Vincenzo Valentini1, Ruud G P M van Stiphout2, Guido Lammering3, Maria A Gambacorta4, Maria C Barba4, Marek Bebenek5, Franck Bonnetain6, Jean F Bosset7, Krzysztof Bujko8, Luca Cionini9, Jean P Gerard10, Claus Rödel11, Aldo Sainato9, Rolf Sauer12, Bruce D Minsky13, Laurence Collette14, Philippe Lambin3. 1. Department of Radiotherapy, Università Cattolica S. Cuore, Rome, Italy. 2. Department of Radiation Oncology (MAASTRO), University Medical Centre Maastricht, The Netherlands; Department of Knowledge Engineering, Maastricht University, The Netherlands. Electronic address: ruud.vanstiphout@maastro.nl. 3. Department of Radiation Oncology (MAASTRO), University Medical Centre Maastricht, The Netherlands. 4. Bioimmagini e Scienze Radiologiche, Università Cattolica S. Cuore, Rome, Italy. 5. Department of Surgical Oncology, Silesian Oncological Centre, Wroclaw, Poland. 6. Department of Statistics, Faculté Médecine Dijon, France. 7. Department of Radiotherapy, CHU Besançon, France. 8. Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. 9. Department of Radiotherapy, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 10. Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France. 11. Department of Radiotherapy and Oncology, University of Frankfurt, Germany. 12. Department of Radiotherapy, University of Erlangen, Germany. 13. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center Houston, USA. 14. Department of Statistics, EORTC Headquarters, Brussels, Belgium.
Abstract
PURPOSE: Personalized treatments based on predictions for patient outcome require early characterization of a rectal cancer patient's sensitivity to treatment. This study has two aims: (1) identify the main patterns of recurrence and response to the treatments (2) evaluate pathologic complete response (pCR) and two-year disease-free survival (2yDFS) for overall survival (OS) and their potential to be relevant intermediate endpoints to predict. METHODS: Pooled and treatment subgroup analyses were performed on five large European rectal cancer trials (2795 patients), who all received long-course radiotherapy with or without concomitant and/or adjuvant chemotherapy. The ratio of distant metastasis (DM) and local recurrence (LR) rates was used to identify patient characteristics that increase the risk of recurrences. FINDINGS: The DM/LR ratio decreased to a plateau in the first 2 years, revealing it to be a critical follow-up period. According to the patterns of recurrences, three patient groups were identified: 5-15% had pCR and were disease free after 2 years (excellent prognosis), 65-75% had no pCR but were disease free (good prognosis) and 15-30% had neither pCR nor 2yDFS (poor prognosis). INTERPRETATION: Compared with pCR, 2yDFS is a stronger predictor of OS. To adapt treatment most efficiently, accurate prediction models should be developed for pCR to select patients for organ preservation and for 2yDFS to select patients for more intensified treatment strategies.
PURPOSE: Personalized treatments based on predictions for patient outcome require early characterization of a rectal cancerpatient's sensitivity to treatment. This study has two aims: (1) identify the main patterns of recurrence and response to the treatments (2) evaluate pathologic complete response (pCR) and two-year disease-free survival (2yDFS) for overall survival (OS) and their potential to be relevant intermediate endpoints to predict. METHODS: Pooled and treatment subgroup analyses were performed on five large European rectal cancer trials (2795 patients), who all received long-course radiotherapy with or without concomitant and/or adjuvant chemotherapy. The ratio of distant metastasis (DM) and local recurrence (LR) rates was used to identify patient characteristics that increase the risk of recurrences. FINDINGS: The DM/LR ratio decreased to a plateau in the first 2 years, revealing it to be a critical follow-up period. According to the patterns of recurrences, three patient groups were identified: 5-15% had pCR and were disease free after 2 years (excellent prognosis), 65-75% had no pCR but were disease free (good prognosis) and 15-30% had neither pCR nor 2yDFS (poor prognosis). INTERPRETATION: Compared with pCR, 2yDFS is a stronger predictor of OS. To adapt treatment most efficiently, accurate prediction models should be developed for pCR to select patients for organ preservation and for 2yDFS to select patients for more intensified treatment strategies.
Authors: Davide Cusumano; Nicola Dinapoli; Luca Boldrini; Giuditta Chiloiro; Roberto Gatta; Carlotta Masciocchi; Jacopo Lenkowicz; Calogero Casà; Andrea Damiani; Luigi Azario; Johan Van Soest; Andre Dekker; Philippe Lambin; Marco De Spirito; Vincenzo Valentini Journal: Radiol Med Date: 2017-12-11 Impact factor: 3.469
Authors: Cynthia Gail Leichman; Shannon L McDonough; Stephen R Smalley; Kevin G Billingsley; Heinz-Josef Lenz; Matthew A Beldner; Aram F Hezel; Mario R Velasco; Katherine A Guthrie; Charles D Blanke; Howard S Hochster Journal: Clin Colorectal Cancer Date: 2017-10-24 Impact factor: 4.481
Authors: Eva Dreussi; Erika Cecchin; Jerry Polesel; Vincenzo Canzonieri; Marco Agostini; Caterina Boso; Claudio Belluco; Angela Buonadonna; Sara Lonardi; Francesca Bergamo; Sara Gagno; Elena De Mattia; Salvatore Pucciarelli; Antonino De Paoli; Giuseppe Toffoli Journal: Int J Mol Sci Date: 2016-09-05 Impact factor: 5.923