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REKTUM KANSERİNDE NEOADJUVAN KEMORADYOTERAPİ SONRASI RADYOLOJİK VE PATOLOJİK YANIT PREDİKTÖRLERİNİN DEĞERLENDİRİLMESİ

Year 2019, Volume: 26 Issue: 3, 256 - 262, 01.09.2019
https://doi.org/10.17343/sdutfd.494552

Abstract

Amaç: Bu çalışmada lokal ileri evre rektum tümörlü olgularda preoperatif
kemo-radyoterapi (KRT) sonrası klinik, radyolojik patolojik özelliklerin radyolojik
ve patolojik yanıt ile korelasyonunun araştırılması amaçlandı.



Gereç
ve Yöntem
: Çalışmada Ocak 2012
ve Mayıs 2017 tarihleri arasında endoskopik biyopsi ile rektum kanseri tanısı
alan ve kliniğimizde neoadjuvan (KRT) uygulanan 26 hasta retrospektif olarak
değerlendirildi. Hastaların tedavi öncesi endoskopik bulguları (dentat çizgiye
uzaklık, çevresel tutulum, ülserasyon), radyolojik tümör boyutu, Pozitron
Emisyon tomografi (PET) de görülen kitle boyutu, lenf nodu pozitifliği, standart
uptake değeri (SUV) düzeyi ile tedavi sonrası radyolojik ve patolojik yanıt
düzeylerinin ilişkisi araştırıldı. Patolojik regresyon düzeyi modifiye Ryan
skorlaması ile değerlendirildi.



Bulgular: Hastaların 19’u erkek 7’si kadın olup median yaşları 61
(40 – 83) idi. Olgularımızın medyan pelvik radyoterapi dozu 4500 cGy (3600 –
5040) tümöre yönelik boost dozu ise median 900 cGy (360 – 900) idi. Biri ileri
yaşta diğeri ise kardiak morbiditesi olan iki hastanın dışında tüm hastalara
radyoterapi eş zamanlı kapasitabin uygulandı. Kemoterapi sonrası yanıt tüm
hastalarda RECIST kriterlerine göre değerlendirildiğinde 1 hasta tam yanıtlı, 10
hasta stabil, kalan 15 hasta ise parsiyel yanıtlı olarak değerlendirildi. Tedavi
sonrası opere edilen 22 hastanın 11’ine abdominoperineal rezeksiyon (APR)
15’ine ise low anterior rezeksiyon (LAR) uygulandı. Radyoterapi sonrası
operasyona kadar geçen süre median 42 gün (15 – 194) olarak hesaplandı. Tedavi
öncesi PET CT de lenf nodu pozitif olan hastaların 11 inde patolojik lenf nodu
saptanmadı. Buna karşın başlangıçta lenf nodu görülmeyen 5 hastanın 1 inde
postop lenf nodu (+) idi. Endoskopide görülen tümörün çevreselliği,  lokalizasyonunun anal verge’den 5 cm ve daha
fazla olması ve radyolojik yanıt varlığı sfinkter koruma açısından anlamlı
bulunurken (sırasıyla p: 0,03, p:0,019 ve p:0,022), radyolojik yanıt üzerinde
incelenen hiçbir faktörün prediktif etkisi saptanmadı. Hastalar risk gruplarına
göre değerlendirildiğinde radyolojik ve patolojik yanıt üzerinde anlamlı bir
etki saptanmadı. 



Operasyon sonrası 1 hastada patolojik tam yanıt saptandı.
Regresyon skoru değerlendirilen 17 hastanın 2’sinde skor 3, 10’unda 2, 5
hastada ise 1 olarak değerlendirildi.



Sonuç: Tümörün çevresel yayılımı,  lokalizasyonunun anal verge’den 5 cm ve daha
yüksek olması ve radyolojik yanıt varlığı sfinkter koruma açısından anlamlı
bulunurken (sırasıyla p: 0,03, p:0,019 ve p:0,022), radyolojik yanıt üzerinde
incelenen hiçbir faktörün prediktif etkisi saptanmadı. 

References

  • KAYNAKLAR1- Fleming FJ, Påhlman L, Monson JR. Neoadjuvant therapy in rectal cancer. Dis Colon Rectum. 2011;54(7):901–2.
  • 2- Glimelius B. Neo-adjuvant radiotherapy in rectal cancer. World J Gastroenterol. 2013;19(46):8489–501.
  • 3- Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.
  • 4- Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33
  • 5- Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99(7):918–28.
  • 6- Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–44.
  • 7- de Campos-Lobato LF, Stocchi L, da Luz Moreira A, Geisler D, Dietz DW, Lavery IC, et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. Ann Surg Oncol. 2011;18(6):1590–8.
  • 8- Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys. 2008;72(1):99–107.
  • 9- Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7.
  • 10- Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–40.
  • 11- Moureau-Zabotto L, Farnault B, de Chaisemartin C, Esterni B, Lelong B, Viret F, et al. Predictive factors of tumor response after neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2011;80(2):483–91.
  • 12- Park YA, Sohn SK, Seong J, Baik SH, Lee KY, Kim NK, et al. Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer. J Surg Oncol. 2006;93(2):145–50.
  • 13- Kuremsky JG, Tepper JE, McLeod HL. Biomarkers for response to neo‑adjuvant chemoradiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2009;74(3):673–88.14- Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum. 2013;56(6):698-703. doi: 10.1097/DCR.0b013e3182837e5b.
  • 15- Huh JW, Jung EJ, Park YA, Lee KY, Sohn SK. Preoperative chemoradiation followed by transanal excision for rectal cancer. J Surg Res. 2008;148:244–250.16- Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001;234:352–358.
  • 17- García-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46(3):298–304.
  • 18- Kalady MF, de Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 2009;250(4):582–9.
  • 19- Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Wolff RA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer. 2007;109(9):1750–5.
  • 20- Park CH, Kim HC, Cho YB, Yun SH, Lee WY, Park YS, et al. Predicting tumor response after preoperative chemoradiation using clinical parameters in rectal cancer. World J Gastroenterol. 2011;17(48):5310–6.
  • 21- Garland ML, Vather R, Bunkley N, Pearse M, Bissett IP. Clinical tumour size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Colorectal Dis. 2014;29(3):301–7.
  • 22- Berman JM, Cheung RJ, Weinberg DS. Surveillance after colorectal cancer resection. Lancet. 2000;355(9201):395–9.
  • 23- Zeng WG, Liang JW, Wang Z, Zhang XM, Hu JJ, Hou HR, et al. Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Chin J Cancer. 2015;34(10):468-74. doi: 10.1186/s40880-015-0033-7.
  • 24- Yoon SM, Kim DY, Kim TH, Jung KH, Chang HJ, Koom WS, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007;69(4):1167–72.
  • 25- Park JW, Lim SB, Kim DY, Jung KH, Hong YS, Chang HJ, et al. Carcinoembryonic antigen as a predictor of pathologic response and a prognostic factor in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and surgery. Int J Radiat Oncol Biol Phys.2009;74(3):810–7.
  • 26- Riesterer O, Milas L, Ang KK. Use of molecular biomarkers for predicting the response to radiotherapy with or without chemotherapy. J Clin Oncol. 2007;25(26):4075–83.
  • 27- Wolthuis AM, Penninckx F, Haustermans K, De Hertogh G, Fieuws S, Van Cutsem E, et al. Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol. 2012;19(9):2833–41.
  • 28- Stein DE, Mahmoud NN, Anné PR, Rose DG, Isenberg GA, Goldstein SD, et al. Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum. 2003;46(4):448–53.
  • 29- Lim SB, Choi HS, Jeong SY, Kim DY, Jung KH, Hong YS, et al. Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg. 2008;248(2):243–51.
  • 30- Bussink J, Kaanders JH, van der Kogel AJ. Tumor hypoxia at the micro-regional level: clinical relevance and predictive value of exogenous and endogenous hypoxic cell markers. Radiother Oncol. 2003;67:3–15.
Year 2019, Volume: 26 Issue: 3, 256 - 262, 01.09.2019
https://doi.org/10.17343/sdutfd.494552

Abstract

References

  • KAYNAKLAR1- Fleming FJ, Påhlman L, Monson JR. Neoadjuvant therapy in rectal cancer. Dis Colon Rectum. 2011;54(7):901–2.
  • 2- Glimelius B. Neo-adjuvant radiotherapy in rectal cancer. World J Gastroenterol. 2013;19(46):8489–501.
  • 3- Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.
  • 4- Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33
  • 5- Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99(7):918–28.
  • 6- Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–44.
  • 7- de Campos-Lobato LF, Stocchi L, da Luz Moreira A, Geisler D, Dietz DW, Lavery IC, et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence. Ann Surg Oncol. 2011;18(6):1590–8.
  • 8- Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys. 2008;72(1):99–107.
  • 9- Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7.
  • 10- Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–40.
  • 11- Moureau-Zabotto L, Farnault B, de Chaisemartin C, Esterni B, Lelong B, Viret F, et al. Predictive factors of tumor response after neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2011;80(2):483–91.
  • 12- Park YA, Sohn SK, Seong J, Baik SH, Lee KY, Kim NK, et al. Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer. J Surg Oncol. 2006;93(2):145–50.
  • 13- Kuremsky JG, Tepper JE, McLeod HL. Biomarkers for response to neo‑adjuvant chemoradiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2009;74(3):673–88.14- Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum. 2013;56(6):698-703. doi: 10.1097/DCR.0b013e3182837e5b.
  • 15- Huh JW, Jung EJ, Park YA, Lee KY, Sohn SK. Preoperative chemoradiation followed by transanal excision for rectal cancer. J Surg Res. 2008;148:244–250.16- Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001;234:352–358.
  • 17- García-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46(3):298–304.
  • 18- Kalady MF, de Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg. 2009;250(4):582–9.
  • 19- Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Wolff RA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer. 2007;109(9):1750–5.
  • 20- Park CH, Kim HC, Cho YB, Yun SH, Lee WY, Park YS, et al. Predicting tumor response after preoperative chemoradiation using clinical parameters in rectal cancer. World J Gastroenterol. 2011;17(48):5310–6.
  • 21- Garland ML, Vather R, Bunkley N, Pearse M, Bissett IP. Clinical tumour size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Colorectal Dis. 2014;29(3):301–7.
  • 22- Berman JM, Cheung RJ, Weinberg DS. Surveillance after colorectal cancer resection. Lancet. 2000;355(9201):395–9.
  • 23- Zeng WG, Liang JW, Wang Z, Zhang XM, Hu JJ, Hou HR, et al. Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Chin J Cancer. 2015;34(10):468-74. doi: 10.1186/s40880-015-0033-7.
  • 24- Yoon SM, Kim DY, Kim TH, Jung KH, Chang HJ, Koom WS, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007;69(4):1167–72.
  • 25- Park JW, Lim SB, Kim DY, Jung KH, Hong YS, Chang HJ, et al. Carcinoembryonic antigen as a predictor of pathologic response and a prognostic factor in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and surgery. Int J Radiat Oncol Biol Phys.2009;74(3):810–7.
  • 26- Riesterer O, Milas L, Ang KK. Use of molecular biomarkers for predicting the response to radiotherapy with or without chemotherapy. J Clin Oncol. 2007;25(26):4075–83.
  • 27- Wolthuis AM, Penninckx F, Haustermans K, De Hertogh G, Fieuws S, Van Cutsem E, et al. Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol. 2012;19(9):2833–41.
  • 28- Stein DE, Mahmoud NN, Anné PR, Rose DG, Isenberg GA, Goldstein SD, et al. Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum. 2003;46(4):448–53.
  • 29- Lim SB, Choi HS, Jeong SY, Kim DY, Jung KH, Hong YS, et al. Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg. 2008;248(2):243–51.
  • 30- Bussink J, Kaanders JH, van der Kogel AJ. Tumor hypoxia at the micro-regional level: clinical relevance and predictive value of exogenous and endogenous hypoxic cell markers. Radiother Oncol. 2003;67:3–15.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Articles
Authors

Emine Elif Özkan

Hasan Erol Eroğlu This is me

Nermin Karahan

Süreyya Şengül This is me

Publication Date September 1, 2019
Submission Date December 10, 2018
Acceptance Date January 18, 2019
Published in Issue Year 2019 Volume: 26 Issue: 3

Cite

Vancouver Özkan EE, Eroğlu HE, Karahan N, Şengül S. REKTUM KANSERİNDE NEOADJUVAN KEMORADYOTERAPİ SONRASI RADYOLOJİK VE PATOLOJİK YANIT PREDİKTÖRLERİNİN DEĞERLENDİRİLMESİ. Med J SDU. 2019;26(3):256-62.

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