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

Carlo Capirci, Vincenzo Valentini, Luca Cionini, Antonino De Paoli, Claus Rodel, Robert Glynne-Jones, Claudio Coco, Mario Romano, Giovanna Mantello, Silvia Palazzi, Falchetti Osti Mattia, Maria Luisa Friso, Domenico Genovesi, Cristiana Vidali, Maria Antonietta Gambacorta, Alberto Buffoli, Marco Lupattelli, Maria Silvia Favretto, Giuseppe La Torre

Research output: Contribution to journalArticle

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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 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.

Original languageEnglish
Pages (from-to)99-107
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume72
Issue number1
DOIs
Publication statusPublished - Sep 1 2008

Fingerprint

Neoadjuvant Therapy
Rectal Neoplasms
therapy
cancer
chemotherapy
Adjuvant Chemotherapy
Survival
metastasis
schedules
Drug Therapy
Appointments and Schedules
Neoplasm Metastasis
Recurrence
Radiation Oncology
prognosis
radiation
surgery
Disease-Free Survival
radiation therapy
Radiotherapy

Keywords

  • Neoadjuvant chemoradiotherapy
  • Pathologic response
  • Prognostic factors
  • Rectal cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

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

In: International Journal of Radiation Oncology Biology Physics, Vol. 72, No. 1, 01.09.2008, p. 99-107.

Research output: Contribution to journalArticle

Capirci, C, Valentini, V, Cionini, L, De Paoli, A, Rodel, C, Glynne-Jones, R, Coco, C, Romano, M, Mantello, G, Palazzi, S, Mattia, FO, Friso, ML, Genovesi, D, Vidali, C, Gambacorta, MA, Buffoli, A, Lupattelli, M, Favretto, MS & La Torre, G 2008, 'Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer: Long-Term Analysis of 566 ypCR Patients', International Journal of Radiation Oncology Biology Physics, vol. 72, no. 1, pp. 99-107. 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 ; La Torre, Giuseppe. / Prognostic Value of Pathologic Complete Response After Neoadjuvant Therapy in Locally Advanced Rectal Cancer : Long-Term Analysis of 566 ypCR Patients. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 72, No. 1. pp. 99-107.
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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 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.",
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AU - Cionini, Luca

AU - De Paoli, Antonino

AU - Rodel, Claus

AU - Glynne-Jones, Robert

AU - Coco, Claudio

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