Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer:A metaanalysis

BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of debate.AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)for locally advanced EC(LAEC).METHODS A comprehensive search was conducted using multiple databases,including PubMed,EMBASE,MEDLINE,Science Direct,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Science and Technology Journal Database,and Chinese Biomedical Literature Database Article.Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected.RESULTS The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival.The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate(OSR)[odds ratio(OR)=0.95],complete response rate(OR=3.15),and R0 clearance rate(CR)(OR=2.25).However,nCT demonstrated a better 5-year OSR(OR=1.02)than nCRT.Moreover,when compared to nCRT,nCT showed reduced risks of cardiac complications(OR=1.15)and pulmonary complications(OR=1.30).CONCLUSION Overall,both nCRT and nCT were effective in terms of survival outcomes for LAEC.However,nCT exhibited better performance in terms of postoperative complications.

Effects of neoadjuvant chemotherapy vs chemoradiotherapy in the treatment of esophageal adenocarcinoma:A systematic review and meta-analysis

BACKGROUND Neoadjuvant therapy is an essential modality for reducing the clinical stage of esophageal cancer;however,the superiority of neoadjuvant chemotherapy(nCT)or neoadjuvant chemoradiotherapy(nCRT)is unclear.Therefore,a discussion of these two modalities is necessary.AIM To investigate the benefits and complications of neoadjuvant modalities.METHODS To address this concern,predefined criteria were established using the PICO protocol.Two independent authors performed comprehensive searches using predetermined keywords.Statistical analyses were performed to identify significant differences between groups.Potential publication bias was visualized using funnel plots.The quality of the data was evaluated using the Risk of Bias Tool 2(RoB2)and the GRADE approach.RESULTS Ten articles,including 1928 patients,were included for the analysis.Significant difference was detected in pathological complete response(pCR)[P<0.001;odds ratio(OR):0.27;95%CI:0.16-0.46],30-d mortality(P=0.015;OR:0.4;95%CI:0.22-0.71)favoring the nCRT,and renal failure(P=0.039;OR:1.04;95%CI:0.66-1.64)favoring the nCT.No significant differences were observed in terms of survival,local or distal recurrence,or other clinical or surgical complications.The result of RoB2 was moderate,and that of the GRADE approach was low or very low in almost all cases.CONCLUSION Although nCRT may have a higher pCR rate,it does not translate to greater long-term survival.Moreover,nCRT is associated with higher 30-d mortality,although the specific cause for postoperative complications could not be identified.In the case of nCT,toxic side effects are suspected,which can reduce the quality of life.Given the quality of available studies,further randomized trials are required.

Effect of postoperative adjuvant chemotherapyon the prognosis of patients with ypT0-3N0 rectalcancer undergoing neoadjuvant chemoradiotherapy

Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods The study participants were 110 patients with locally advanced rectal cancer. Thirty-fourpatients did not receive postoperative AC treatment, and the other 76 patients received postoperative ACtreatment. The differences in the 5-year overall survival (OS) and disease-free survival (DFS) between thetwo groups were compared.Results Age was an important determinant of the patients’ decision to undergo postoperative treatment.Patients who did not receive AC treatment were significantly older than those who received AC treatment(P < 0.05). The tumor location (distance above anal margin) in the AC group was significantly larger thanthat in the non-AC group (P < 0.05). Moreover, there was no significant difference in the 5-year DFS andOS between the two groups. Postoperative AC did not significantly improve the prognosis of patients withrectal cancer. Age, tumor differentiation, and the number of resected lymph nodes were independent factorsaffecting the OS of patients (P < 0.05). Older patients, patients with lower degree of tumor differentiation,and patients with <12 resected lymph nodes showed worse prognosis (P < 0.05).Conclusion Patients with rectal cancer whose ypT0-3N0 stage is reduced after neoadjuvantchemoradiotherapy, especially those without adverse prognostic factors, do not need AC after surgery.

Neoadjuvant intermediate-course versus long-course chemoradiotherapy in T3-4/N0+rectal cancer:Istanbul R-02 phase II randomized study

Radiation therapy(RT)is typically applied using one of two standard approaches for preoperative treatment of resectable locally advanced rectal cancer(LARC):short-course RT(SC-RT)alone or long-course RT(LC-RT)with concurrent fluorouracil(5-FU)chemotherapy.The Phase II single-arm KROG 11-02 study using intermediate-course(IC)(33 Gy(Gray)/10 fr(fraction)with concurrent capecitabine)preoperative chemoradiotherapy(CRT)demonstrated a pathologically complete response rate and a sphincter-sparing rate that were close to those of LC-CRT.The current trial aim to compare the pathological/oncological outcomes,toxicity,and quality of life results of LC-CRT and IC-CRT in cases of LARC.The prescribed dose was 33 Gy/10 fr for the IC-CRT group and 50.4 Gy/28 fr for the LC-CRT group.Concurrent chronomodulated capecitabine(Brunch regimen)1650 mg/m2/daily chemotherapy treatment was applied in both groups.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer Module(EORTC QLQ-CR29)was administered at baseline and at three and six months after CRT.A total of 60 patients with LARC randomized to receive IC-CRT(n=30)or LC-CRT(n=30)were included in this phase II randomized trial.No significant difference was noted between groups in terms of pathological outcomes,including pathological response rates(ypT0N0-complete response:23.3%vs.16.7%,respectively,and ypT0-2N0-downstaging:50%for each;p=0.809)and Dworak score-based pathological tumor regression grade(Grade 4-complete response:23.3 vs.16.7%,p=0.839).The 5-year overall survival(73.3 vs.86.7%,p=0.173)rate was also similar.The acute radiation dermatitis(p<0.001)and any hematological toxicity(p=0.004)rates were significantly higher in the LC-CRT group,while no significant difference was noted between treatment groups in terms of baseline,third month,and sixth month EORTC QLQ-CR29 scores.

Adjuvant chemoradiotherapy vs adjuvant chemotherapy in locally advanced Siewert type Ⅱ/Ⅲ adenocarcinoma of gastroesophageal junction after D2/R0 resection

BACKGROUND For Siewert type Ⅱ/Ⅲ adenocarcinoma of gastroesophageal junction(AGE), the efficacy of adjuvant chemoradiotherapy(CRT) after D2/R0 resection remains uncertain.AIM To determine whether CRT was superior to chemotherapy(CT) alone after D2/R0 resection for locally advanced Siewert type Ⅱ/Ⅲ AGE.METHODS We identified 316 locally advanced Siewert type Ⅱ/Ⅲ AGE patients who were treated with D2/R0 resection at National Cancer Center from 2011 to 2018.57 patients received adjuvant CRT and 259 patients received adjuvant CT.We followed patients for overall survival(OS), relapse-free survival, and recurrence pattern.RESULTS Five-year OS rates of the CRT group and the CT group for all patients were 66.7% and 41.9%(P = 0.010).Five-year OS rates of the CRT group and the CT group for Siewert type Ⅲ AGE patients were 65.7% and 43.9%(P = 0.006).Among the 195 patients whose recurrence information could be obtained, 18 cases(34.6%) and 61 cases(42.7%) were diagnosed as recurrence in the CRT group and CT group, respectively.The local and regional recurrence rates in the CRT group were lower than that in the CT group(22.2% vs 24.6%, 27.8% vs 39.3%).Multivariable cox regression analysis showed that vascular invasion, nerve invasion, and adjuvant CRT were important prognostic factors for Siewert type Ⅲ AGE.CONCLUSION For locally advanced Siewert type Ⅲ AGE, adjuvant CRT may prolong OS and reduce the regional recurrence rate.

Benefit of adjuvant chemoradiotherapy in patients with pathologically lymph node-positive and locally advanced gastric cancer

Objective This study aimed to compare the effectiveness of adjuvant chemoradiotherapy(CRT)and adjuvant chemotherapy(ChT)for T3–4/N+gastric cancer(GC)following D2/R0 dissection,and identify the specific subgroups that could benefit from adjuvant CRT.Methods All eligible patients were divided into the CRT group and ChT group.We assessed the survival outcomes and patterns of recurrence for each group,and determined the prognostic factors for survival by performing Cox proportional risk regression analyses.Results A total of 192 gastric cancer patients were included in the study.The estimated 3-year and 5-year disease-free survival(DFS)probabilities in the CRT and ChT groups were 52.9%vs.36.7%(P=0.024)and 41.2%vs.31.1%(P=0.148),respectively,and the estimated 3-year and 5-year overall survival(OS)probabilities were 82.4%vs.70.0%(P=0.044)and 52.0%vs.35.6%(P=0.022).Patients in the CRT group had a lower risk of locoregional recurrence than those in the ChT group(20.6%vs.34.4%;P=0.031).The subset analyses revealed that patients with stage N1–2 disease were more likely to benefit from adjuvant CRT than from adjuvant ChT(DFS:53.1%vs.36.4%;P=0.039;OS:53.1%vs.38.6%;P=0.036).Conclusion For locally advanced gastric cancer patients with LN+,adjuvant CRT showed superior survival benefits compared with adjuvant ChT alone.Patients with N1–2 achieved better survival from adjuvant CRT.

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

AIM To clarify the role of neoadjuvant concurrent chemoradiotherapy(NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma(CCA).METHODS We retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows:(1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or(2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging. RESULTS The median disease-free survival(DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were26.0 and 15.1 mo, respectively(P = 0.91). The median overall survival(OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively(P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis(P = 0.01). CONCLUSION NACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer

Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.

Long-term outcomes in patients with ypT0 rectal cancer after neoadjuvant chemoradiotherapy and curative resection

Objective： For patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy（NCRT）, significant pathological response of the primary tumor has been proposed to identify candidates for organ preservation. However, this does not address metastatic lymph nodes in the mesorectum. The aim of this study was to assess the incidence of lymph node metastases in ypT0 patients treated with NCRT and curative resection and to explore risk factors associated with survival.Methods： This was a retrospective study of patients with ypT0 rectal cancer after NCRT and curative resection at a tertiary care center in China from 2005 to 2014.Results： A total of 60（18.6%） patients who underwent surgery after NCRT and achieved ypT0 were enrolled in this study; one patient was excluded owing to lack of follow-up. Of these 59 patients, lymph node metastases were found in the mesorectum（ypT0N＋） in eight（13.6%） patients. After a median follow-up of 52 months, 5-year recurrence-free survival（82.7% vs. 62.5%, P=0.014） and overall survival（OS）（90.9% vs. 70.0%, P=0.032） were much higher in ypN0 than yp N＋ patients. Multivariate analyses showed that ypN＋ status（P=0.009） and perioperative blood transfusion（BT）（P=0.001） were significantly independent risk factors associated with recurrence; however, no factor was correlated with 5-year OS.Conclusions： Patients with ypT0N0 rectal cancer can achieve excellent long-term outcomes; however, positive lymph nodes or tumor deposits can still be found in 13.6% of ypT0 patients. Nodal positivity in the mesorectum and perioperative BT are independent risk factors for recurrence.

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer:The debate continues

Rectal carcinoma represents the 30% of all colorectal cancers, with about 40000 new cases/years. In the past two decades, the management of rectal cancer has made important progress, highlighting the main role of a multimodality strategy approach, combining surgery, radiation therapy and chemotherapy. Nowadays, surgery remains the primary treatment and neoadjuvant chemoradiotherapy, based on fluoropyrimidine(5-FU) continuous infusion, is considered the standard in locally advanced rectal carcinoma. The aim is to reduce the incidence of local recurrence and to perform a conservative surgery. To improve these purposes different drugs combination have been tested in the neo-adjuvant setting. At American Society of Clinical Oncology 2014 an important abstract was presented focusing on the role of adding oxaliplatin to concomitant treatment, in patients with locally advanced rectal carcinoma. Rodel et al reported on the CAO/ARO/AIO-04 randomized phase Ⅲ trial that compared standard treatment with 5-FU and radiation therapy, to oxaliplatin plus 5-FU inassociation with radiation therapy. The addition of oxaliplatin to the neo-adjuvant treatment has been shown to improve disease-free survival from 71.2% to 75.9%(P = 0.03). This editorial was planned to clarify the optimal treatment in patients with locally advanced rectal cancer, considering the results from CAO/ARO/AIO-04 study.

Risk factors for local recurrence following neoadjuvant chemoradiotherapy for rectal cancers

Local recurrence(LR)has an adverse impact on rectal cancer treatment.Neoadjuvant chemoradiotherapy(nCRT)is increasingly administered to patients with progressive cancers to improve the prognosis.However,LR still remains a problem and its pattern can alter.Correspondingly,new risk factors have emerged in the context of nCRT in addition to the traditional risk factors in patients receiving non-neoadjuvant therapies.These risk factors are decisive when reviewing treatment options.This review aims to elucidate the distinctive risk factors related to LR of rectal cancers in patients receiving nCRT and to clarify their clinical significance.A search was conducted on PubMed to identify original studies investigating patients with rectal cancer receiving nCRT.Outcomes of interest,especially potential risk factors for LR in patients with nCRT,were then analyzed.The clinical importance of these risk factors is discussed.Remnant cancer cells,lymph-nodes and tumor response were found to be major risk factors.Remnant cancer cells decide the status of resection margins.Local excision following nCRT is promising in ypT0-1N0M0 cases.Dissection of lateral lymph nodes should be considered in advanced lowlying cancers.Although better tumor response resulted in a relatively lower recurrence rate,the evidence available is insufficient to justify a non-operative approach in clinical complete responders to nCRT.LR cannot be totally avoided by current multidisciplinary approaches.The related risk factors resulting from nCRT should be considered when making decisions regarding treatment selection.

Radiotherapy with neoadjuvant chemotherapy versus concurrent chemoradiotherapy for ascending-type nasopharyngeal carcinoma:a retrospective comparison of toxicity and prognosis

Background:In the era of intensity?modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NACT)in treating ascending?type nasopharyngeal carcinoma(NPC)is under?evaluated.This study was to compare the efficacy of NACT followed by IMRT(NACT+RT)with the efficacy of concurrent chemoradiotherapy(CCRT)on ascending?type NPC.Methods:Clinical data of 214 patients with ascending?type NPC treated with NACT+RT or CCRT between Decem?ber 2009 and July 2011 were analyzed.Of the 214 patients,98 were treated with NACT followed by IMRT,and 116 were treated with CCRT.The survival rates were assessed using Kaplan–Meier analysis,and the survival curves were compared using a log?rank test.Results:The 4?year overall survival,locoregional failure?free survival,distant failure?free survival,and failure?free sur?vival rates were not significantly different between the two groups(all P>0.05).However,patients in the CCRT group exhibited more severe acute adverse events than did patients in the NACT+RT group during radiotherapy,includ?ing leukopenia(30.2%vs.15.3%,P=0.016),neutropenia(25.9%vs.11.2%,P=0.011),and mucositis(57.8%vs.40.8%,P=0.028).After radiotherapy,patients in the CCRT group exhibited significantly higher rates of xerostomia(21.6%vs.Conclusions:The treatment outcomes of the NACT+RT and CCRT groups were similar;however,CCRT led to higher rates of acute and late toxicities.NACT+RT may therefore be a better treatment strategy for ascending?type NPC.

An Absolute Standardized Uptake Value Is More Useful than the Decreased Rate of Uptake of FDG-PET to Predict Responses to Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Background: Neoadjuvant chemoradiotherapy (CRT) is frequently performed for esophageal squamous cell carcinoma. In this study, we retrospectively assessed the standardized uptake value (SUV) of FDG-PET against decreased rates of SUV to assess the response of advanced esophageal squamous cell carcinoma patients to neoadjuvant CRT, and the correlation of this response with histopathological findings. Patients and Methods: Thirty-three patients receiving CRT followed by surgery were analyzed. Results: Using the decreased rate of maximum SUV, the sensitivity and specificity in distinguishing complete responders (CR) from non-CR patients was 63% and 44%. Using the maximum SUV before surgery, the sensitivity and specificity for distinguishing pathological CR from non-CR was 88% and 56%. Conclusions: To identify complete responders of CRT for esophageal cancer, absolute maximum SUV value is a better predictor than decreased rate of the maximum SUV.

Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma

BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unclear. In this clinical trial, weprospectively investigated the efficacy and safety of NCRT plus surgery in thetreatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in thetreatment of potentially resectable TESCC.METHODSThirty patients with advanced TESCC hospitalized in our hospital from July2016 to June 2019 were prospectively studied. All patients received NCRT, whichincluded intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f)and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2,23 for two cycles). Surgery was performed after radiotherapy and chemotherapy.The effectiveness and safety of these treatments were observed.RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) andpartial response in 26 cases (86.7%), yielding an objective response rate of 100%.All patients underwent radical surgery successfully. The R0 resection rate was100%, and the pathologic complete response rate was 33.3%. The incidence ofgrade III- IV granulocytopenia was 10% during the NCRT, and anastomoticleakage occurred in one patient after surgery.CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce thetumor size, increase R0 resection rate, and achieve obvious pathologicaldegradation, with mild adverse reactions. Thus, it is worthy of wider clinicalapplication.

Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

BACKGROUND Distant relapse is the leading cause of cancer-related death in locally advanced rectal cancer.Neoadjuvant chemoradiation(NACRT)followed by surgery inevitably delays delivery of systemic treatment.Some patients show early distant metastasis before systemic treatment.AIM To identify the most effective treatments.We investigated prognostic factors for distant metastasis,especially early distant metastasis,using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.METHODS From January 2015 through December 2019,rectal cancer patients who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system were included.Radiotherapy was delivered to the whole pelvis with concomitant chemotherapy.Patients received surgery 6-8 wk after completion of NACRT.Adjuvant chemotherapy was administered at the physician’s discretion.RESULTS A total of 127 patients received NACRT.Ninety-three patients(73.2%)underwent surgery.The R0 resection rate was 89.2%in all patients.Pathologic tumor and node downstaging rates were 41.9%and 76.3%.Half the patients(n=69)received adjuvant chemotherapy after surgery.The 3-year distant metastasis-free survival(DMFS)and overall survival(OS)rates were 81.7%and 83.5%.On univariate analyses,poorly differentiated tumors,>5 cm,involvement of mesorectal fascia(MRF),or presence of extramural involvement(EMVI)were associated with worse DMFS and OS.Five patients showed distant metastasis at their first evaluation after NACRT.Patients with early distant metastasis were more likely to have poorly differentiated tumor(P=0.025),tumors with involved MRF(P=0.002),and EMVI(P=0.012)than those who did not.CONCLUSION EMVI,the involvement of MRF,and poor histologic grade were associated with early distant metastasis.In order to control distant metastasis and improve treatment outcome,selective use of neoadjuvant treatment according to individualized risk factors is necessary.Future studies are required to determine effective treatment strategies for patients at high risk for distant metastasis.

Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer

AIM To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy(CRT) and surgery in locally advanced rectal cancer.METHODS We evaluated 87 patients with locally advanced mid-or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at ?i?li Hamidiye Etfal Training and Research Hospital,Istanbul between January 2009 and January 2014.Patients were divided into two groups according to the intervalbefore surgery: < 8 wk(group Ⅰ) and ≥ 8 wk(group Ⅱ).Data related to patients,cancer characteristics and pathological examination were collected and analyzed.RESULTS When the distribution of timing between group Ⅰ(n = 45) and group Ⅱ(n = 42) was viewed,comparison of interval periods(median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group Ⅰ and 10.1 ± 2.2 wk in group Ⅱ(P < 0.001).The median follow-up period for all patients was 34.5(9.9-81) mo.group Ⅱ had significantly higher rates of pathological complete response(p CR) than group Ⅰ had(19% vs 8.9%,P = 0.002).Rate of tumor regression grade(TRG) poor response was 44.4% in group Ⅰ and 9.5% in group Ⅱ(P < 0.002).A poor pathological response was associated with worse disease-free survival(P = 0.009).The interval time did not show any association with local recurrence(P = 0.79).CONCLUSION Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging,improve p CR rate,and decrease the rate of TRG poor response.

Lymph node regression grading of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Neoadjuvant chemoradiotherapy(nCRT)and total rectal mesenteric excision are the main standards of treatment for locally advanced rectal cancer(LARC).Lymph node regression grade(LRG)is an indicator of prognosis and response to preoperative nCRT based on postsurgical metastatic lymph node pathology.Common histopathological findings in metastatic lymph nodes after nCRT include necrosis,hemorrhage,nodular fibrosis,foamy histiocytes,cystic cell reactions,areas of hyalinosis,residual cancer cells,and pools of mucin.A number of LRG systems designed to classify the amount of lymph node regression after nCRT is mainly concerned with the relationship between residual cancer cells and regressive fibrosis and with estimating the number of lymph nodes existing with residual cancer cells.LRG offers significant prognostic information,and in most cases,LRG after nCRT correlates with patient outcomes.In this review,we describe the systematic classification of LRG after nCRT,patient prognosis,the correlation with tumor regression grade,and the typical histopathological findings of lymph nodes.This work may serve as a reference to help predict the clinical complete response and determine lymph node regression in patients based on preservation strategies,allowing for the formulation of more accurate treatment strategies for LARC patients,which has important clinical significance and scientific value.

Predictive value of a serum tumor biomarkers scoring system for clinical stage Ⅱ/Ⅲ rectal cancer with neoadjuvant chemoradiotherapy

BACKGROUND Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer(RC)response.Carcinoembryonic antigen(CEA)is the most widely used blood-based marker of RC and has proven to be an effective predictive marker.Cancer antigen 19-9(CA19-9)is another tumor biomarker used for RC diagnosis and postoperative monitoring,as well as monitoring of the therapeutic effect.Using a panel of tumor markers for RC outcome prediction is a practical approach.AIM To assess the predictive effect of pre-neoadjuvant chemoradiotherapy(NCRT)CEA and CA19-9 levels on the prognosis of stage II/III RC patients.METHODS CEA and CA19-9 levels were evaluated 1 wk before NCRT.According to the receiver operating characteristic curve analysis,the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01,respectively.The novel serum tumor biomarker(NSTB)scores were as follows:score 0:Pre-NCRT CEA<3.55 and CA19-9<19.01;score 2:Pre-NCRT CEA>3.55 and CA19-9>19.01;score 1:Other situations.Pathological information was recorded according to histopathological reports after the operation.RESULTS In the univariate analysis,pre-NCRT CEA<3.55[P=0.025 for overall survival(OS),P=0.019 for disease-free survival(DFS)],pre-NCRT CA19-9<19.01(P=0.014 for OS,P=0.009 for DFS),a lower NSTB score(0-1 vs 2,P=0.009 for OS,P=0.005 for DFS)could predict a better prognosis.However,in the multivariate analysis,only a lower NSTB score(0-1 vs 2;for OS,HR=0.485,95%CI:0.251-0.940,P=0.032;for DFS,HR=0.453,95%CI:0.234-0.877,P=0.019)and higher pathological grade,node and metastasis stage(0-I vs II-III;for OS,HR=0.363,95%CI:0.158-0.837,P=0.017;for DFS,HR=0.342,95%CI:0.149-0.786,P=0.012)were independent predictive factors.CONCLUSION The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT,and the combined index had a stronger predictive effect.

Effect of Weight Loss on Survival in Esophageal Cancer Patients undergoing Neoadjuvant Chemoradiotherapy and Surgery

Objective This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma.Methods We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital&Institute between 2003 and 2017.The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy:severe weight loss(>10%),high weight loss(5%~10%),and low weight loss(<5%).The correlations of weight loss with toxicity,progressionfree survival,and overall survival were investigated.Results The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups(P=0.041).The 1-year overall survival rates in the severe,high,and low weight loss groups were 62.5%,85.0%,and 90.7%,respectively;the corresponding 3-year overall survival rates were 21.9%,47.3%,and 68.8%,respectively,and the corresponding 5-year overall survival rates were 21.9%,31.0%,and 44.4%,respectively.The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival.Any leukopenia(P=0.024),leukopenia of at least grade 3(P=0.021),and anemia(P=0.042)occurred more frequently in the severe weight loss group.Conclusions Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients,whereas a stable weight confers a better prognosis.

Role of adjuvant chemoradiotherapy and chemotherapy in patients with resected gallbladder carcinoma: a multiinstitutional analysis (KROG 19-04)

Objective:The effectiveness of adjuvant treatments for resected gallbladder carcinoma(GBC)has remained unclear due to lack of randomized controlled trials;thus,the aim of present study was to evaluate the role of adjuvant treatments,including chemoradiotherapy(CRT)and/or chemotherapy(CTx),in patients with resected GBC.Methods:A total of 733 GBC patients who received curative-intent surgical resection were identified in a multi-institutional database.Of 733 patients,372(50.8%)did not receive adjuvant treatment,whereas 215(29.3%)and 146(19.9%)received adjuvant CTx and CRT,respectively.The locoregional recurrence-free survival(LRFS),recurrence-free survival(RFS),and overall survival(OS)of the adjuvant treatment groups were compared according to tumor stage(stage II vs.stage III–IV).Results:In stage II disease(n=381),the 5-year LRFS,RFS,and OS were not significantly different among the no-adjuvant therapy,CTx,and CRT groups,and positive resection margin,presence of perineural invasion,and Nx classification were consistently associated with worse LRFS,RFS,and OS in the multivariate analysis(P<0.05).For stage III–IV(n=352),the CRT group had significantly higher 5-year LRFS,RFS,and OS than the no-adjuvant therapy and CTx groups(67.8%,45.2%,and 56.9%;37.9%,28.8%,and 35.4%;and 45.0%,30.0%,and 45.7%,respectively)(P<0.05).Conclusions:CRT has value as adjuvant treatment for resected GBC with stage III–IV disease.Further study is needed for stage II disease with high-risk features.