Histopathological, Radiological, and Demographic Factors Predicting the Response to Neoadjuvant Therapy for Rectal Cancer

Emine Yildirim,Ferhat Cengel,Sibel Bektas,Irem Yanik,Ahmet Muzaffer Er,Zekeriya Pelen,Perihan Özkan Gumuskaya

doi:10.1007/s12029-021-00697-9

Abstract

While the treatment for early stage rectal cancer is surgery, when a diagnosis is made at a locally advanced stage, it is recommended to start treatment with neoadjuvant chemoradiotherapy. Therefore, it is important to determine which patients will respond best to neoadjuvant treatment. The aim of this study was to investigate which hematological, histopathological, and radiological parameters can predict the response to chemoradiotherapy. A retrospective examination was made of 43 patients who underwent surgery following neoadjuvant chemoradiotherapy because of locally advanced stage rectal cancer. Demographic data were collected from the patient files, and the radiological, histopathological, and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment. In the postoperative evaluation, a pathological complete response was determined in 25.50% of the patients. Lymphovascular invasion, perineural invasion, and absence of necrosisis were seen to be statistically related to major response (p < 0.05), and in patients where the tumor was closer than 6cm to the anal verge, the response was better CONCLUSION: When the findings were examined, histopathological lymphovascular invasion, perineural invasion, the presence of necrosis, and the anal verge distance were evaluated as parameters predicting the response to neoadjuvant chemoradiotherapy in rectal cancer.

Highlights

According to the 2018 GLOBOCAN data of the World Health Organisation (WHO), colorectal cancer (CRC) constitutes 11% of all cancer diagnoses, is the third most commonly diagnosed cancer worldwide, and is the third most common cause of cancer-related deaths [1]
Demographic data were collected from the patient files, and the radiological, histopathological and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment
Lymphovascular invasion, perineural invasion and absence of necrosisis were seen to be statistically related to major response (p

Summary

Introduction

According to the 2018 GLOBOCAN data of the World Health Organisation (WHO), colorectal cancer (CRC) constitutes 11% of all cancer diagnoses, is the third most commonly diagnosed cancer worldwide, and is the third most common cause of cancer-related deaths [1]. The gold standard treatment in surgery for rectal cancer is to remove the tumor and drained lymph nodes to obtain R0 resection. While surgical treatment is sufficient in early stage rectal cancer, the standard treatment in locally advanced stage rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NCRT) followed by radical surgery [3]. Most recent studies have shown that mean survival is increased and local recurrence is significantly decreased in rectal cancer patients with PCR after NCRT [4,5,6]. When clinical studies that have compared NCRT with adjuvant chemoradiotherapy (ACRT) are examined, the rate of local recurrence and systemic toxicity has been found to be lower, and patient compliance higher compared to postoperative radiotherapy, but this has caused no significant difference in survival [7,8]. When compared with adjuvant therapy, NCRT increases the chance of protecting the sphincter against tumors located in the lower rectum [9]

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