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Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients

Abstract

Purpose: In the literature, a favorable prognosis was observed for complete pathologic response after preoperative therapy (ypCR) in patients with locally advanced rectal cancer. The aim of this study is to verify whether ypCR predicts a favorable outcome in a large series of patients. Methods and Materials: The Gastro-Intestinal Working Group of the Italian Association of Radiation Oncology collected clinical data for 566 patients with ypCR (ypT0N0) after neoadjuvant therapy. Eligibility criteria included locally advanced rectal cancer with no evidence of metastases at the time of diagnosis, evidence of ypCR after preoperative radiotherapy {+-} chemotherapy (CT). Results: Median radiation dose was 50 Gy. A total of 527 patients (93%) received one of 12 different neoadjuvant CT schedules. Sphincter preservation, anteroposterior resection, and endoscopic surgery were performed in 73%, 22%, and 5% of patients, respectively. Adjuvant CT was administered to 22% of patients. Median follow-up was 46.4 months. Locoregional recurrence occurred in 7 patients (1.6%). Distant metastases occurred in 49 patients (8.9%). Overall, 5-year rates of disease-free survival, overall survival, and cancer-specific survival were 85%, 90%, and 94%, respectively. In multivariate analysis, only age and clinical stage statistically correlated with survival outcome. Adjuvant CT was still of borderline significance (worse for  More>>
Authors:
Capirci, Carlo; [1]  Valentini, Vincenzo; [2]  Cionini, Luca; [3]  De Paoli, Antonino; [4]  Rodel, Claus; [5]  Glynne-Jones, Robert; [6]  Coco, Claudio; [7]  Romano, Mario; [8]  Mantello, Giovanna; [9]  Palazzi, Silvia; [10]  Mattia, Falchetti Osti; [11]  Friso, Maria Luisa; [12]  Genovesi, Domenico; [13]  Vidali, Cristiana; [14]  Gambacorta, Maria Antonietta; [2]  Buffoli, Alberto; [15]  Lupattelli, Marco; [16]  Favretto, Maria Silvia; [17]  La Torre, Giuseppe [18] 
  1. Department of Radiotherapy, State Hospital, Rovigo (Italy)
  2. Department of Radiotherapy, Catholic University, Roma (Italy)
  3. Department of Radiotherapy, S. Chiara University, Pisa (Italy)
  4. Department of Radiotherapy, Centro Oncologico di Riferimento, Aviano (Italy)
  5. Department of Radiotherapy, University of Frankfurt, Frankfurt (Germany)
  6. Mount Vernon Hospital, Northwood (United Kingdom)
  7. Department of Surgery, Catholic University, Roma (Italy)
  8. Department of Radiotherapy, State Hospital, Verona (Italy)
  9. Department of Radiotherapy, State Hospital, Ancona (Italy)
  10. Department of Radiotherapy, Sapienza University, Roma (Italy)
  11. Department of Radiotherapy, State Hospital, Ravenna (Italy)
  12. Department of Radiotherapy, Padova (Italy)
  13. Department of Radiotherapy, State Hospital, Chieti University (Italy)
  14. Department of Radiotherapy, State Hospital, Trieste (Italy)
  15. Department of Radiotherapy, State Hospital, Udine (Italy)
  16. Department of Radiotherapy, State Hospital, Perugia (Italy)
  17. Department of Radiotherapy, State Hospital, Vicenza (Italy)
  18. Department of Epidemiology, Catholic University, Roma (Italy)
Publication Date:
Sep 01, 2008
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 72; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2007.12.019; PII: S0360-3016(07)04759-1; Copyright (c) 2008 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; COMBINED THERAPY; DIAGNOSIS; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; RECTUM; SURGERY
OSTI ID:
21124429
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US08R2672007133
Availability:
Available from http://dx.doi.org/10.1016/j.ijrobp.2007.12.019;INIS
Submitting Site:
INIS
Size:
page(s) 99-107
Announcement Date:
Feb 26, 2009

Citation Formats

Capirci, Carlo, Valentini, Vincenzo, Cionini, Luca, De Paoli, Antonino, Rodel, Claus, Glynne-Jones, Robert, Coco, Claudio, Romano, Mario, Mantello, Giovanna, Palazzi, Silvia, Mattia, Falchetti Osti, Friso, Maria Luisa, Genovesi, Domenico, Vidali, Cristiana, Gambacorta, Maria Antonietta, Buffoli, Alberto, Lupattelli, Marco, Favretto, Maria Silvia, and La Torre, Giuseppe. Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients. United States: N. p., 2008. Web. doi:10.1016/j.ijrobp.2007.12.019.
Capirci, Carlo, Valentini, Vincenzo, Cionini, Luca, De Paoli, Antonino, Rodel, Claus, Glynne-Jones, Robert, Coco, Claudio, Romano, Mario, Mantello, Giovanna, Palazzi, Silvia, Mattia, Falchetti Osti, Friso, Maria Luisa, Genovesi, Domenico, Vidali, Cristiana, Gambacorta, Maria Antonietta, Buffoli, Alberto, Lupattelli, Marco, Favretto, Maria Silvia, & La Torre, Giuseppe. Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients. United States. https://doi.org/10.1016/j.ijrobp.2007.12.019
Capirci, Carlo, Valentini, Vincenzo, Cionini, Luca, De Paoli, Antonino, Rodel, Claus, Glynne-Jones, Robert, Coco, Claudio, Romano, Mario, Mantello, Giovanna, Palazzi, Silvia, Mattia, Falchetti Osti, Friso, Maria Luisa, Genovesi, Domenico, Vidali, Cristiana, Gambacorta, Maria Antonietta, Buffoli, Alberto, Lupattelli, Marco, Favretto, Maria Silvia, and La Torre, Giuseppe. 2008. "Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients." United States. https://doi.org/10.1016/j.ijrobp.2007.12.019.
@misc{etde_21124429,
title = {Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients}
author = {Capirci, Carlo, Valentini, Vincenzo, Cionini, Luca, De Paoli, Antonino, Rodel, Claus, Glynne-Jones, Robert, Coco, Claudio, Romano, Mario, Mantello, Giovanna, Palazzi, Silvia, Mattia, Falchetti Osti, Friso, Maria Luisa, Genovesi, Domenico, Vidali, Cristiana, Gambacorta, Maria Antonietta, Buffoli, Alberto, Lupattelli, Marco, Favretto, Maria Silvia, and La Torre, Giuseppe}
abstractNote = {Purpose: In the literature, a favorable prognosis was observed for complete pathologic response after preoperative therapy (ypCR) in patients with locally advanced rectal cancer. The aim of this study is to verify whether ypCR predicts a favorable outcome in a large series of patients. Methods and Materials: The Gastro-Intestinal Working Group of the Italian Association of Radiation Oncology collected clinical data for 566 patients with ypCR (ypT0N0) after neoadjuvant therapy. Eligibility criteria included locally advanced rectal cancer with no evidence of metastases at the time of diagnosis, evidence of ypCR after preoperative radiotherapy {+-} chemotherapy (CT). Results: Median radiation dose was 50 Gy. A total of 527 patients (93%) received one of 12 different neoadjuvant CT schedules. Sphincter preservation, anteroposterior resection, and endoscopic surgery were performed in 73%, 22%, and 5% of patients, respectively. Adjuvant CT was administered to 22% of patients. Median follow-up was 46.4 months. Locoregional recurrence occurred in 7 patients (1.6%). Distant metastases occurred in 49 patients (8.9%). Overall, 5-year rates of disease-free survival, overall survival, and cancer-specific survival were 85%, 90%, and 94%, respectively. In multivariate analysis, only age and clinical stage statistically correlated with survival outcome. Adjuvant CT was still of borderline significance (worse for adjuvant CT). No relation was found between survival and neoadjuvant CT schedules. Conclusion: A ypCR after neoadjuvant therapy identified a favorable group of patients, even in this large series of 566 patients collected in 61 centers. Locoregional recurrence occurred only in 1.6% patients.}
doi = {10.1016/j.ijrobp.2007.12.019}
journal = []
issue = {1}
volume = {72}
place = {United States}
year = {2008}
month = {Sep}
}