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Rektal Adenokarsinomlarda Neoadjuvan Kemoradyoterapi Cevabı ile Prognostik Parametreler Arasındaki İlişkinin Araştırılması

Yıl 2021, Cilt: 43 Sayı: 2, 149 - 156, 30.03.2021

Öz

Rektal karsinomlarda cerrahi ve sonrasında (adjuvan) kemoradyoterapi ile pelvik nüks oranı oldukça yüksektir. Bu nedenle neoadjuvan kemoradyoterapi (KRT), rektal kanserlerde giderek daha fazla kullanılan bir tedavi protokolüdür. Çalışmamızda rektal kanserlerde tedavi cevabını ortaya koymayı ve hangi klinik-morfolojik prognostik parametrelerin tedavi cevabını tahmin etmede etkili olduğunu belirlemeyi amaçladık. 2016-2019 yılları arasında tanı almış ve neoadjuvan KRT tedavisi görmüş 46 rektal kanserli hasta çalışmaya dahil edildi. Vakalar prognostik parametreler ve tümör regresyon derecesi (TRD) açısından iki patolog tarafından tekrar değerlendirildi. TRD’yi değerlendirmek için Modifiye Ryan Skorlama sistemi kullanıldı. Tedavi öncesi tümör çapı ve uzak metastaz gibi bazı parametrelerle Mikrosatellit instabilite (MSİ) durumunu gösteren veriler, bilgisayarda hasta dosyaları araştırılarak elde edildi. Çalışmaya dahil edilen 46 olgunun 19’u kadın 27’si erkektir. Olguların 44 tanesi klasik adenokarsinom, 2 tanesi müsinöz adenokarsinomdur. Tedavi sonrası yanıtı değerlendirmek için kullanılan TRD’ye göre, olguların 1’i (%2,2) tam yanıt (Skor 0), 8’i (%17,4) tama yakın yanıt (Skor 1), 18’i (%39,1) kısmi yanıt (Skor 2) ve 19’u (%41,3) ise yanıt yok ya da kötü yanıt (Skor 3) göstermiştir. Prognostik parametrelerden yalnızca tümör derecesi ile tedavi cevabı arasında istatiksel olarak anlamlı bir ilişki saptanmıştır (p = 0,021). KRT sonrası tedavi cevabı patolojik tümör derecesi ile ters orantılıdır. Düşük dereceli tümörlerde tedavi cevabı daha iyidir. KRT alan rektal kanserli hastalarda sağ kalım, tedavi öncesi klinik evre tarafından değil, daha çok tedavi sonrası TRD’yi de içeren patolojik evre tarafından belirlenmektedir. Rektal kanserli hastalarda KRT’ye tümör yanıtı adjuvan kemoterapi planlanmasında da etkili olmaktadır.

Destekleyen Kurum

yok

Kaynakça

  • Referans 1. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, in press. http://gco.iarc.fr/
  • Referans 2. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA: A Cancer Journal for Clinicians. 2016; 66: 7-30.
  • Referans 3. Willett CG, Ryan DP. Neoadjuvant chemoradiotherapy, radiotherapy, and chemotherapy for rectal adenocarcinoma. (Jun 2020) https://www.uptodate.com/contents/neoadjuvant-chemoradiotherapy-radiotherapy-and-chemotherapy-for-rectal-adenocarcinoma.
  • Referans 4. Fokas E, Liersch T, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014; 32: 1554.
  • Referans 5. Vecchio FM, Valentini V, Minsky BD, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005; 62: 752.
  • Referans 6. Fokas E, Ströbel P, Fietkau R, et al. Tumor Regression Grading After Preoperative Chemoradiotherapy as a Prognostic Factor and Individual-Level Surrogate for Disease-Free Survival in Rectal Cancer. J Natl Cancer Inst. 2017; 109.
  • Referans 7. Greenbaum A, Martin DR, Bocklage T, Lee J-H, Ness SA, Rajput A. Tumor Heterogeneity as a Predictor of Response to Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer. Clin Colorectal Canc. 2019; 18(2): 102-9.
  • Referans 8. Martin ST. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012; 99: 918-28.
  • Referans 9. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Brit J Surg. 2012; 99(5): 603-612.
  • Referans 10. Ryan R, Gibbons D, Hyland JMP, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47(2):141-146.
  • Referans 11. Kim SH, Chang HJ, Kim DY, et al. What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy? Cancer Res Treat. 2016; 48(3):998-1009.
  • Referans 12. Lo DS, Pollett A, Siu LL, et al. Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer. Cancer. 2008;112(1):50-54.
  • Referans 13. Gavioli M, Luppi G, Losi L, et al. Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rectum. 2005;48(10):1851-1857.
  • Referans 14. Marisa D. Santos, Cristina Silva, Anabela Rocha, et al. Tumor Regression Grades: Can They Influence Rectal Cancer Therapy Decision Tree? Int J Clın Oncol. 2013;1-8.
  • Referans 15. Nagtegaal ID, Arends MJ, Odze RD, Lam AK (Eds) (2019). WHO Classification of Tumours. Digestive System Tumours, 5th ed. IARC, Lyon, FRANCE.
  • Referans 16. Minsky BD, Rodel C. Identifying the most predictive post-chemoradiation TRG system for rectal cancer. J Natl Cancer Inst. 2014; 106
  • Referans 17. Jessup JM, Goldberg RM, Asare AE, et al. Colon and Rectum. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), AJCC, Chicago. 2017;251.
  • Referans 18. Ryan R, Gibbons D, Hyland JM, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005; 47:141.
  • Referans 19. Bartley AN, Fitzgibbons PL, Broaddus RR, et al. Template for Reporting Results of DNA Mismatch Repair Testing in Patients Being Considered for Checkpoint Inhibitor Immunotherapy. College of American Pathologists (CAP). 2018.
  • Referans 20. Sekiya S, Imamura K, Takeuchi S, et al. Pathological complete response of locally advanced colon cancer after preoperative radiotherapy: a case report and narrative review of the literature. Surg Case Rep. 2018;4: 58
  • Referans 21. Carlomagno C, Pepe S, D’Armiento FP, et al. Predictive Factors of Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer. Oncology 2010; 78: 369-375
  • Referans 22. Tan Y, Fu D, Li D, et al. Predictors and Risk Factors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Population-Based Analysis. Front Oncol 2019;9: 497
  • Referans 23. Gopal P, Lu P, Ayers GD, et al. Tumor deposits in rectal adenocarcinoma after neoadjuvant chemoradiation are associated with poor prognosis. Mod Pathol. 2014; 27(9): 1281-1287
  • Referans 24. Cai Y, Lu X, Zhu X, et al. Histological tumor response assessment in colorectal liver metastases after neoadjuvant chemotherapy: impact of the variation in tumor regression grading and peritumoral lymphoYYtic infiltration. Journal of Cancer 2019; 10(23): 5852-5861
  • Referans 25. Delitto D, George TJ Jr, Loftus TJ, et al. Prognostic Value of Clinical vs Pathologic Stage in Rectal Cancer Patients Receiving Neoadjuvant Therapy. J Natl Cancer Inst 2018; 110:460.
  • Referans 26. Lee HS, Choi DH, Park HC, et al. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer. Radiat Oncol J 2016;34(3):186-192
  • Referans 27. Li YH, Li JL, Zhu XG, et al. Associations of tumor regression grade with outcomes in patients with locally advanced rectal cancer treated with preoperative two-week course of radiotherapy Oncotarget. 2017; 8(59): 100165-175.

Investigation of The Relationship Between Neoadjuvant Chemoradiotherapy Response and Prognostic Parameters In Rectal Adenocarcinomas

Yıl 2021, Cilt: 43 Sayı: 2, 149 - 156, 30.03.2021

Öz

In rectal carcinomas, the rate of pelvic recurrence is quite high with surgery and adjuvant chemoradiotherapy (CRT). Therefore, neoadjuvant chemoradiotherapy (CRT) is used increasingly in rectal cancers. In our study, we aimed to reveal the CRT response in rectal cancers and to determine which clinical-morphological prognostic parameters are effective in predicting the treatment response. Forty-six patients with rectal cancer diagnosed between 2016-2019 and treated with neoadjuvant CRT were included in the study. The cases were re-examined by two pathologists for prognostic parameters and tumor regression grade (TRG). Modified Ryan Scoring system was used to evaluate TRG. Data showing Microsatellite instability (MSI) status with some parameters such as tumor diameter and distant metastasis before treatment were obtained by searching patient files on the computer. Nineteen of the 46 cases were female and 27 were male. Forty-four of the cases are classical adenocarcinoma and 2 of them are mucinous adenocarcinoma. According to TRG, which was used to evaluate the treatment response, 1 (2.2%) of the cases showed complete response (Score 0); 8 (17.4%) showed near-complete response (Score 1); 18 (39.1%) showed partial response (Score 2) and 19 (41.3%) showed no response or poor response (Score 3). A statistically significant relationship was found among prognostic parameters only between tumor grade and treatment response (p = 0.021). Response to treatment after CRT is in the inverse ratio to the pathological grade of the tumor. The treatment response is better in low grade tumors. In patients with rectal cancer and treated with neoadjuvant CRT, survival is determined not by the pre-treatment clinical staging, but rather by the pathological staging, which includes TRG after treatment. Tumor response to CRT is also effective in planning adjuvant chemotherapy in patients with rectal cancer.

Kaynakça

  • Referans 1. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, in press. http://gco.iarc.fr/
  • Referans 2. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA: A Cancer Journal for Clinicians. 2016; 66: 7-30.
  • Referans 3. Willett CG, Ryan DP. Neoadjuvant chemoradiotherapy, radiotherapy, and chemotherapy for rectal adenocarcinoma. (Jun 2020) https://www.uptodate.com/contents/neoadjuvant-chemoradiotherapy-radiotherapy-and-chemotherapy-for-rectal-adenocarcinoma.
  • Referans 4. Fokas E, Liersch T, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014; 32: 1554.
  • Referans 5. Vecchio FM, Valentini V, Minsky BD, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005; 62: 752.
  • Referans 6. Fokas E, Ströbel P, Fietkau R, et al. Tumor Regression Grading After Preoperative Chemoradiotherapy as a Prognostic Factor and Individual-Level Surrogate for Disease-Free Survival in Rectal Cancer. J Natl Cancer Inst. 2017; 109.
  • Referans 7. Greenbaum A, Martin DR, Bocklage T, Lee J-H, Ness SA, Rajput A. Tumor Heterogeneity as a Predictor of Response to Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer. Clin Colorectal Canc. 2019; 18(2): 102-9.
  • Referans 8. Martin ST. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012; 99: 918-28.
  • Referans 9. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Brit J Surg. 2012; 99(5): 603-612.
  • Referans 10. Ryan R, Gibbons D, Hyland JMP, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47(2):141-146.
  • Referans 11. Kim SH, Chang HJ, Kim DY, et al. What Is the Ideal Tumor Regression Grading System in Rectal Cancer Patients after Preoperative Chemoradiotherapy? Cancer Res Treat. 2016; 48(3):998-1009.
  • Referans 12. Lo DS, Pollett A, Siu LL, et al. Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer. Cancer. 2008;112(1):50-54.
  • Referans 13. Gavioli M, Luppi G, Losi L, et al. Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rectum. 2005;48(10):1851-1857.
  • Referans 14. Marisa D. Santos, Cristina Silva, Anabela Rocha, et al. Tumor Regression Grades: Can They Influence Rectal Cancer Therapy Decision Tree? Int J Clın Oncol. 2013;1-8.
  • Referans 15. Nagtegaal ID, Arends MJ, Odze RD, Lam AK (Eds) (2019). WHO Classification of Tumours. Digestive System Tumours, 5th ed. IARC, Lyon, FRANCE.
  • Referans 16. Minsky BD, Rodel C. Identifying the most predictive post-chemoradiation TRG system for rectal cancer. J Natl Cancer Inst. 2014; 106
  • Referans 17. Jessup JM, Goldberg RM, Asare AE, et al. Colon and Rectum. In: AJCC Cancer Staging Manual, 8th, Amin MB (Ed), AJCC, Chicago. 2017;251.
  • Referans 18. Ryan R, Gibbons D, Hyland JM, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005; 47:141.
  • Referans 19. Bartley AN, Fitzgibbons PL, Broaddus RR, et al. Template for Reporting Results of DNA Mismatch Repair Testing in Patients Being Considered for Checkpoint Inhibitor Immunotherapy. College of American Pathologists (CAP). 2018.
  • Referans 20. Sekiya S, Imamura K, Takeuchi S, et al. Pathological complete response of locally advanced colon cancer after preoperative radiotherapy: a case report and narrative review of the literature. Surg Case Rep. 2018;4: 58
  • Referans 21. Carlomagno C, Pepe S, D’Armiento FP, et al. Predictive Factors of Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer. Oncology 2010; 78: 369-375
  • Referans 22. Tan Y, Fu D, Li D, et al. Predictors and Risk Factors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Population-Based Analysis. Front Oncol 2019;9: 497
  • Referans 23. Gopal P, Lu P, Ayers GD, et al. Tumor deposits in rectal adenocarcinoma after neoadjuvant chemoradiation are associated with poor prognosis. Mod Pathol. 2014; 27(9): 1281-1287
  • Referans 24. Cai Y, Lu X, Zhu X, et al. Histological tumor response assessment in colorectal liver metastases after neoadjuvant chemotherapy: impact of the variation in tumor regression grading and peritumoral lymphoYYtic infiltration. Journal of Cancer 2019; 10(23): 5852-5861
  • Referans 25. Delitto D, George TJ Jr, Loftus TJ, et al. Prognostic Value of Clinical vs Pathologic Stage in Rectal Cancer Patients Receiving Neoadjuvant Therapy. J Natl Cancer Inst 2018; 110:460.
  • Referans 26. Lee HS, Choi DH, Park HC, et al. Correlation between tumor regression grade and rectal volume in neoadjuvant concurrent chemoradiotherapy for rectal cancer. Radiat Oncol J 2016;34(3):186-192
  • Referans 27. Li YH, Li JL, Zhu XG, et al. Associations of tumor regression grade with outcomes in patients with locally advanced rectal cancer treated with preoperative two-week course of radiotherapy Oncotarget. 2017; 8(59): 100165-175.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

İsmail Saygın 0000-0002-6013-6378

Emel Çakır 0000-0002-9845-366X

Yayımlanma Tarihi 30 Mart 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 43 Sayı: 2

Kaynak Göster

Vancouver Saygın İ, Çakır E. Rektal Adenokarsinomlarda Neoadjuvan Kemoradyoterapi Cevabı ile Prognostik Parametreler Arasındaki İlişkinin Araştırılması. Osmangazi Tıp Dergisi. 2021;43(2):149-56.


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