 95% CI (0.11-0.81), p = 0.017) remained significant predictors of DFS. An elevated pretherapeutic NLR was associated with higher T stage, inferior DFS, and poor pathological response to neoadjuvant RCT. |
| |
|
|
|
|
Men: 142 |
|
T-stage |
|
|
| |
|
|
|
|
|
|
N-stage |
|
|
| |
|
|
|
|
Female: 78 |
|
Gross tumor volume |
|
|
| |
|
|
|
|
|
|
Age |
|
|
| |
|
|
|
|
|
|
CEA |
|
|
| |
|
|
|
|
|
|
Grading |
|
|
| |
|
|
|
|
|
|
CRP |
|
|
| |
|
|
|
|
|
|
NLR |
|
|
| |
|
|
|
|
|
|
Absolut neutrophil count |
|
|
| |
|
|
|
|
|
|
Absolut leukocyte count |
Among these, only tumor volume (HR 0.33, 95% CI (0.14-0.83), p = 0.017) and NLR (HR 0.3, 95% CI (0.11-0.81), p = 0.017) remained significant on multivariate analysis. |
|
| Toiyama Y., et al. |
2015 |
Cohort Study |
No info |
Patients with tumors in the lower two thirds of the rectum and staged over T2 or T1 (tumor invading to submucosa) with clinical N1, which represent clinical stages I-III. |
89 |
64.5 |
Age |
OS rates were signifcantly lower in rectal cancer patients with elevated PLT counts, elevate NLR counts and pathologic TNM stage III (ypN+). |
This retrospective study enrolled 89 patients with lLARC who underwent neoadjuvant CRT for whom platelet (PLT) counts and SIR status [neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR)] were available. Both clinical values of PLT and SIR status in rectal cancer patients were investigated. Elevated PLT, NLR, PLR, and pathologic TNM stage III [ypN(+)] were associated with significantly poor overall survival (OS). Elevated PLT, NLR, and ypN(+) were shown to independently predict OS. Elevated PLT and ypN(þ) significantly predicted poor disease-free survival (DFS). Elevated PLT was identified as the only independent predictor of DFS. PLT counts are a promising pre-CRT biomarker for predicting recurrence and poor prognosis in rectal cancer. |
| |
|
|
|
|
|
|
Gender |
|
|
| |
|
|
|
|
Men: 66 |
|
ypT |
|
|
| |
|
|
|
|
|
|
ypN |
|
|
| |
|
|
|
|
Female: 23 |
|
Tumor Pathology |
|
|
| |
|
|
|
|
|
|
Radiation effect |
|
|
| |
|
|
|
|
|
|
PLT |
|
|
| |
|
|
|
|
|
|
NLR |
|
|
| |
|
|
|
|
|
|
PLR |
|
|
| |
|
|
|
Aged 80 years or younger. |
|
|
|
DFS rate were significantly lower in rectal cancer patients with elevated PLT counts than in those with lower levels. |
|
| |
|
|
|
No invasion of the external sphincter muscle or elevator muscle of the anus. |
|
|
|
|
|
| |
|
|
|
No evidence of deep venous thrombosis. |
|
|
|
|
|
| Abdul-Jail K., et al. |
2013 |
Cohort Study |
No info |
Patients with T3/4 and/or node-positive rectal cancer who underwent neoadjuvant
5-Fluorouracil-based CRT followed by surgical resection. |
153 |
63 |
Age |
pCR:
5-year DFS = 100% and OS rate = 88% |
The aim of this study was to evaluate the prognostic impact of TRG in a cohort of patients with LARC treated with neoadjuvant CRT. The lack of standardization of TRG is the major source of variability in published studies. In order to understand which system that evaluates TRG is the most informative, 4 systems were tested. One-hundred and 53 patients were included in this cohort. 23.5% of patients achieved pCR had a 5-year DFS rate of 100% compared with a DFS rate of 74% for 76.5% of patients without pCR (p = 0.003). The Royal College of Pathologists TRG condenses the Mandard 5 point TRG by stratifying patients into three groups with distinct 5-year DFS rates of 100%, 86% and 67% respectively (p = 0.001). In multivariate analysis, pathological nodal status and circumferential resection margin, but not TRG, remained significant predictors of DFS (p = 0.002, p = 0.035, p = 0.310, respectively). Findings support the notion that pCR status, nodal status after neoadjuvant CRT and CRM status are predictors of long-term survival in patients with LARC. |
| |
|
|
|
|
|
|
Sex |
|
|
| |
|
|
|
|
Men: 105 |
|
Tumor location |
|
|
| |
|
|
|
|
Female: 48 |
|
Radiological nodal stage (pretreatment) |
Cum survival: TRG (1 = 100%, 2 = 82%, 3 = 68% 4 = -no info; 5 = 62%); |
|
| |
|
|
|
|
|
|
Radiological nodal status (pretreatment) |
Modified Mandard 3 point TRG system (1 = 92%, 2 = 68%, 3 = 65%) |
|
| |
|
|
|
|
|
|
Dose of radiotherapy |
RC path (A = 100%, B = 86%, C = 67%); CAP system (0 = 100%, 1 = 86%, 2 = 68% 3 = 65%); |
|
| |
|
|
|
|
|
|
Type of surgery |
|
|
| |
|
|
|
|
|
|
Pathological tumor stage |
|
|
| |
|
|
|
|
|
|
pCR |
Modified Mandard 4-point TRGN system (N1 = 100%, N2 = 95%, N3 = 60%, N4 = no info); |
|
| |
|
|
|
|
|
|
Pathological nodal status |
|
|
| |
|
|
|
|
|
|
CRM |
|
|
| |
|
|
|
|
|
|
RC path tumor regression grade (Mandard system) |
Pathological nodal status (ypN0 = 94%, ypN1/2 = 46%); |
|
| |
|
|
|
|
|
|
Nodal downstaging status |
RC path system stratified to pathological nodal status (A = 100%, B node negative = 96%, B node positive = 87%, C node negative = 71%); |
|
| |
|
|
|
|
|
|
|
Nodal status (N0-ypN0 = 94%, N0-ypN1/2 = 87%, N1/2-ypN1/2 = 31%) |
|
| Xue Dou, et al. |
2013 |
Cohort Study |
Patients with WBC greater than 10 × 109/L or lower then 4 × 109/L. |
Patients with clinical T3-T4 stage low rectal cancer, treated in Shandong Cancer Hospital and Institute, China between June 2004 and December 2007. |
88 |
50 < 50 years old and 38 ≥50 years old |
Age |
5-Year DFS: cN stage (negative - 71.30%; positive - 50.80%); |
All factors were evaluated in 88 patients with LARC treated with pre-operative long course nCRT at Shandong Cancer Hospital and Institute, China, between June 2004 and December 2007. High lymphocyte ratios before nCRT and good tumor regression (TRG 3-4) were significantly associated with 5-year DFS (p < 0.05). Pretreatment nodal status was also associated with 5-year DFS and 5-year OS (p < 0.05). Multivariate analysis confirmed that the pretreatment lymphocyte ratio and lymph nodal status were independent prognostic factors. The study suggests that patients with high lymphocyte ratios before nCRT will have good tumor response and high 5-year DFS and OS. |
| |
|
|
|
|
Men: 53 |
|
Gender |
|
|
| |
|
|
|
|
|
|
Histology |
|
|
| |
|
|
|
|
Female: 35 |
|
cT stage |
Tumor response (TRG 0-2 - 63.70%; TRG 3-4 - 80.20%); |
|
| |
|
|
|
|
|
|
cN stage |
|
|
| |
|
|
|
|
|
|
Tumor size |
|
|
| |
|
|
|
|
|
|
Distance from anal verge |
|
|
| |
|
|
|
All patients were diagnosed with primary rectal adenocarcinoma and no evidence of metastasis was found. |
|
|
WBC (lymphocyte, neutrophil, monocyte, eosinophil and basophil count and ratio) |
Lymphocyte ratio (<24.6%-55.70%; ≥24.6%-70.10%). |
|
| |
|
|
|
|
|
|
Tumor response |
5-Year OS: cN stage (negative- 78.00%; positive- 59.10%); |
|
| |
|
|
|
|
|
|
|
Lymphocyte ratio (<24.6%- 72.60%; ≥24.6%- 83.30%) |
|
| A.S Dahadda et al. |
2011 |
Cohort Study |
Patients that refused to have surgery upon the completion of radiotherapy. |
Patients with LARC, cT3/4 and/or N+ and that were considered inoperable or of borderline resectability due to potential CRM involvement. |
158 |
65 |
Age |
5-Year DFS: TRG2 node negative - 57%; TRG2 node positive - 39%; TRG3-5 node negative - 50%; TRG3-5 node positive - 20% |
The study involved 158 patients with LARC treated with pre-operative long course nCRT at Nottingham University Hospital between April 2001 and December 2008. Surgery was performed after an interval of 6-10 weeks. |
| |
|
|
|
|
Men: 105 |
|
Gender |
|
|
| |
|
|
|
|
|
|
Site of tumor |
|
|
| |
|
|
|
|
Female: 53 |
|
Pre-op treatment |
|
|
| |
|
|
|
|
|
|
Type of resection |
|
|
| |
|
|
|
|
|
|
Resection margin |
|
|
| |
|
|
|
|
|
|
TRG |
|
|
| |
|
|
|
Referred to Nottingham City Hospital, UK, between April 2001 and December 2008 for long course preoperative chemo/radiotherapy. |
|
|
CRM |
5-Year OS: TRG2 node negative- 60%; TRG3-5 node negative - 49%; TRG3-5 node positive - 32% |
The response to the pre-operative treatment was graded by a single pathologist using the five point Mandard score. |
| |
|
|
|
|
|
|
Nodal status |
|
|
| |
|
|
|
|
|
|
Perineural invasion |
|
The Mandard score was clearly related to both DFS (p < 0.001) and OS (p < 0.012). On multivariate analysis perineural invasion, nodal status, TRG and CRM were the most powerful predictors of DFS. |
| |
|
|
|
|
|
|
|
|
The Mandard tumor regression score is an independent prognostic factor and predicts for long-term outcome following pre-operative QT/RT in rectal cancer. |
| Jong Hoon Lee, et al. |
2011 |
Cohort Study |
Patients that had previous cancer other than non-melanoma skin cancer. |
Patients with LARC who had been treated with preoperative CRT plus curative laparoscopic surgery between January 2003 and January 2009. |
274 |
60 |
Age |
5-Year OS: non-pCR group - 71.2%; pCR group - 86.0% |
The study involved 274 patients with LARC who had been treated with preoperative CRT plus curative laparoscopic surgery between January 2003 and January 2009. At the time of analysis (September 2009), a follow-up period of ≥6 months was available for all patients, and the median follow-up time was 43 months. |
| |
|
|
|
|
Men: 193 |
|
Gender |
|
|
| |
|
|
|
|
|
|
Tumor stage |
|
|
| |
|
|
Patients that had evidence of distant metastases. |
|
Female: 81 |
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Nodal stage |
5-year DFS: non-pCR group - 73.3%; pCR group - 88.4% |
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Distance of tumor from anal verge |
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Patients that had previously received radiotherapy to the pelvis. |
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Pre-CRT CEA |
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CRT operation interval |
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Tumor grade |
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From all the predictors evaluated, a significant statistical difference was found in the pre-CRT CEA level. It is possible to conclude that preoperative CRT and laparoscopic surgery are related to favorable long-term outcomes. |
| Klautke G., et al. |
2005 |
Clinical Trial |
Pregnant or lactating women, patients with unresolved bowel obstruction or ileus. |
Male and female patients with histologically confirmed adenocarcinoma of the rectum with nonmetastatic disease at locally advanced stage that made R0 resection and sphincter preservation uncertain. |
37 |
62 |
Extent of resection |
OS at 4 years: Resection:
R0 = 81%, R1 = 0%
Nodal status: pN0/1 = 80%, pN2 = 33% |
This study aimed to evaluate the feasibility and efficacy of neoadjuvant CRT intensified with irinotecan in patients with LARC. |
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Men: 27 |
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Postoperative nodal status |
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Patients with a history of chronic diarrhea. |
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Female: 10 |
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Pathohistological response rate |
Disease specific OS at 4 years:
Resection:
R0 = 84%, R1 = 0%
4-Year DFS Nodal status:
pN0: 92%, pN1 = 80%, pN2 = 0% |
Extent of resection and postoperative nodal status were significant predictors of overall and disease free survival. |
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Intensified neoadjuvant CRT with irinotecan can be safely administered and results in a high pCR rate. |
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Measurable disease (at least one bidimensional measurable tumor lesion). |
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DFS at 4 years: pCR or MDR = 88%
Partial response = 58% |
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Performance status ≤2. |
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Aadequate haematologic, hepatic and renal function. |
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Life expectancy of at least 3 months. |
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| Stanley K.T. Yu, et al. |
2013 |
Cohort study |
Patients who received short-course preoperative RT or RT alone. |
Patients diagnosed with LARC that underwent clinical examination, colonoscopy, MRI pelvis and CT chest, abdomen and pelvis (CT CAP) as staging. |
281 |
63 |
Age |
3-Year OS: responders - 90%; nonrespon. - 70% |
The study involved 281 patients with LARC who were diagnosed and received neoajuvant CRT and surgical treatment, and underwent clinical examination, colonoscopy, MRI pelvis and CT chest, abdomen and pelvis (CT CAP) as staging. The study concluded that rectal tumor height and MR extramural venous invasion (EMVI) status are more important than baseline size and stage of the tumor as predictors of response to chemoradiation. Both magnetic resonance imaging (MRI) and pathologic- defined responders have significantly improved survival. |
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Gender |
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Men: 175 |
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Neoadjuvant CRT |
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Had no MRI performed before and after CRT. |
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Female: 106 |
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Pre-CRT tumor characteristics |
3-Year DFS: responders - 79%; nonrespon. - 63% |
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Did not undergo surgery after CRT. |
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MRI staging |
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Incomplete histology data. |
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Post-CRT tumor characteristics |
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Other malignancies. |
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mrEMVI positive pre CRT to negative status post-CRT |
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mrCRM positive pre-CRT to negative status post-CRT |
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