Effect Of Preoperative Radiotherapy Research Articles

A commentary on 'Effect of preoperative radiotherapy on stage IB2 and IIA2 cervical cancer: A retrospective cohort study'.

A commentary on 'Effect of preoperative radiotherapy on stage IB2 and IIA2 cervical cancer: A retrospective cohort study'.

Impact of Preoperative vs Postoperative Radiotherapy on Overall Survival of Locally Advanced Breast Cancer Patients

BackgroundThe treatment for locally advanced breast cancer (LABC) is a severe clinical problem. The postoperative radiotherapy is a conventional treatment method for patients with LABC, whereas the effect of preoperative radiotherapy on outcome of LABC remains controversial. This study aimed to examine and compare the overall survival (OS) in patients with LABC who underwent preoperative radiotherapy or postoperative radiotherapy.MethodsThis retrospective cohort study included 41,618 patients with LABC from the National Cancer Database (NCDB) between 2010 and 2014. We collected patients’ demographic, clinicopathologic, treatment and survival information. Propensity score was used to match patients underwent pre-operative radiotherapy with those who underwent post-operative radiotherapy. Cox proportional hazard regression model was performed to access the association between variables and OS. Log-rank test was conducted to evaluate the difference in OS between groups.ResultsThe estimated median follow-up of all included participants was 69.6 months (IQR: 42.84-60.22); 70.1 months (IQR: 46.85-79.97) for postoperative radiotherapy, 68.5 (IQR: 41.13-78.23) for preoperative radiotherapy, and 67.5 (IQR: 25.92-70.99) for no radiotherapy. The 5-year survival rate was 80.01% (79.56-80.47) for LABC patients who received postoperative radiotherapy, 64.08% (57.55-71.34) for preoperative radiotherapy, and 59.67% (58.60-60.77) for no radiotherapy. Compared with no radiation, patients receiving postoperative radiotherapy had a 38% lower risk of mortality (HR=0.62, 95%CI: 0.60-0.65, p<0.001), whereas those who received preoperative radiotherapy had no significant survival benefit (HR=0.88, 95%CI: 0.70-1.11, p=0.282). Propensity score matched analysis indicated that patients treated with preoperative radiotherapy had similar outcomes as those treated with postoperative radiotherapy (AHR=1.23, 95%CI: 0.88-1.72, p=0.218). Further analysis showed that in C0 (HR=1.45, 95%CI: 1.01-2.07, p=0.044) and G1-2 (AHR=1.74, 95%CI: 1.59-5.96, p=0.001) subgroup, patients receiving preoperative radiotherapy showed a worse OS than those who received postoperative radiotherapy.ConclusionsPatients with LABC underwent postoperative radiotherapy had improved overall survival, whereas no significant survival benefit was observed in patients receiving preoperative radiotherapy. Preoperative radiotherapy did not present a better survival than postoperative radiotherapy for LABC patients.

Effects of preoperative radiotherapy on survival of patients with stage II and III esophageal squamous cell carcinoma: A population-based study.

The impact of preoperative radiotherapy (PRT) on survival in patients with stage II and III esophageal squamous cell carcinoma (ESCC) remains controversial. The aim of this study was to explore the effect of PRT on survival of these patients.Patients with stage II and III ESCC who underwent chemotherapy ± PRT were identified and retrieved from the SEER database from 2010 to 2015. Cox regression analysis was used to identify independent prognostic factors in patients. Subgroup analysis stratified by T stage and N stage was performed. Kaplan–Meier survival analysis was performed to assess disease specific survival (DSS).A total of 1160 patients were retrieved, of whom 289 (24.9%) underwent PRT plus chemotherapy, and 871 (75.1%) did not receive PRT. In multivariate analysis, PRT plus chemotherapy was a favorable prognostic factor for patients with stage T2 (hazard ratio [HR], 0.364, 95% CI, 0.202–0.658; P < .001), T3 (HR, 0.536, 95% CI, 0.413–0.695; P < .001) and T4 (HR, 0.318, 95% CI, 0.125–0.805; P = .016), but PRT plus chemotherapy was not statistically significant on DSS in patients with T1 disease (HR, 0.556, 95% CI, 0.262–1.179; P = .126). All 3 different N stages (N0, N1, and N2 + N3) were statistically significant (P < .05) in chemotherapy with or without PRT.In conclusion, patients with stage II and III ESCC at the T2-T4 stage gained significant survival benefit from PRT plus chemotherapy.

The effect of preoperative radiotherapy on surgical resectability, tumor volume and the necrosis rate of soft tissue sarcomas: A retrospective single-center analysis

IntroductionThe mainstay of soft tissue sarcoma treatment is limb preserving resection, often combined with radiotherapy, preferably preoperative radiotherapy. The goal of this study is to retrospectively assess the effect of preoperative (neoadjuvant) radiotherapy on the minimal distance to critical neurovascular structures, on tumor volume and the necrosis rate. Material and methodsThe data of fifty-one patients treated for a localized soft tissue sarcoma (STS) of the extremity or the trunk were retrospectively reviewed. All patients were analyzed with MR imaging before and after preoperative radiotherapy to determine the impact of radiotherapy on the precise planning and execution of the surgical excision of the tumor. The volume of the tumor as well as the distance to anatomically relevant structures were measured on MRI. Tumor type, characteristics and necrosis rate were obtained from the pathology report. ResultsAt latest follow-up (median 51 months (range 6–113)) 32/51 (63%) patients were alive. The minimal distance between the myxoid liposarcomas (n = 12) and the vessels was significantly increased by preoperative radiotherapy from 1.09 mm [0–21.1] to 5.23 mm [0–32.70] (P = 0.045). High-grade tumors showed a significant increase in tumor volume after irradiation (p = 0.03) and a significantly greater necrosis rate than low-grade tumors (p < 0.001). ConclusionPreoperative radiotherapy significantly increases the minimal distance from myxoid liposarcomas to the vessel. In the subgroup of STS that demonstratea volume reduction the distance to nerves and vessels increases, but with the low number of cases, this increase is not statistically significant. The effect of preoperative radiotherapy on the tumor volume varies greatly, whereas the subtype of myxoid liposarcoma shows a significant volume reduction in all cases.

Effect of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery: A retrospective cohort study

Amac: Laparoskopik kolorektal kanserlerde aciga gecis uzerinde neoadjuvan radyoterapi uygulanmasinin ve acil sartlarda operasyon yapilmasinin etkisi acik degildir. Bu nedenle Neoadjuvan radyoterapi alinmasi ve acil cerrahinin preoperatif acik cerrahiye gecis uzerine etkilerini degerlendirmek amaclandi. Yontemler: Ekim 2016 – Ocak 2018 tarihleri arasinda ayni cerrahi ekip tarafindan ailesel polipozis koli, kolon malign neoplazisi ve rektum malign neoplazisi nedeniyle ayni cerrahi ekip tarafindan opere edilen 67 hastanin dosyalari retrospektif olarak incelendi. Laparoskopik tamamlanan veya laparoskopik baslanip acik cerrahiye gecilen 55 hasta calismaya dahil edildi. Calismadan cikarilma kriterleri; direk acik cerrahi uygulanmak, benign veya malign sebeplerle daha once kolorektal cerrahi uygulanmis olmak, morbid obezite (vucut kitle indeksi >40 kg/m2) ve verilere ulasilamamaktir. Hastalar demografik ozellikleri (yas, cinsiyet), tumor lokalizasyonu, cerrahinin acil ya da elektif olarak yapilmasi, preoperatif kemoterapi ve radyoterapi uygulanmasi, aciga gecis nedenleri acisindan degerlendirildi. Bulgular: Calismaya dahil edilen 55 hastanin 35’i erkek (%63,6), 20’si kadin (%36,4) hastaydi. Hastalarin yas ortalamasi 58,4 (13,4) (22 – 80) yasti. Aciga gecilen hastalarin yas ortalamasi 62,86 (8,91) (53 – 73) ve laparoskopik tamamlanan hastalarin yas ortalamasi 57,71 (13,84) (22 – 80) yasti (P=0,216). Hastalarin operasyon nedenleri; 3 sag kolon kanseri (%5,5), 6 sol kolon kanseri (%10.9), 37 rektum kanseri (%67,3), 5 rektosigmoid bolge tumoru (%9,1) ve 4 familiyal polipozis koli sendromu zemininde gelisen adenokarsinomdu (%7,3). 7 hastada cerrahiye laparoskopik baslandi ancak acik cerrahiye gecilmek zorunda kalindi (%12,7). 47 hasta elektif sartlarda (%85,5) opere edilirken 8 hasta acil sartlarda (%14,5) opere edildi. Aciga gecilen 7 hastanin 5’i acil sartlarda opere olurken 2 hasta elektif sartlarda opere edildi (P<0,001). 38 hasta (%69,1) neoadjuvan radyoterapi almamisken (3’u sadece kemoterapi, 35’i hicbir neoadjuvan tedavi almadi), 17 hastaya (%39,1) neoadjuvan kemoterapi ve radyoterapi kombinasyonu verilmisti. Aciga gecilen 7 hastadan 1’inde neoadjuvan radyoterapi uygulanmisken, 6’si neoadjuvan radyoterapi almamisti (P=0,308). Sonuc: Laparoskopik kolorektal cerrahi, elektif sartlarda konvansiyonel acik cerrahi kadar basari ile uygulanabilen bir cerrahidir. Preoperatif radyoterapi alinmasi ile aciga gecis arasinda iliski yoktur.

Preoperative Radiotherapy Leads to Significant Differences in the Plasma Protein Profile of Rectal Cancer Patients

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for 10% of the global cancer burden. Rectal cancer accounts for around 30% of CRC cases, and patients with resectable rectal cancer are often given preoperative radiotherapy (PRT) to reduce the rate of local recurrence. The human plasma proteome is an exceptionally complex proteome and ideal to study due to its ability to reflect the presence of diseases such as cancer and the ease of obtaining blood samples. Previous proteomic studies involving rectal cancer patients have mostly focused on the identification of proteins involved in resistance to radiotherapy. Objective: The aim of this study was to investigate the overall effects of PRT on plasma protein expression in rectal cancer patients, as there is a lack of such studies. Methods: Here, we have used mass spectrometry and subsequent statistical analyses to analyze the plasma samples of 30 rectal cancer patients according to PRT status (positive or negative) and tumor stage (II or III). Results and Conclusions: We discovered 42 proteins whose levels differed significantly between stage II and III rectal cancer patients who did or did not receive PRT. This study shows that PRT, although localized to the pelvis, leads to measurable, tumor stage-specific changes in plasma protein expression. Future studies of plasma proteins should, when relevant, take this into account and be aware of the widespread effects that PRT has on the plasma proteome.

Effect of preoperative radiotherapy with boost dose to lateral pelvic lymph node on the prognosis of patients with locally advanced rectal cancer

Objective To evaluate the effect of preoperative radiotherapy with boost dose to lateral pelvic lymph nodes (LPN) on the prognosis of patients with locally advanced rectal cancer (LARC) treated with preoperative simultaneous chemoradiotherapy. Methods The clinical data of 116 LARC patients with complete follow-up who received adjuvant chemoradiotherapy and curative resection between March 2011 and April 2017 in Liuzhou Worker's Hospital were analyzed retrospectively. The patients were classified into two groups according to the LPN metastatic status from preoperative image: patients without suspected LPN metastasis who received preoperative simultaneous chemoradiotherapy (pelvic irradiation: 45-50.4 Gy; chemotherapy regimen: based on 5-fluorouracil) plus radical operation (the regular group, 85 cases), and patients with suspected LPN metastasis who received local boost radiation on the basis of whole radiotherapy in pelvic cavity (the boost group, 31 cases). Additional radiation boost with a total dose of 59.4-61.6 Gy to LPN was administrated to patients in the boost group. The adverse reactions of acute radiotherapy in both groups were compared by using χ2 test and Fisher exact test. Kaplan-Meier method was used to make survival analysis and Log-rank was used to make the testing. Results The common acute adverse reactions of both groups were grade 1-2 in newly adjuvant chemoradiotherapy. Significant acute adverse reactions (grade 3 or higher) in the regular group and the boost group included diarrhea [15.3% (13/85) vs. 19.4% (6/31), χ2= 0.273, P= 0.601], leukopenia [9.4% (8/85) vs. 9.7% (3/31), χ2= 0.006, P= 0.941], and radiodermatitis [4.7% (4/85) vs. 6.5% (2/31), P= 0.657]. The median follow-up time was 30.3 months (11.1-82.3 months). Locoregional recurrence occurred in 10 patients of the regular group and 4 patients of the boost group, and 16 patients and 6 patients died of the regular group and the boost group respectively. Kaplan-Meier survival results showed that there were no significant differences in local recurrence-free survival rate (χ2= 0.121, P= 0.728) and overall survival rate (χ2= 0.605, P= 0.469). Conclusion Radiotherapy boost to LPN can offset the poor prognosis of LPN metastases on patients with LARC and can be considered as a safe and effective treatment option for LARC patients with suspected LPN metastasis. Key words: Rectal neoplasms; Lateral pelvic lymph nodes; Simultaneous chemoradiotherapy; Radiation boost

Preoperative radiotherapy and curative surgery for the management of localised rectal carcinoma.

This is an update of the original review published in 2007.Carcinoma of the rectum is a common malignancy, especially in high income countries. Local recurrence may occur after surgery alone. Preoperative radiotherapy (PRT) has the potential to reduce the risk of local recurrence and improve outcomes in rectal cancer. To determine the effect of preoperative radiotherapy for people with localised resectable rectal cancer compared to surgery alone. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; Issue 5, 2018) (4 June 2018), MEDLINE (Ovid) (1950 to 4 June 2018), and Embase (Ovid) (1974 to 4 June 2018). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant ongoing trials (4 June 2018). We included randomised controlled trials comparing PRT and surgery with surgery alone for people with localised advanced rectal cancer planned for radical surgery. We excluded trials that did not use contemporary radiotherapy techniques (with more than two fields to the pelvis). Two review authors independently assessed the 'Risk of bias' domains for each included trial, and extracted data. For time-to-event data, we calculated the Peto odds ratio (Peto OR) and variances, and for dichotomous data we calculated risk ratios (RR) using the random-effects method. Potential sources of heterogeneity hypothesised a priori included study quality, staging, and the use of total mesorectal excision (TME) surgery. We included four trials with a total of 4663 participants. All four trials reported short PRT courses, with three trials using 25 Gy in five fractions, and one trial using 20 Gy in four fractions. Only one study specifically required TME surgery for inclusion, whereas in another study 90% of participants received TME surgery.Preoperative radiotherapy probably reduces overall mortality at 4 to 12 years' follow-up (4 trials, 4663 participants; Peto OR 0.90, 95% CI 0.83 to 0.98; moderate-quality evidence). For every 1000 people who undergo surgery alone, 454 would die compared with 45 fewer (the true effect may lie between 77 fewer to 9 fewer) in the PRT group. There was some evidence from subgroup analyses that in trials using TME no or little effect of PRT on survival (P = 0.03 for the difference between subgroups).Preoperative radiotherapy may have little or no effect in reducing cause-specific mortality for rectal cancer (2 trials, 2145 participants; Peto OR 0.89, 95% CI 0.77 to 1.03; low-quality evidence).We found moderate-quality evidence that PRT reduces local recurrence (4 trials, 4663 participants; Peto OR 0.48, 95% CI 0.40 to 0.57). In absolute terms, 161 out of 1000 patients receiving surgery alone would experience local recurrence compared with 83 fewer with PRT. The results were consistent in TME and non-TME studies.There may be little or no difference in curative resection (4 trials, 4673 participants; RR 1.00, 95% CI 0.97 to 1.02; low-quality evidence) or in the need for sphincter-sparing surgery (3 trials, 4379 participants; RR 0.99, 95% CI 0.94 to 1.04; I2 = 0%; low-quality evidence) between PRT and surgery alone.Low-quality evidence suggests that PRT may increase the risk of sepsis from 13% to 16% (2 trials, 2698 participants; RR 1.25, 95% CI 1.04 to 1.52) and surgical complications from 25% to 30% (2 trials, 2698 participants; RR 1.20, 95% CI 1.01 to 1.42) compared to surgery alone.Two trials evaluated quality of life using different scales. Both studies concluded that sexual dysfunction occurred more in the PRT group. Mixed results were found for faecal incontinence, and irradiated participants tended to resume work later than non-irradiated participants between 6 and 12 months, but this effect had attenuated after 18 months (low-quality evidence). We found moderate-quality evidence that PRT reduces overall mortality. Subgroup analysis did not confirm this effect in people undergoing TME surgery. We found consistent evidence that PRT reduces local recurrence. Risk of sepsis and postsurgical complications may be higher with PRT.The main limitation of the findings of the present review concerns their applicability. The included trials only assessed short-course radiotherapy and did not use chemotherapy, which is widely used in the contemporary management of rectal cancer disease. The differences between the trials regarding the criteria used to define rectal cancer, staging, radiotherapy delivered, the time between radiotherapy and surgery, and the use of adjuvant or postoperative therapy did not appear to influence the size of effect across the studies.Future trials should focus on identifying participants that are most likely to benefit from PRT especially in terms of improving local control, sphincter preservation, and overall survival while reducing acute and late toxicities (especially rectal and sexual function), as well as determining the effect of radiotherapy when chemotherapy is used and the optimal timing of surgery following radiotherapy.

Pathological complete response of locally advanced colon cancer after preoperative radiotherapy: a case report and narrative review of the literature

BackgroundThe oncological effectiveness of preoperative radiotherapy for locally advanced colon cancer is unclear. We report a case of pathological complete response in a patient with locally advanced ascending colon cancer after preoperative radiotherapy following failure of chemotherapy.Case presentationA 65-year-old Japanese woman presented with malaise and hematochezia. A computed tomography (CT) revealed a tumor in the ascending colon which seemed to infiltrate the adjacent structures. She was diagnosed with locally advanced ascending colon cancer stages T4b, N2a, M0, and IIIC. We selected modified FOLFOX6 with panitumumab as neoadjuvant chemotherapy. However, we discontinued the chemotherapy after the 8th cycle because of disease progression and severe adverse effects. The patient then underwent radiotherapy of 60 Gy in 30 fractions, resulting in significant tumor size reduction. One month after the radiotherapy, we performed a right hemicolectomy with multivisceral resection without complications. Histopathologically, we found no residual cancer cells in the resected specimen. The patient remains alive and has not required additional therapies for 24 months, as there are no signs of recurrence.ConclusionsThe present case suggests that preoperative radiotherapy might be an effective treatment options for locally advanced colon cancer.

Surgical treatment of hepatocellular carcinoma with advanced portal vein tumor thrombus combined with pre-operative radiotherapy.

385 Background: Hepatocellular carcinoma (HCC) with advanced portal vein tumor thrombus (PVTT) in the main portal trunk (MPT) or the first branch of portal vein has poor prognosis. We attempted a multidisciplinary treatment to irradiate the PVTT prior to surgical resection. In this study, we evaluate the therapeutic effect of preoperative radiotherapy (Pre-RT) for HCC with advanced PVTT. Methods: The postoperative prognosis was retrospectively examined in 75 patients with advanced PVTT out of 1,045 patients who underwent hepatectomy for HCC between 1990 and 2015 in our institute. The treatment outcome was compared between the patients who underwent Pre-RT (30Gy/10fr) for PVTT before operation (RT group, n = 34) and patients not underwent Pre-RT (non-RT group, n = 41). Results: Among 75 patients with advanced PVTT, there was no difference in age, sex, extent of PVTT (MPT or first branch of PV), HBV, HCV, T-Bil, PT(%), ICG R15%, Child-Pugh classification, AFP, DCP, intra-operative blood loss, tumor size, tumor number, coexisting hepatic vein or bile duct tumor thrombus, presence of the residual tumor between RT and non-RT group other than adjuvant chemotherapy administration (p = 0.0009). The 5-year overall survival rate of all 75 cases was 18.5%. There was a significant overall survival extension in RT group with 29.4% compared to 16.2% in non-RT group (p = 0.039, log-rank test). Surgery without residual lesions was performed in 64 patients, of which the 5-year recurrence-free survival rate was 10.9%. The 5-year recurrence-free survival rate of RT group (n = 30) (16.1%) was significantly better than non-RT group (n = 34) (5.5%) (p = 0.027, log-rank test). Univariate analysis using Cox proportional hazard model demonstrated that the Pre-RT was the only significant prognostic factor (HR 0.595, 95% CI 0.356 - 0.981, p = 0.042) for overall survival, and the Pre-RT and tumor size over 10cm for recurrence-free survival among these patient’s factors. Conclusions: Multidisciplinary treatment combined preoperative radiotherapy to PVTT and subsequent surgical resection improve the prognosis for the patients of HCC with advanced PVTT extend to MPT or first branch of PV.

Abstract B27: Analysis of the immune infiltrate in undifferentiated pleomorphic sarcoma of the extremity and trunk in response to radiotherapy

Abstract Introduction: Undifferentiated pleomorphic sarcoma of the extremity and trunk (ET UPS) presents a unique diagnostic and therapeutic challenge. Recently, immunotherapy has been employed in the treatment of patients with advanced UPS with preliminary evidence of benefit in 40% of a small initial cohort (SARC028). However, there is currently a paucity of data characterizing the immune infiltrate population in ET UPS. Radiotherapy (RT) is associated with improved locoregional control in combination with surgery. Localized RT has been shown in other tumor types to promote tumor antigen release and enhance tumor-specific targeting by the adaptive immune system. The aim of this study was two-fold: 1) to characterize the immune infiltrate in ET UPS and 2) to evaluate the effect of preoperative RT on immune cell infiltrates in ET UPS. Methods: We identified 17 matched ET UPS tumor samples before and after RT. Immunohistochemistry for CD8, CD4, PD-L1, PD1, CD3, CD163, and FOXP3 was performed on the matched pairs. Changes in immune infiltrate over time between the pairs were compared with a paired t-test. Results: CD8, CD4, PD-L1, PD1, CD3, CD163, and FoxP3 positive cells were identified in all samples. The effects were variable, but there was an overall trend towards an increase in the density of tumor-infiltrating immune cells of all assayed types in ET UPS following completion of RT, with increases in the median number of CD8 (55 vs. 111 cells/mm2, p=0.17), CD4 (3 vs. 13 cells/mm2, p=0.01), CD3 (158 vs. 219 cells/mm2, p=0.06), CD163 (1363 vs. 2001 cells/mm2, p=0.76), and FOXP3 (14 vs. 25 cells/mm2, p=0.23) positive cells in RT-treated tumor sections. Interestingly, although PD-L1 was not expressed in any pre-RT ET UPS tumors, positive PD-L1 expression was observed in 21% (3/14) of tumors after RT treatment (p=0.07). Conclusion: An immune infiltrate is present in ET UPS at the time of diagnosis, with a trend towards increased density of immune infiltrate and PD-L1 expression after completion of RT. These data support evaluating immune checkpoint inhibitors with standard of care RT in the treatment of ET UPS. Citation Format: Emily Z. Keung, Jen-Wei Tsai, Ali M. Ali, Janice N. Cormier, Andrew J. Bishop, B. Ashleigh Guadagnolo, Kelly K. Hunt, Keila E. Torres, Neeta Somaiah, Jennifer A. Wargo, Alexander Lazar, Wei-Lien Wang, Cristina L. Roland. Analysis of the immune infiltrate in undifferentiated pleomorphic sarcoma of the extremity and trunk in response to radiotherapy [abstract]. In: Proceedings of the AACR Conference on Advances in Sarcomas: From Basic Science to Clinical Translation; May 16-19, 2017; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(2_Suppl):Abstract nr B27.

Establishment of a logistic regression model for the predicting of radio-sensitivity of preoperative radiotherapy in rectal cancer

Objective To investigate the correlation between the biomarkers related to radio-sensitivity and preoperative radiotherapy in rectal cancer patients, and to establish a logistic regression model to predict the effect of the preoperative radiotherapy through detecting the expression levels of the molecular markers. Methods 33 patients with rectal cancer who received preoperative radiotherapy from January 2010 to January 2015 were retrospectively analyzed. Patients' information was also collected including the serum level of carcino-embryonic antigen(CEA), the immune-histochemical expression levels of vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), thymidylate synthase (TS) and Ki-67, and image data (CT or magnetic resonance imaging) before radiotherapy, preoperative clinical staging and the postoperative pathologic staging. According to the postoperative pathological remission, the treatment effects of preoperative radiotherapy included effective (CR+PR) and ineffective (PD+SD) were evaluated. The relationship between these molecular markers and the curative effect of preoperative radiotherapy was analyzed by logistic regression analysis using SPSS v17.0 software, and a logistic curative effect prediction model was established. Results As a result of single factor and multiple factors logistic binary regression analysis, CEA, VEGF and Ki-67 were recognized as the interested factors for the radio-sensitivity predicting in patients with rectal cancer who received preoperative radiotherapy. A molecular markers predictive model for radio-sensitivity in preoperative radiotherapy in rectal cancer is as follow: log P=1.700-0.276×CEA-0.238×VEGF-0.135×EGFR+1.377×TS+0.080×Ki-67. Serum CEA level and the expression of VEGF might associate with radio-resistant, and the expression of Ki-67 might associate with better reaction to preoperative radiotherapy. Conclusion The levels of serum CEA, VEGF and Ki-67 may be the predictors of radio-sensitivity in rectal cancer patients who received preoperative radiotherapy. Key words: Rectal neoplasms; Radiotherapy; Tumor markers, biological; Radiation tolerance

Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection: Post Hoc Analysis of a Randomized Controlled Trial.

Evidence regarding the effect of preoperative radiotherapy on anastomotic integrity remains conflicting in rectal cancer surgery. Prospective comparisons with appropriate controls are needed. This study aimed to assess the impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection. This was a post hoc analysis of a randomized controlled trial (NCT01211210). Data were retrieved from the leading center of the trial, which is a tertiary hospital. The full analysis population of 318 patients was included. Patients were randomly assigned to receive preoperative radiation (50 Gy per 25 fractions) and 5-fluorouracil infusion, alone (arm A) or combined with oxaliplatin (arm B), or preoperative chemotherapy with 5-fluorouracil and oxaliplatin without radiation (arm C). The rates of anastomotic leakage and stenosis were calculated for each treatment arm. Multivariate analysis was used to verify the effect of preoperative radiotherapy. The treatment arms were comparable in terms of most baseline characteristics, but more diversions were used in the chemoradiotherapy arms. Anastomotic leakage occurred in 20.2% of patients in arm A, 23.6% of patients in arm B, and 8.5% of patients in arm C (p = 0.007). The corresponding rates of stenosis were 17.0%, 18.9%, and 6.8% (p = 0.02). Multivariate analysis confirmed the correlation between preoperative radiotherapy and clinical leakage (p = 0.02), which was associated with delayed stenosis (p < 0.001). For patients undergoing chemoradiotherapy, radiation proctitis was identified as an independent risk factor for clinical leakage (p = 0.01) and stenosis (p < 0.001). The main limitations were discrepancies in stoma creation and chemotherapy regimen among the treatment arms. Preoperative radiotherapy increases the risk of anastomotic leakage and stenosis after rectal cancer resection. Clinical leakage independently contributes to the development of stenosis.

The Effects of Preoperative Radiotherapy on Head and Neck Free Flap Anastomosis Success

The long-term survival benefit of neoadjuvant radiotherapy for oropharyngeal tumors is controversially discussed in the literature. To bring more light into this important debate, we evaluated our cases. In this retrospective study the main focus was the relationship between neoadjuvant irradiation and anastomosis failure. Other influencing factors including previous operative treatment and tumor stage and type also were studied. In total, 7 anastomoses failed (total failure rate, 8.4%; n= 83); 1 of the 7 underwent neoadjuvant irradiation (failure rate, 3.1%; n= 32). All 7 anastomosis failures were in squamous cell carcinoma cases, with 5 of them staged as T4. Our data suggest that neoadjuvant radiotherapy for oropharyngeal carcinoma does not increase the risk of postoperative anastomosis failure compared with surgical reconstruction alone. Furthermore, the data suggest a correlation between the stage and type of tumor.

Effect of preoperative radiotherapy on stage IB2 and IIA2 cervical cancer: A retrospective cohort study

IntroductionThe aim of the retrospective study was to investigate the therapeutic efficiency of the preoperative intracavitary radiotherapy combined with radical surgery on postoperative complications and long-term survival in patients with stage IB2 and IIA2 cervical cancer (CC). MethodsFrom January 1995 to December 2012, a total of 171 patients with stage IB2 or IIA2 CC were recruited into the study. They were divided into two groups according to the treatment modality provided: preoperative radiotherapy followed by radical surgery (n = 80), and radical surgery alone (n = 91). The clinical curative effect, postoperative complications and the postoperative prognosis of patients were evaluated and compared in two groups. The tumor response and survival of patients in two groups were observed in follow-up study. ResultsThere were no significant differences in the incidence of postoperative complications, intraoperative blood loss and surgery duration (P > 0.05) between the two groups. Preoperative radiotherapy did not improve the postoperative prognosis yet. Though patients undergoing preoperative radiotherapy showed the similar 1- (92.50% vs. 84.62%), 3- (85.00% vs. 81.32%) and 5-year (80.00% vs. 74.72%) survival rates, the 3- and 5-year locoregional control rates of them were much higher than those undergoing surgery alone (P < 0.05). ConclusionPreoperative radiotherapy combined with radical surgery could improve locoregional control rate and would not increase the risk of postoperative complications. It may be a feasible treatment mode for early stage CC carcinoma.

Observation on the effect of preoperative radiotherapy on the local advanced middle and low rectal cancer

Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy. Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively. 40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F, 1.8-2.0 Gy/F, 5 F/W, combining with the synchronous capecitabine chemotherapy (1 650 mg/m2, 2 F/d, d1-14/d21-35), and accepted operation 4-6 weeks after the radiotherapy. The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F, 5 Gy/F, 5 F/W, and got the operation in 2 weeks after the radiotherapy. Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 % (34/40), 65.0 % (26/40)] were higher than those in preoperative short-course radiotherapy group [58.3 % (14/24), 33.3 % (8/24)] (χ2 = 5.689, P= 0.019; χ2 = 6.040, P= 0.041). There were no significant differences between the two groups on the index of remission rates, radiation injury, surgical complications, and overall survival rate of 1, 3, 5 years (all P> 0.05). Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference. But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate, without increasing the radiation injury and surgical complications. Key words: Rectal neoplasms; Radiotherapy; Colorectal surgery

Probabilities of benefit and harms of preoperative radiotherapy for rectal cancer: What do radiation oncologists tell and what do patients understand?

ObjectiveProbabilities of benefits and harms of treatment may help patients when making a treatment decision. This study aimed to examine (1) whether and how radiation oncologists convey probabilities to rectal cancer patients, and (2) patients’ estimates of probabilities of major outcomes of rectal cancer treatment. MethodsFirst consultations of oncologists and patients eligible for preoperative radiotherapy (PRT) (N=90) were audio taped. Tapes were transcribed verbatim and coded to identify probabilistic information presented. Patients (N=56) filled in a post-consultation questionnaire on their estimates of probabilities. ResultsProbabilities were mentioned in 99% (local recurrence), 75% (incontinence), 72% and 40% (sexual dysfunction in males and females, respectively) of cases. Most patients (89%) correctly estimated that PRT decreases the probability of local recurrence, and 10% and 38%/54% that it increases the probability of incontinence and sexual dysfunction in males/females, respectively. Patients tended to underestimate the probabilities of harms of treatment. ConclusionOur results show that oncologists almost always mention probabilities of benefit of PRT. In contrast, probabilities of harms often go unmentioned. The effect of PRT on adverse events is often underestimated. Practice implicationsOncologists should stay alert to patients’ possible misunderstanding of probabilistic information and should check patients’ perceptions of probabilities.

639 - Study of the Effect of Radical Surgery Combined with Pre- or Postoperative Radiotherapy in Treatment of Resectable Rectal Cancer

ABSTRACT Back ground preoperative radiotherapy in resectable rectal cancer has a number of potential advantages, most importantly, preventing local recurrence, increasing survival and down-staging effect. Purpose This study was done to compare between the effect of preoperative radiotherapy and postoperative radiotherapy in treatment of resectable rectal carcinoma. The primary endpoints are local recurrence rate, overall survival (OS) and disease free survival (DFS). The secondary endpoints are to evaluate down-staging, treatment toxicity, and ability to do sphincter preservation, aiming at choosing the optimal treatment modality. Patients and methods This study included 100 patients with resectable rectal carcinoma who presented to Surgical Gastro Entrology Center and Clinical Oncology and Nuclear Medicine Department, Mansoura University during the period between January 2007 and September 2009. The included patients were randomized in two groups; group I: 50 patients received preoperative radiotherapy and group II: 50 patients received postoperative radiotherapy. Concurrent 5-fluorouracil- based chemotherapy was given to all patients. Two major types of surgery were done: abdomino-perineal resection with a permanent colostomy and low anterior resection with colorectal or coloanal anastomosis. Results Preoperative radiotherapy resulted in pathologic complete response in 3 patients. T down-staging occurred in 18 out of 50 patients (36%) with statistically significant difference (p = 0.008). N down-staging occurred in 10 out of 24 patients. Sphincter preservation was more in group I. Delayed wound healing was the most common postoperative complication in group I with no significant difference. After a median follow up of 18 months, local recurrence rate and distant metastasis were higher in group II. The 2-years disease free survival was 72% and 60% in group I and II respectively with no statistically significant difference between both groups. Conclusion This study concluded that preoperative radiotherapy is better than postoperative radiotherapy as regard local control, Sphincter preservation with higher disease free survival and overall survival. No difference in treatment toxicity between both groups. Disclosure All authors have declared no conflicts of interest.

Effect of radical surgery combined with pre- or postoperative radiotherapy in treatment of resectable rectal cancer

Objective This study was done to compare between the effect of preoperative radiotherapy and postoperative radiotherapy in treatment of resectable rectal carcinoma. The primary endpoints are local recurrence rate, overall survival (OS) and disease free survival (DFS). The secondary endpoints are to evaluate down-staging, treatment toxicity, and ability to do sphincter preservation, aiming at choosing the optimal treatment modality.

Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum

Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.