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Aim: This study aims to investigate potential associations between the stem cell population and the degree of tumor regression in breast carcinomas treated with neoadjuvant therapy. Settings and Design: The study included 92 patients with breast carcinoma who received neoadjuvant therapy. Tumor regression was defined based on Miller and Payne grading system. Patients with grade 1 or 2 regression on a 5-point scale were included in group 1 (n = 37), grade 3 regression in group 2 (n = 32), and grade 4 or 5 regression in group 3 (n = 23). Materials and Methods: Immunohistochemical staining was performed on paraffin block sections of every case using CD44, CD24, CD29, CD133, ID4, and ALDH1 antibodies to detect stem cells. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS), version 23.0 (IBM Corp., Armonk, NY, USA) software was used for statistical analyses, and a P value less than 0.05 was considered statistically significant. Results: Histologically high-grade tumors are more common in the near-complete/complete response group (P = 0.004). HER2-positive tumors were more common in the complete/near-complete response group (P = 0.054). Tumor cells positive for stem cell markers CD44 and CD24 were more common in the poor response group (P = 0.027 and P = 0.001, respectively). CD29 expression was reduced in the posttreatment residual tumor tissue in the near-complete/complete response group. Conclusion: High CD44 and CD24 expression may be a predictor of poor response/nonresponse to neoadjuvant therapy in breast carcinomas. Background: In recent years, stem cells have been defined as the main cell population responsible for resistance to anticancer therapies.
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Objective:To explore the pathological differences of surgically resected specimens of advanced esophageal squamous cell carcinoma (ESCC) to different neoadjuvant therapies (neoadjuvant radiochemotherapy and toripalimab combined with neoadjuvant radiochemotherapy).Methods:Thirty patients diagnosed with advanced ESCC who underwent surgical operation after neoadjuvant therapy in Jiangsu Cancer Hospital from October 2020 to September 2021 were included. Among them, 15 patients received neoadjuvant radiochemotherapy (radiochemotherapy group) and 15 patients were treated with toripalimab combined with radiochemotherapy (immunotherapy combined with radiochemotherapy group). Surgically resected specimens were collected. The histopathological features of primary esophageal lesions and the responses of involved lymph nodes were analyzed and compared between two groups.Results:The major pathological response (MPR) rate in the radiochemotherapy group was 10/15, and 14/15 in the immunotherapy combined with radiochemotherapy group ( P=0.17). The pathological complete response (pCR) rate of the primary lesions in the radiochemotherapy group was 7/15, and 10/15 in the immunotherapy combined with radiochemotherapy group ( P=0.46). In the radiochemotherapy group, the incidence rate of tertiary lymphoid structure (TLS) was 7/15, and 12/15 in the immunotherapy combined with radiochemotherapy group ( P=0.02). The incidence rate of necrosis in the radiochemotherapy group was 6/15, and 1/15 in the immunotherapy combined with radiochemotherapy group ( P=0.03). In addition, the incidence rate of foam cell infiltration in the radiochemotherapy group was 6/15, and 13/15 in the immunotherapy combined with radiochemotherapy group ( P=0.01). Furthermore, the pCR rate of involved lymph nodes in the radiochemotherapy group was 7/33, and 11/12 in the immunotherapy combined with radiochemotherapy group ( P<0.001). Conclusion:Compared with the radiochemotherapy group, the incidence of TLS and foam cell infiltration is higher, the incidence of necrosis is lower and clinical efficacy of involved lymph nodes is higher in the immunotherapy combined with radiochemotherapy group, prompting that toripalimab combined with neoadjuvant radiochemotherapy exert higher synergistic immune effect.
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The overall efficacy of neoadjuvant chemotherapy for locally advanced gastric cancer has been recognized. However, neoadjuvant chemotherapy is ineffective in a subset of patients due to tumor heterogeneity. The tumor regression grade (TRG) has unique advantages in assessing the efficacy of neoadjuvant chemotherapy for gastric cancer. Nonetheless, since TRG is dependent on postoperative pathology, it becomes a significant topic today to mine TRG predictors to more accurately select appropriate patients for neoadjuvant chemotherapy. Therefore, to understand the relevant research progress and current research challenges of TRG predictors after neoadjuvant chemotherapy for gastric cancer from the aspects of biomarkers, immunity, inflammatory indicators, body composition, imaging indicators, etc., is conducive to further clinical research and practice.
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OBJECTIVE@#To investigate the value of pretreatment inflammatory-nutritional biomarkers in predicting the pathological response of locally advanced rectal cancer (LARC) after neoadjuvant chemotherapy (nCT).@*METHODS@#This retrospective study included eligible participants who underwent nCT followed by radical surgery. Pretreatment inflammatory nutritional biomarkers were calculated within one week prior to nCT. Correlations between biomarkers and pathological responses were analyzed. The cut-off values of the pretreatment biomarkers for predicting non-response were determined using receiver operating characteristic (ROC) curve analysis. The inflammation-nutrition score was calculated using the lymphocyte level, neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI).@*RESULTS@#A total of 235 patients were retrospectively recruited between January 2017 and September 2022. Lower lymphocyte levels, lymphocyte monocyte ratio (LMR), and PNI, and higher NLR and platelet-to-lymphocyte ratio (PLR) were observed in patients without response. Multivariate logistic regression analysis revealed that NLR could independently predict non-response to nCT in patients with LARC. The sensitivity and specificity of the inflammation-nutrition score for predicting nonresponse were 71.2% and 61.7%, respectively.@*CONCLUSION@#The pretreatment inflammation-nutrition score is a practical parameter for predicting non-response to nCT in patients with LARC. Patients with high scores were more likely to respond poorly to nCT.
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Humans , Retrospective Studies , Neoadjuvant Therapy , Lymphocytes , Biomarkers , Rectal Neoplasms/pathologyABSTRACT
@#China is a country with a high incidence of esophageal cancer. Most patients are already in the locally advanced stage when first diagnosed. Preoperative neoadjuvant therapy followed by surgery has become the standard treatment mode for them. Closely related to prognosis, the evaluation of tumor response is essential. Response evaluation criteria in solid tumors is the gold standard to evaluate tumor response, but the lesions must meet the measurement standards. Tumor regression grading (TRG) systems are designed to classify regressive changes after neoadjuvant treatment based on histopathological results to reveal prognostic information. Concentrating on pathologic assessment of esophageal cancer following neoadjuvant therapy, this article reviews histopathological changes, commonly used TRG systems and current debate.
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Background: The present study aimed to explore the effect of neoadjuvant therapy and tumor regression grade (TRG) on the shrinkage in the distal surgical margin (DSM) induced by formalin fixation in rectal cancer. Materials and Methods: In this prospective study, the DSM of resected 61 specimens of rectal and rectosigmoid junction adenocarcinoma were measured following fresh and formalin fixation. The measurements were performed within the first 15 min after resection and at 24 h after formalin fixation without pinning and were compared with regard to neoadjuvant treatment status and TRG. Results: In the patients that received neoadjuvant therapy, the fresh and postfixation DSM values were 32.2 mm and 22.7 mm, respectively, and the mean shrinkage rate was 34.7% (P < 0.001). In the patients that did not receive neoadjuvant therapy, the fresh and postfixation DSM values were 54.03 mm and 41.9 mm, respectively, and the mean shrinkage rate was 23.7% (P < 0.001). The mean shrinkage rate was 41.9% in TRG 1, 29.4% in TRG 2, and 31.9 in TRG 3 specimens. The mean shrinkage rate was higher in specimens with a DSM of ?20 mm compared to specimens with a DSM of >20 mm (46.2% vs. 24.9%). Conclusion: A complete or near-complete tumor regression in patients with rectal cancer undergoing neoadjuvant therapy increases the shrinkage of DSM. Moreover, this shrinkage rate is likely to be higher and the pathological DSM is likely to be closer than expected in cases that present a better clinical response to neoadjuvant therapy, particularly in distal rectal cancer.
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Background: The present study aimed to explore the effect of neoadjuvant therapy and tumor regression grade (TRG) on the shrinkage in the distal surgical margin (DSM) induced by formalin fixation in rectal cancer. Materials and Methods: In this prospective study, the DSM of resected 61 specimens of rectal and rectosigmoid junction adenocarcinoma were measured following fresh and formalin fixation. The measurements were performed within the first 15 min after resection and at 24 h after formalin fixation without pinning and were compared with regard to neoadjuvant treatment status and TRG. Results: In the patients that received neoadjuvant therapy, the fresh and postfixation DSM values were 32.2 mm and 22.7 mm, respectively, and the mean shrinkage rate was 34.7% (P < 0.001). In the patients that did not receive neoadjuvant therapy, the fresh and postfixation DSM values were 54.03 mm and 41.9 mm, respectively, and the mean shrinkage rate was 23.7% (P < 0.001). The mean shrinkage rate was 41.9% in TRG 1, 29.4% in TRG 2, and 31.9 in TRG 3 specimens. The mean shrinkage rate was higher in specimens with a DSM of ?20 mm compared to specimens with a DSM of >20 mm (46.2% vs. 24.9%). Conclusion: A complete or near-complete tumor regression in patients with rectal cancer undergoing neoadjuvant therapy increases the shrinkage of DSM. Moreover, this shrinkage rate is likely to be higher and the pathological DSM is likely to be closer than expected in cases that present a better clinical response to neoadjuvant therapy, particularly in distal rectal cancer.
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Introduction: Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor. Materials and Methods: During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed. Results: Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions). Conclusion: In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.
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Objective To investigate the effects of different neoadjuvant treatments on tumor regression, surgical complications and low anterior resection syndrome (LARS) in patients with rectal cancer. Methods We included 127 patients with rectal cancer receiving neoadjuvant treatments, and they were divided into long-term concurrent chemoradiotherapy group (n=42), short-term radiotherapy+chemotherapy group (n=39) and chemotherapy group (n=46). The pathological results, clinical data and follow-up results were collected. The factors that may affect tumor regression, surgical complications and low anterior resection syndrome after rectal cancer surgery were statistically analyzed and concluded. Results The pCR rates were 28.51%, 10.3% and 8.6% in long-term concurrent chemoradiotherapy group, short-term radiotherapy+chemotherapy group and chemotherapy group, respectively. There were 14 (33.33%), 9 (23.07%) and 10 (21.74%) patients with perioperative complications in three groups, respectively. A total of 91 patients were enrolled in the LARS study. There were 49 (53.84%) cases with LARS symptoms, including 17 (18.68%) cases with severe LARS. In three groups, there were 27 cases (including 13 cases of severe LARS), 12 cases (including 2 cases of severe LARS) and 9 cases (including 2 cases of severe LARS) of LARS symptoms, respectively. Conclusion Three neoadjuvant treatments have good surgical safety. Long-term concurrent chemoradiotherapy and short-term radiotherapy+chemotherapy have advantages in tumor regression, but the former is more likely to cause LARS symptoms and affect the quality of life.Comprehensive consideration is needed in the choice of clinical treatments.
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Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Chemoradiotherapy , Diffusion Magnetic Resonance Imaging , Magnetic Resonance Imaging , Neoadjuvant Therapy , Rectal Neoplasms/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To investigate the expression and correlation of Runt-related transcription factor 3(RUNX3)and enhancer of zeste homolog 2(EZH2)in rectal cancer,and to reveal the relationship between the expression of RUNX3 and EZH2 and the sensitivity of XELOX regimen to neoadjuvant chemotherapy in locally advanced rectal cancer patients. Methods The carcinoma and paracancerous tissues of 31 patients with rectal adenocarcinoma and no preoperative antitumor therapy were selected as cancer group and paracancer group,respectively.The relative mRNA levels of RUNX3 and EZH2 in the two groups were measured by real-time quantitative reverse transcription-polymerase chain reaction,and the protein levels were determined by immunohistochemical assay.The expression of RUNX3 and EZH2 was compared between cancer tissue and paracancerous tissue.The pre-treatment wax blocks of 26 patients with locally advanced rectal cancer who received 3 cycles of XELOX regimen as neoadjuvant chemotherapy before surgery were selected as the pre-neoadjuvant therapy group,and the postoperative pathological wax blocks were selected as the post-neoadjuvant treatment group.Tumor regression grade(TRG)was determined to evaluate the efficacy of neoadjuvant therapy.Immunohistochemical assay was used to detect the protein levels of RUNX3 and EZH2 in the two groups,and then the relationship between the expression patterns of the two proteins and the efficacy of neoadjuvant chemotherapy was analyzed. Results Compared with paracancerous tissue,the cancer tissue showed down-regulated mRNA level and reduced positive protein expression rate of RUNX3,while up-regulated mRNA level(
Subject(s)
Humans , Core Binding Factor Alpha 3 Subunit/genetics , Enhancer of Zeste Homolog 2 Protein/genetics , Neoadjuvant Therapy , Rectal Neoplasms/drug therapy , Transcription Factor 3ABSTRACT
Objective To investigate the application value of diameter change of superior rectal vein (SRV) and inferior mesenteric vein (IMV) by CT examination in the efficacy evaluation of neoadjuvant therapy for locally advanced rectal cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 40 patients with locally advanced rectal carcer who underwent neoadjuvant therapy in the First Affiliated Hospital of Chongqing Medical University were collected.There were 28 males and 12 females,aged from 12 to 75 years,with the age of (55± 12)years.All patients underwent radical resection of rectal cancer according to the principle of total mesorectal resection after neoadjuvant therapy.Observation indicators:(1) MRI examination;(2) CT examination;(3) surgical situations;(4) follow-up.Follow-up was performed using outpatient examination to detect postoperative complications up to June 2019.The measurement data with normal distribution were represented as Mean±SD,and paired sample t test was used for intra-group comparison.Count data were described as absolute numbers or percentages.Results (1) MRI examination:there were 22 patients with positive extramural vascular invasion (EMVI) and 18 with negative EMVI.(2) CT examination:the diameter of SRV was (3.9 ± 0.9) mm and (3.0 ± 0.6) mm before and after neoadjuvant therapy,showing a significant difference (t=5.75,P＜0.05).Subgroup analysis:for the 30 patients with response to neoadjuvant therapy,the diameter of SRV changed significantly after neoadjuvant therapy [(4.1 ± 1.0) mm vs.(3.4±0.7) mm,t =6.20,P＜0.05];for the 10 patients without response to neoadjuvant therapy,the diameter of SRV showed no significant difference after neoadjuvant treatment [(3.6±0.6)mm vs.(3.5±0.8)mm,t=1.13,P＞0.05].The diameter of SRV was (4.2±0.8)mm in 22 patients with EMVI and (3.7±0.8)mm in 18 patients with negative EMVI,showing a significant difference between the two groups (t =2.45,P＜0.05).The diameter of IMV was (5.1 ± 0.9)mm and (4.2±0.9)mm before and after neoadjuvant therapy,showing a significant difference (t=4.16,P＜ 0.05).Subgroup analysis:for the 30 patients with response to neoadjuvant therapy,the diameter of IMV changed significantly after neoadjuvant treatment [(5.1 ± 0.9) mm vs (4.6± 0.8) mm,t =0.76,P＜ 0.05];for the 10 patients without response to neoadjuvant therapy,the diameter of SRV showed no significant difference after neoadjuvant treatment [(5.0±0.9)mm vs (4.8±1.0)mm,t=0.76,P＞0.05].The diameter of IMV was (4.8± 0.9) mm in 22 patients with EMVI and (4.6±0.8) mm in 18 patients with negative EMVI,showing no significant difference between the two groups (t =2.45,P＞ 0.05).(3) Surgical situations:40 patients underwent radical resection of rectal cancer,including 4 with synchronous liver metastases undergoing resection of metastases.(4) Follow-up:40 patients were followed up for 3.0-6.0 months,with a median follow-up time of 4.5 months.One of 40 patients with perineal incision infection was improved and discharged after dressing change,1 with anastomotic leakage on the 5th day after operation was improved and discharged after conservative treatment,1 of 2 with adhesive intestinal obstruction was improved after surgery and 1 was improved after conservative treatment,other 36 patients were discharged and no obvious abnormality occured during the follow-up.Conclusions The diameters of SRV and IMV in patients with locally advanced rectal cancer can be significantly decreased significantly after neoadjuvant therapy.The diameters of SRV and IMV can be used as potential indices to evaluate the effects of neoadjuvant therapy for rectal cancer,and the SRV had a higher evaluation value.
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Objective To explore whether CT perfusion imaging (CTPI)parameters can early predict the curative effect of anlotinib hydrochloride and their predictive accuracy for the treatment in lung cancer patients.Methods 2 6 patients with advanced nonGsmall cell lung cancer (NSCLC)were treated with anlotinib hydrochloride and underwent CTPI scanning before chemotherapy,after the first and second treatment cycle respectively.The average values of perfusion value (PV),peak enhancement image (PEI),time to peak (TTP),blood volume (BV)and the change rate of these parameters after one treatment cycle every time were measured and recorded. According to the response evaluation criteria in solid tumors 1.1 (RECIST1.1),the maximum diameter of the target tumor was measured and the tumor regression rate after two treatment cycles was calculated.Then a correlation analysis was conducted between the change rate of perfusion parameters (PV%,PEI%,TTP%,BV%)after one treatment cycle and the tumor regression rate (D%)after two treatment cycles. The ROC curve was performed to evaluate the accuracy of those parameters.Results PV after one treatment cycle was significantly lower than that before treatment,and PV% showed a statistical difference (P＝0.00).The PV% after one treatment cycle was positively correlated with D% after two treatment cycles (r＝0.56).In addition,the AUC of PV% and BV% were 0.99 and 0.88 respectively, and specificity were both 100%,with sensitivity respectively 75.7% and 82.6%.Conclusion CTPI can early reflect the curative effect of anlotinib hydrochloride for advanced NSCLC and provide more options for clinical evaluation.
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BACKGROUND: We aimed to establish robust histoprognostic predictors on residual rectal cancer after preoperative chemoradiotherapy (CRT).METHODS: Analyzing known histoprognostic factors in 146 patients with residual disease allows associations with patient outcome to be evaluated.RESULTS: The median follow-up time was 77.8 months, during which 59 patients (40.4%) experienced recurrence and 41 (28.1%) died of rectal cancer. On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0.005). On multivariate analysis, higher ypTNM stage and CRM positivity were identified as independent prognostic factors for RFS (ypTNM stage, p=0.024; CRM positivity, p<0.001) and CSS (p=0.022, p=0.017, respectively). Furthermore, CRM positivity was an independent predictor of reduced RFS and CSS, irrespective of subgrouping according to downstage (non-downstage, p<0.001 and p<0.001; downstage, p=0.002 and p=0.002) or lymph node metastasis (non-metastasis, p<0.001 and p=0.001; metastasis, p<0.001 and p<0.001).CONCLUSION: CRM status may be as powerful as ypTNM stage as a prognostic indicator for patient outcome in patients with residual rectal cancer after preoperative CRT.
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Humans , Chemoradiotherapy , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Neoplasm, Residual , Prognosis , Rectal Neoplasms , RecurrenceABSTRACT
Objective To explore the clinical and imaging factors influencing the patients' prognosis after preoperative radiotherapy for local advanced rectal cancer.Methods We retrospectively analyzed 106 locally advanced rectal cancer patients from June 2004 to September 2015 in our institution.All patients underwent preoperative radiotherapy.According to the Mandard score,patients were divided into 5 groups (TRG1-5).All patients were divided into two groups according to the TRG,which including good responder (TRG1 + 2) and poor responder (TRG3 + 4 + 5) groups.All of the tumor ADC values of post-RT were measured by Diffusion-weighted MRI technology,and the relationship between tumor ADC values of post-RT and TRG was analyzed.Results In univariate analysis,age,chemotherapy,pT,pN,differentiation degree,vascular invasion and TRG were significantly associated with overall survival (x2 =3.945-8.110,P ＜ 0.05).Multivariate analysis indicated that differentiation degree and TRG were the independent prognostic factors for OS (x2 =5.221,6.563,P ＜ 0.05).No significant difference was found between long-course and short-course radiotherapy group (P ＞ 0.05) in OS.The good responder group had a favorable survival in 5-year OS compared to the poor responder group (x2 =8.110,P ＜ 0.05).Preoperative radiotherapy,preoperative chemotherapy,pathological type,differentiation degree and gross type,vascular tumor thrombus and tumor ADC values of post-RT were significantly associated with TRG (x2 =4.189-18.139,P ＜ 0.05).The best critical point of tumor ADC values of post-RT was 1.7 x 10-3 mm2/s by using ROC curve.The accuracy of tumor ADC values of post-RT in predicting TRG1 + 2 was 70％.Conclusions The TRG can predict the efficacy of preoperative radiotherapy in patients with locally advanced rectal cancer based on the Mandard score.There was no significant difference in OS between long-course radiotherapy group and short-course radiotherapy group.The tumor ADC values of post-RT might become a potential factor to predict TRG in patients with locally advanced rectal cancer after preoperative radiotherapy.
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Objective To evaluate the value of endorectal elastography with strain ratio to estimate local advanced rectal cancer after neoadjuvant radiochemotherapy.Methods In a retrospective study, endorectal ultrasound,endorectal elastography and enhanced rectal MRI were performed in 67 patients with local advanced rectal cancer after neoadjuvant radiochemotherapy.The imaging results were compared with postoperative pathological T stage and NCCN TRG.Results There was no significant difference in the diagnosis accuracy between T stage of ERUS(55.2%)and MRI(56.7%).Endorectal elastography results showed lesions confined to the rectal wall(T0-2 stage)were softer than lesions invaded the peripheral fat (T3)and the difference was statistically significant(P <0.05).When the cut-off point was set at SR<2.78,the sensitivity,specificity and accuracy of diagnosis of T0-2 were 64.7%,87.5% and 70.1% respectively.The lesion tended to have a greater SR value when residual tumor components increased(a higher NCCN TRG).Conclusions Endorectal elastography is an useful and effective imaging method to evaluate local advanced rectal cancer after neoadj uvant radiochemotherapy.It can help ERUS and rectal MRI to evaluate the lesions.
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PURPOSE: Tumor regression grade (TRG) is predictive of therapeutic response in rectal cancer patients after chemoradiotherapy (CRT) followed by curative resection. However, various TRG systems have been suggested, with subjective categorization, resulting in interobserver variability. This study compared the prognostic validity of four different TRG systems in order to identify the most ideal TRG system. MATERIALS AND METHODS: This study included 933 patients who underwent preoperative CRT and curative resection. Primary tumors alone were graded according to the American Joint Committee on Cancer (AJCC), Dworak, and Ryan TRG systems, and both primary tumors and regional lymph nodes were graded according to a modified Dworak TRG system. The ability of each TRG system to predict recurrence-free survival (RFS) and overall survival (OS) was analyzed using chi-square and C statistics. RESULTS: All four TRG systems were significantly predictive of both RFS and OS (p < 0.001 each), however none was a better predictor of prognosis than ypStage. Among the four TRGs, the mDworak TRG system was a better predictor of RFS and OS than the AJCC, Dworak, and Ryan TRG systems, and both the chi-square and C statistics were higher for the former, although the differences were not statistically significant. The combination of ypStage and the modified Dworak TRG better predicted RFS and OS than ypStage alone. CONCLUSION: The modified Dworak TRG system for evaluation of entire tumors including regional lymph nodes is a better predictor of survival than current TRG systems for evaluation of the primary tumor alone.
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Humans , Chemoradiotherapy , Joints , Lymph Nodes , Observer Variation , Prognosis , Rectal NeoplasmsABSTRACT
PURPOSE: To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. MATERIALS AND METHODS: We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. RESULTS: Average rectal volume and ARA were 11.3 mL and 2.9 cm². After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). CONCLUSION: Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary.
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Humans , Chemoradiotherapy , Medical Records , Rectal Neoplasms , Tumor BurdenABSTRACT
Objective To explore the related factors of tumor regression speed during radiotherapy for esophageal cancer and analyze the relationship between recent clinical curative effect and tumor regression speed.Methods 68 previously untreated esophageal cancer patients were treated with three dimensional conformal intensity modulated radiation therapy (3D-IMRT).The radiation dose was 64 Gy/32 times (95 ％ PTV).All the patients were divided into 3 groups according to the size of primary lesions during the entire course of radiotherapy.Fast regression was defined as a complete response before dose 32 Gy,slow regression with dose in the range of 64 Gy and other cases as residual disease.The correlations of tumor regression speed with age,gender,classification,length of lesion and the lesion location were analyzed.And the relationship between recent clinical curative effect and tumor regression speed was discussed.Results The age,gender,classification and the lesion location were not associated with tumor regression (P ＞ 0.05).There was a negative correlation between tumor regression speed and the length of lesion [88.9 ％ (16/18),69.2 ％ (18/26) and 12.5 ％ (3/24) in fast,slow and residual group,respectively,x2 =27.923,P ＜ 0.05].There was a positive correlation between recent clinical curative effect and tumor regression speed (r =0.415,P ＜ 0.05).Conclusion The length of primary lesion is an independent risk factor for recent clinical curative effect and tumor regression speed of esophageal cancer patients treated with 3D-IMRT.
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Objective To retrospectively analyze the influence of intensity-modulated radiotherapy (IMRT) on tumor regression in primary nasopharyngeal carcinoma (NPC).Methods 272 patients with NPC received radical radiotherapy alone,196 by IMRT with a total treatment time of 6 weeks,and 76 by bilateral field conventional radiotherapy (CRT) with the total treatment timc of 7 weeks.Results By the end of radiotherapy,the primary tumor and neck lymph node residual rates of the IMRT group were 36.7％ and 44.2％,respectively,both significantly higher than those of the GRT group (21.1％ and 26.6％,x2 =6.15,3.99,P ＜ 0.05).Three months after the radiotherapy,residual lesions were observed at the nasopharynx or neck lymph nodes in 12 of the IMRT group,with a residual rate of 6.1％,not significantly different from that of the CRT group (9.2％,7/76).The 12 residual lesions of the IMRT group all vanished completely 4 -9 months after the radiotherapy.Conclusions There is an obvious difference in regressive mode between IMRT and CRT technique in NPC treatment.At the end of IMRT,the tumor residual rate is slightly increased.However,the delivered dose of gross tumor volume (GTV) is sufficient,and the boost dose should not be delivered indiscreetly.