The Korean journal of internal medicine

  • 제31권1호
  • /
  • Pages.134-144
  • /
  • 2016
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of treatment response and tissue necrosis as prognostic indicators following neoadjuvant chemoradiotherapy in rectal cancer patients

  • Jung, Ji-Han (Department of Hospital Pathology, College of Medicine, The Catholic University of Korea) ;
  • An, Ho Jung (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung-Jin (Department of General Surgery, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jonghoon (Department of Radiation Oncology, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kang-Moon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sung Hwan (Department of Radiation Oncology, College of Medicine, The Catholic University of Korea) ;
  • Cho, Hyeon-Min (Department of General Surgery, College of Medicine, The Catholic University of Korea) ;
  • Shim, Byoung Yong (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • 투고 : 2014.09.03
  • 심사 : 2014.12.05
  • 발행 : 2016.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: The objective of this study was to assess the prognostic roles of treatment response and tissue necrosis after chemoradiotherapy (CRT) in locally advanced rectal cancer. Methods: A total of 243 patients with locally advanced rectal cancer who underwent neoadjuvant CRT were included. Three treatment response groups were classified by their pathological stage results: complete treatment response (CTR), intermediate treatment response (ITR), and poor treatment response (PTR). Three tissue necrosis groups were classified based on tissue pathological results: complete necrosis response (CNR), intermediate necrosis response (INR), and poor necrosis response (PNR). Results: Overall survival (OS) and recurrence-free survival (RFS) rate at three years were 74.5% and 61.3%, respectively. The 3-year OS rates of the CTR, ITR, and PTR groups were 83.7%, 75.9%, and 69.7%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 69.0%, and 52.1%, respectively (p < 0.001). The 3-year OS rates of the CNR, INR, and PNR groups were 83.7%, 80.6%, and 61.8%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 68.9%, and 44.3%, respectively (p < 0.001). When compared to CTR/CNR, PTR/PNR was strongly related to an increased risk of recurrence (hazard ratio [HR], 5.53; 95% confidence interval [CI], 2.01 to 15.23 vs. HR, 6.37; 95% CI, 2.29 to 17.74, respectively) in univariate Cox regression. Both PTR and PNR were strongly associated with shorter RFS and OS when compared with CTR and CNR in the multivariate Cox regression. Conclusions: Tissue necrosis is an equally important prognostic marker as treatment response for oncologic outcomes in locally advanced rectal cancer.

키워드

참고문헌

  1. Kockerling F, Reymond MA, Altendorf-Hofmann A, Dworak O, Hohenberger W. Influence of surgery on metachronous distant metastases and survival in rectal cancer. J Clin Oncol 1998;16:324-329. https://doi.org/10.1200/JCO.1998.16.1.324
  2. Nuyttens JJ, Robertson JM, Yan D, Martinez A. The influence of small bowel motion on both a conventional three-field and intensity modulated radiation therapy (IMRT) for rectal cancer. Cancer Radiother 2004;8:297-304. https://doi.org/10.1016/S1278-3218(04)00086-1
  3. Arbea L, Ramos LI, Martinez-Monge R, Moreno M, Aristu J. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol 2010;5:17. https://doi.org/10.1186/1748-717X-5-17
  4. Samuelian JM, Callister MD, Ashman JB, Young-Fadok TM, Borad MJ, Gunderson LL. Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2012;82:1981-1987. https://doi.org/10.1016/j.ijrobp.2011.01.051
  5. O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Ko CY. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum 2004;47:2064-2069. https://doi.org/10.1007/s10350-004-0738-1
  6. Rodel C, Liersch T, Becker H, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 2012;13:679-687. https://doi.org/10.1016/S1470-2045(12)70187-0
  7. Chua YJ, Barbachano Y, Cunningham D, et al. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol 2010;11:241-248. https://doi.org/10.1016/S1470-2045(09)70381-X
  8. Klautke G, Feyerherd P, Ludwig K, Prall F, Foitzik T, Fietkau R. Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer. Br J Cancer 2005;92:1215-1220. https://doi.org/10.1038/sj.bjc.6602492
  9. Silberfein EJ, Kattepogu KM, Hu CY, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol 2010;17:2863-2869. https://doi.org/10.1245/s10434-010-1119-8
  10. Park IJ, You YN, Agarwal A, et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol 2012;30:1770-1776. https://doi.org/10.1200/JCO.2011.39.7901
  11. Rodel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23:8688-8696. https://doi.org/10.1200/JCO.2005.02.1329
  12. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010;11:835-844. https://doi.org/10.1016/S1470-2045(10)70172-8
  13. Santos MD, Silva C, Rocha A, Matos E, Nogueira C, Lopes C. Prognostic value of mandard and dworak tumor regression grading in rectal cancer: study of a single tertiary center. ISRN Surg 2014;2014:310542.
  14. Capirci C, Valentini V, Cionini L, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72:99-107. https://doi.org/10.1016/j.ijrobp.2007.12.019
  15. Breugom AJ, van den Broek CB, van Gijn W, et al. The value of adjuvant chemotherapy in rectal cancer patients after preoperative radiotherapy or chemoradiation followed by TME-surgery: the PROCTOR/SCRIPT study. Eur J Cancer 2013;49(Suppl 3):S1.
  16. Cionini L, Sainato A, De Paoli A, et al. Final results of randomized trial on adjuvant chemotherapy after preoperative chemoradiation in rectal cancer. Radiother Oncol 2010;96(Suppl 1):S113-S114.
  17. Bosset JF, Calais G, Mineur L, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 2014;15:184-190. https://doi.org/10.1016/S1470-2045(13)70599-0
  18. Hong YS, Nam BH, Kim KP, et al. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol 2014;15:1245-1253. https://doi.org/10.1016/S1470-2045(14)70377-8