DOI QR코드

DOI QR Code

Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer

  • Lee, Hong Seok (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hee Chul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Jeong Il (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Kwangzoo (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.04.01
  • Accepted : 2016.06.17
  • Published : 2016.09.30

Abstract

Purpose: To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. Materials and Methods: We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Results: Average rectal volume and ARA were 11.3 mL and $2.9cm^2$. After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Conclusion: Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary.

Keywords

References

  1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat 2013;45:1-14. https://doi.org/10.4143/crt.2013.45.1.1
  2. Klint A, Engholm G, Storm HH, et al. Trends in survival of patients diagnosed with cancer of the digestive organs in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncol 2010;49:578-607. https://doi.org/10.3109/02841861003739330
  3. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731-40. https://doi.org/10.1056/NEJMoa040694
  4. Janjan NA, Abbruzzese J, Pazdur R, et al. Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer. Radiother Oncol 1999;51:153-60. https://doi.org/10.1016/S0167-8140(99)00054-7
  5. Berger C, de Muret A, Garaud P, et al. Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys 1997;37:619-27. https://doi.org/10.1016/S0360-3016(96)00577-9
  6. Dhadda AS, Dickinson P, Zaitoun AM, Gandhi N, Bessell EM. Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer. Eur J Cancer 2011;47:1138-45. https://doi.org/10.1016/j.ejca.2010.12.006
  7. Fokas E, Liersch T, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol 2014;32:1554-62. https://doi.org/10.1200/JCO.2013.54.3769
  8. Gerard JP, Chapet O, Nemoz C, et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. J Clin Oncol 2004;22:2404-9. https://doi.org/10.1200/JCO.2004.08.170
  9. Teh BS, Dong L, McGary JE, Mai WY, Grant W 3rd, Butler EB. Rectal wall sparing by dosimetric effect of rectal balloon used during intensity-modulated radiation therapy (IMRT) for prostate cancer. Med Dosim 2005;30:25-30. https://doi.org/10.1016/j.meddos.2004.10.005
  10. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 1997;12:19-23. https://doi.org/10.1007/s003840050072
  11. Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012;30:1926-33. https://doi.org/10.1200/JCO.2011.40.1836
  12. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005;23:5644-50. https://doi.org/10.1200/JCO.2005.08.144
  13. Moore HG, Gittleman AE, Minsky BD, et al. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum 2004;47:279-86. https://doi.org/10.1007/s10350-003-0062-1
  14. Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005;61:665-77. https://doi.org/10.1016/j.ijrobp.2004.06.206
  15. Appelt AL, Ploen J, Vogelius IR, Bentzen SM, Jakobsen A. Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys 2013;85:74-80. https://doi.org/10.1016/j.ijrobp.2012.05.017
  16. de Crevoisier R, Tucker SL, Dong L, et al. Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2005;62:965-73. https://doi.org/10.1016/j.ijrobp.2004.11.032
  17. Ki Y, Kim WT, Nam J, et al. Probiotics for rectal volume variation during radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2013;87:646-50. https://doi.org/10.1016/j.ijrobp.2013.07.038
  18. Stasi M, Munoz F, Fiorino C, et al. Emptying the rectum before treatment delivery limits the variations of rectal dose-volume parameters during 3DCRT of prostate cancer. Radiother Oncol 2006;80:363-70. https://doi.org/10.1016/j.radonc.2006.08.007
  19. Smitsmans MH, Pos FJ, de Bois J, et al. The influence of a dietary protocol on cone beam CT-guided radiotherapy for prostate cancer patients. Int J Radiat Oncol Biol Phys 2008;71:1279-86. https://doi.org/10.1016/j.ijrobp.2008.03.036
  20. Li XA, Yu C, Holmes T. A systematic evaluation of air cavity dose perturbation in megavoltage x-ray beams. Med Phys 2000;27:1011-7. https://doi.org/10.1118/1.598966
  21. Ostwald PM, Kron T, Hamilton CS. Assessment of mucosal underdosing in larynx irradiation. Int J Radiat Oncol Biol Phys 1996;36:181-7.
  22. Niroomand-Rad A, Harter KW, Thobejane S, Bertrand K. Air cavity effects on the radiation dose to the larynx using Co-60, 6 MV, and 10 MV photon beams. Int J Radiat Oncol Biol Phys 1994;29:1139-46. https://doi.org/10.1016/0360-3016(94)90411-1
  23. Chong I, Hawkins M, Hansen V, et al. Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography. Int J Radiat Oncol Biol Phys 2011;81:e431-8. https://doi.org/10.1016/j.ijrobp.2011.04.060

Cited by

  1. The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma vol.50, pp.3, 2016, https://doi.org/10.4143/crt.2017.252
  2. Baseline neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in rectal cancer patients following neoadjuvant chemoradiotherapy vol.105, pp.5, 2016, https://doi.org/10.1177/0300891618792476