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Title: Predictive Factors of Tumor Response After Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer

Purpose: Neoadjuvant chemoradiation followed by surgery is the standard of care for locally advanced rectal cancer. The aim of this study was to correlate tumor response to survival and to identify predictive factors for tumor response after chemoradiation. Methods and Materials: From 1998 to 2008, 168 patients with histologically proven locally advanced adenocarcinoma treated by preoperative chemoradiation before total mesorectal excision were retrospectively studied. They received a radiation dose of 45 Gy with a concomitant 5-fluorouracil (5-FU)-based chemotherapy. Analysis of tumor response was based on lowering of the T stage between pretreatment endorectal ultrasound and pathologic specimens. Overall and progression-free survival rates were correlated with tumor response. Tumor response was analyzed with predictive factors. Results: The median follow-up was 34 months. Five-year disease-free survival and overall survival rates were, of 44.4% and 74.5% in the whole population, 83.4% and 83.4%, respectively, in patients with pathological complete response, 38.6% and 71.9%, respectively, in patients with tumor downstaging, and 29.1and 58.9% respectively, in patients with absence of response. A pretreatment carcinoembryonic antigen (CEA) level of <5 ng/ml was significantly independently associated with pathologic complete tumor response (p = 0.019). Pretreatment small tumor size (p = 0.04), pretreatment CEA level of <5 ng/mlmore » (p = 0.008), and chemotherapy with capecitabine (vs. 5-FU) (p = 0.04) were significantly associated with tumor downstaging. Conclusions: Downstaging and complete response after CRT improved progression-free survival and overall survival of locally advanced rectal adenocarcinoma. In multivariate analysis, a pretreatment CEA level of <5 ng/ml was associated with complete tumor response. Thus, small tumor size, a pretreatment CEA level of < 5ng/ml, and use of capecitabine were associated with tumor downstaging.« less
Authors:
 [1] ;  [1] ;  [2] ;  [3] ;  [2] ;  [4] ;  [5] ;  [6] ;  [2] ;  [5] ;  [2] ;  [4] ;  [1]
  1. Department of Radiation Oncology, Paoli-Calmettes Institute, Marseilles (France)
  2. Department of Surgical Oncology, Paoli-Calmettes Institute, Marseilles (France)
  3. Department of Statistic, Paoli-Calmettes Institute, Marseilles (France)
  4. Department of Medical Oncology, Paoli-Calmettes Institute, Marseilles (France)
  5. Department of Gastro-Enterology, Paoli-Calmettes Institute, Marseilles (France)
  6. Department of Pathology, Paoli-Calmettes Institute, Marseilles (France)
Publication Date:
OSTI Identifier:
21491748
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 80; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2010.02.025; PII: S0360-3016(10)00259-2; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOEMBRYONIC ANTIGEN; CARCINOMAS; COMBINED THERAPY; RADIATION DOSES; RECTUM; RESPONSE FUNCTIONS; SURGERY; SURVIVAL CURVES; URACILS ANTIGENS; AZINES; BODY; DIGESTIVE SYSTEM; DISEASES; DOSES; FUNCTIONS; GASTROINTESTINAL TRACT; HETEROCYCLIC COMPOUNDS; HYDROXY COMPOUNDS; INTESTINES; LARGE INTESTINE; MEDICINE; NEOPLASMS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; PYRIMIDINES; THERAPY