Consuelo Rosa1,2, Monica Di Tommaso1, Luciana Caravatta3, Maria Taraborrelli1, Lucrezia Gasparini1, Fiorella Cristina Di Guglielmo1, Andrea Delli Pizzi2,4, Sebastiano Cinalli5, Michele Marchioni6, Marta Di Nicola6, Carmine Lanci7, Giampiero Ausili Cefaro1, Domenico Genovesi1,2. 1. Department of Radiation Oncology, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Via Dei Vestini, 66100, Chieti, Italy. 2. Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy. 3. Department of Radiation Oncology, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Via Dei Vestini, 66100, Chieti, Italy. lcaravatta@hotmail.com. 4. Department of Radiology, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy. 5. Division of Pathology, SS. Annunziata Hospital, Chieti, Italy. 6. Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy. 7. Department of Surgery, SS. Annunziata Hospital, Chieti, Italy.
Abstract
PURPOSE: The effect of neoadjuvant chemoradiotherapy (CRT) and the relationship between pathological complete response (pCR) with clinical outcomes has been evaluated in elderly locally advanced rectal cancer (LARC) patients. METHODS: We retrospectively analyzed 117 LARC patients treated with conformal RT and concomitant fluoropirimidine-based chemotherapy. A dose of 4500 cGy, on the pelvis, up to 5500 cGy on the tumor was delivered. Multidisciplinary evaluation, including geriatric assessment, was previously performed to identify frail patients unsuitable for combined treatment. RESULTS: The median age was 75 (range 70-88 years), and 103 (88%) patients had ECOG Performance Status (PS) = 0. All patients except one completed CRT. Ten (8.5%) patients temporarily suspended CRT for acute severe hematologic complication, diarrhea and/or proctitis and hypokalemia. Of the 103 operated patients (88%), a pCR, according to Mandard tumor regression grade (TRG) score, was obtained in 28 patients (27.2%), with TRG1-2 rate of 43.7%. The 3- and 5-year overall survival (OS) rates were 80.2% ± 4.2% and 68.0% ± 5.2%, 72.4% ± 4.5% and 57.8% ± 5.2% for disease-free survival (DFS), and 92.2% ± 2.8% and 89.5% ± 3.9% for loco-regional control. Patients with TRG1-2 had 3- and 5-year OS rates of 84.1% ± 6.6% and 84.1% ± 6.6% compared with 82.8% ± 5.5% and 67.7% ± 7.2% for patients with TRG3-5 (p = 0.012). The 3- and 5-year DFS rates for patients with TRG1-2 were 77.6% ± 7.0% and 74.2% ± 7.5% compared with 70.9% ± 6.3% and 54.7% ± 7.3% for patients with TRG3-5 (p = 0.009). CONCLUSION: Our results reported good tolerability and clinical outcomes of neoadjuvant CRT, with a benefit in patients ≥ 70 years, confirming the prognostic role of pCR on clinical outcomes.
PURPOSE: The effect of neoadjuvant chemoradiotherapy (CRT) and the relationship between pathological complete response (pCR) with clinical outcomes has been evaluated in elderly locally advanced rectal cancer (LARC) patients. METHODS: We retrospectively analyzed 117 LARC patients treated with conformal RT and concomitant fluoropirimidine-based chemotherapy. A dose of 4500 cGy, on the pelvis, up to 5500 cGy on the tumor was delivered. Multidisciplinary evaluation, including geriatric assessment, was previously performed to identify frail patients unsuitable for combined treatment. RESULTS: The median age was 75 (range 70-88 years), and 103 (88%) patients had ECOG Performance Status (PS) = 0. All patients except one completed CRT. Ten (8.5%) patients temporarily suspended CRT for acute severe hematologic complication, diarrhea and/or proctitis and hypokalemia. Of the 103 operated patients (88%), a pCR, according to Mandard tumor regression grade (TRG) score, was obtained in 28 patients (27.2%), with TRG1-2 rate of 43.7%. The 3- and 5-year overall survival (OS) rates were 80.2% ± 4.2% and 68.0% ± 5.2%, 72.4% ± 4.5% and 57.8% ± 5.2% for disease-free survival (DFS), and 92.2% ± 2.8% and 89.5% ± 3.9% for loco-regional control. Patients with TRG1-2 had 3- and 5-year OS rates of 84.1% ± 6.6% and 84.1% ± 6.6% compared with 82.8% ± 5.5% and 67.7% ± 7.2% for patients with TRG3-5 (p = 0.012). The 3- and 5-year DFS rates for patients with TRG1-2 were 77.6% ± 7.0% and 74.2% ± 7.5% compared with 70.9% ± 6.3% and 54.7% ± 7.3% for patients with TRG3-5 (p = 0.009). CONCLUSION: Our results reported good tolerability and clinical outcomes of neoadjuvant CRT, with a benefit in patients ≥ 70 years, confirming the prognostic role of pCR on clinical outcomes.
Entities:
Keywords:
Good performance status; Older patients; Outcomes; Pathological response; Radiotherapy; Rectal cancer
Authors: Linn M Åsli; Tom B Johannesen; Tor Å Myklebust; Bjørn Møller; Morten Tandberg Eriksen; Marianne Grønlie Guren Journal: Radiother Oncol Date: 2017-05-05 Impact factor: 6.280
Authors: Danielle N Margalit; Harvey J Mamon; Marek Ancukiewicz; Wendy Kobayashi; David P Ryan; Lawrence S Blaszkowsky; Jeffrey Clark; Christopher G Willett; Theodore S Hong Journal: Int J Radiat Oncol Biol Phys Date: 2011-03-04 Impact factor: 7.038
Authors: D M Jiang; S Raissouni; J Mercer; A Kumar; R Goodwin; D Y Heng; P A Tang; C Doll; A MacLean; E Powell; J Price-Hiller; J Monzon; W Y Cheung; M M Vickers Journal: Ann Oncol Date: 2015-07-30 Impact factor: 32.976
Authors: J R Bergquist; C A Thiels; C R Shubert; E B Habermann; A V Hayman; M D Zielinski; K L Mathis Journal: World J Surg Date: 2016-02 Impact factor: 3.352
Authors: Lindsey C F De Nes; Thea C Heil; Rob H A Verhoeven; Valery E P P Lemmens; Harm J Rutten; Johannes H W De Wilt; Pauline A J Vissers Journal: Cancers (Basel) Date: 2022-05-31 Impact factor: 6.575