Clinical Predictive Factors of Pathologic Tumor Response After Preoperative Chemoradiotherapy in Rectal Cancer

Overview

Journal Radiat Oncol J

Specialty Oncology

Date 2012 Nov 22

PMID 23170288

Citations 26

Authors

Chi Hwan Choi

Won Dong Kim

Sang Jeon Lee

Woo-Yoon Park

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer.

Materials And Methods: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response.

Results: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR.

Conclusion: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.

Citing Articles

Changes in T Lymphocyte Subsets in Different Tumors Before and After Radiotherapy: A Meta-analysis.

Wang Q, Li S, Qiao S, Zheng Z, Duan X, Zhu X Front Immunol. 2021; 12:648652.

PMID: 34220806 PMC: 8242248. DOI: 10.3389/fimmu.2021.648652.

Clinical Significance of Glucose to Lymphocyte Ratio (GLR) as a Prognostic Marker for Patients With Pancreatic Cancer.

Zhong A, Cheng C, Kai J, Lu R, Guo L Front Oncol. 2020; 10:520330.

PMID: 33117673 PMC: 7561421. DOI: 10.3389/fonc.2020.520330.

Do microsatellite instability (MSI) and deficient mismatch repair (dMMR) affect the pathologic complete response (pCR) in patients with rectal cancer who received neoadjuvant treatment?.

Acar T, Acar N, Kamer E, Tekindal M, Cengiz F, Kar H Updates Surg. 2019; 72(1):73-82.

PMID: 31863279 DOI: 10.1007/s13304-019-00697-2.

Neutrophil to Lymphocyte Ratio is a Predictive Factor of Malignant Potential for Intraductal Papillary Mucinous Neoplasms of the pancreas.

Ohno R, Kawamoto R, Kanamoto M, Watanabe J, Fujii M, Ohtani H Biomark Insights. 2019; 14:1177271919851505.

PMID: 31210727 PMC: 6552332. DOI: 10.1177/1177271919851505.

Associations of lymphocyte percentage and red blood cell distribution width with risk of lung cancer.

Ma C, Wang X, Zhao R J Int Med Res. 2019; 47(7):3099-3108.

PMID: 31167586 PMC: 6683910. DOI: 10.1177/0300060519850417.

References

Garcia-Aguilar J, Pollack J, Lee S, Hernandez de Anda E, Mellgren A, Wong W . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum. 2002; 45(1):10-5. DOI: 10.1007/s10350-004-6106-3. View

Galon J, Costes A, Sanchez-Cabo F, Kirilovsky A, Mlecnik B, Lagorce-Pages C . Type, density, and location of immune cells within human colorectal tumors predict clinical outcome. Science. 2006; 313(5795):1960-4. DOI: 10.1126/science.1129139. View

Kalady M, Campos-Lobato L, Stocchi L, Geisler D, Dietz D, Lavery I . Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 2009; 250(4):582-9. DOI: 10.1097/SLA.0b013e3181b91e63. View

Choi C, Kang H, Kim W, Kim T, Lee J, Huh S . Prognostic value of baseline lymphocyte count in cervical carcinoma treated with concurrent chemoradiation. Int J Radiat Oncol Biol Phys. 2007; 71(1):199-204. DOI: 10.1016/j.ijrobp.2007.09.024. View

Bujko K, Nowacki M, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Pudelko M . Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004; 72(1):15-24. DOI: 10.1016/j.radonc.2003.12.006. View

Beets-Tan R, Beets G . Rectal cancer: review with emphasis on MR imaging. Radiology. 2004; 232(2):335-46. DOI: 10.1148/radiol.2322021326. View

Laghi L, Bianchi P, Miranda E, Balladore E, Pacetti V, Grizzi F . CD3+ cells at the invasive margin of deeply invading (pT3-T4) colorectal cancer and risk of post-surgical metastasis: a longitudinal study. Lancet Oncol. 2009; 10(9):877-84. DOI: 10.1016/S1470-2045(09)70186-X. View

Yeo S, Kim D, Kim T, Chang H, Oh J, Park W . Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg. 2010; 252(6):998-1004. DOI: 10.1097/SLA.0b013e3181f3f1b1. View

Das P, Skibber J, Rodriguez-Bigas M, Feig B, Chang G, Wolff R . Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer. 2007; 109(9):1750-5. DOI: 10.1002/cncr.22625. View

10.

Kuss I, Hathaway B, Ferris R, Gooding W, Whiteside T . Decreased absolute counts of T lymphocyte subsets and their relation to disease in squamous cell carcinoma of the head and neck. Clin Cancer Res. 2004; 10(11):3755-62. DOI: 10.1158/1078-0432.CCR-04-0054. View

11.

Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee S, Madoff R, Rothenberger D . A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003; 46(3):298-304. DOI: 10.1007/s10350-004-6545-x. View

12.

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R . Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351(17):1731-40. DOI: 10.1056/NEJMoa040694. View

13.

OToole C, UNSGAARD B . Clinical status and rate of recovery of blood lymphocyte levels after radiotherapy for bladder cancer. Cancer Res. 1979; 39(3):840-3. View

14.

RIESCO A . Five-year cancer cure: relation to total amount of peripheral lymphocytes and neutrophils. Cancer. 1970; 25(1):135-40. DOI: 10.1002/1097-0142(197001)25:1<135::aid-cncr2820250120>3.0.co;2-9. View

15.

Conroy T, Luporsi E, Peiffert D, Lapeyre M, Boissel P, Guillemin F . Prognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer. Int J Radiat Oncol Biol Phys. 1998; 42(5):935-41. DOI: 10.1016/s0360-3016(98)00345-9. View

16.

Kim U, Papatestas A, AUFSES Jr A . Prognostic significance of peripheral lymphocyte counts and carcinoembryonic antigens in colorectal carcinoma. J Surg Oncol. 1976; 8(3):257-62. DOI: 10.1002/jso.2930080312. View

17.

Kim J, Beets G, Kim M, Kessels A, Beets-Tan R . High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?. Eur J Radiol. 2004; 52(1):78-83. DOI: 10.1016/j.ejrad.2003.12.005. View

18.

Yoon S, Kim D, Kim T, Jung K, Chang H, Koom W . Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007; 69(4):1167-72. DOI: 10.1016/j.ijrobp.2007.04.047. View

19.

Canadas-Garre M, Becerra-Massare P, Lopez de la Torre-Casares M, Villar-del Moral J, Cespedes-Mas S, Vilchez-Joya R . Reduction of false-negative papillary thyroid carcinomas by the routine analysis of BRAF(T1799A) mutation on fine-needle aspiration biopsy specimens: a prospective study of 814 thyroid FNAB patients. Ann Surg. 2012; 255(5):986-92. DOI: 10.1097/SLA.0b013e31824e8d70. View

20.

Bosset J, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A . Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results--EORTC 22921. J Clin Oncol. 2005; 23(24):5620-7. DOI: 10.1200/JCO.2005.02.113. View