Neoadjuvant Chemoradiotherapy In Patients Research Articles

Identification of microRNA Biomarkers of Response to Neoadjuvant Chemoradiotherapy in Esophageal Adenocarcinoma Using Next Generation Sequencing.

Clinical trials report improved overall survival following neoadjuvant chemoradiotherapy in patients undergoing surgery for esophageal adenocarcinoma, with a 10-15% survival improvement. MicroRNAs (miRNAs) are small noncoding RNAs that are known to direct the behavior of cancers, including response to treatment. We investigated the ability of miRNAs to predict outcomes after neoadjuvant chemoradiotherapy. Endoscopic biopsies from esophageal adenocarcinomas were obtained before neoadjuvant chemoradiotherapy and esophagectomy. miRNA levels were measured in the biopsies using next generation sequencing and compared with pathological response in the surgical resection, and subsequent survival. miRNA ratios that predicted pathological response were identified by Lasso regression and leave-one-out cross-validation. Association between miRNA ratio candidates and relapse-free survival was assessed using Kaplan-Meier analysis. Cox regression and Harrell's C analyses were performed to assess the predictive performance of the miRNAs. Two miRNA ratios (miR-4521/miR-340-5p and miR-101-3p/miR-451a) that predicted the pathological response to neoadjuvant chemoradiotherapy were found to be associated with relapse-free survival. Pretreatment expression of these two miRNA ratios, pretreatment tumor differentiation, posttreatment AJCC histopathological tumor regression grading, and posttreatment tumor clearance/margins were significant factors associated with survival in Cox regression analysis. Multivariate analysis of the two ratios together with pretherapy factors resulted in a risk prediction accuracy of 85% (Harrell's C), which was comparable with the prediction accuracy of the AJCC treatment response grading (77%). miRNA-ratio biomarkers identified using next generation sequencing can be used to predict disease free survival following neoadjuvant chemoradiotherapy and esophagectomy in patients with esophageal adenocarcinoma.

ANALYSIS OF HEMATOLOGIC, HEPATIC AND PANCREATIC TOXICITY DURING NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER

Purpose.We analyzed the frequency and severity of hematologic, hepatic and pancreatic toxicity during and after completion of neoadjuvant chemoradiotherapy in patients with gastric cancer.Material and methods. Phase II clinical trial was conducted to evaluate the efficacy of the combined modality treatment including neoadjuvant chemoradiotherapy followed by D2 gastrectomy for patients with locally advanced gastric cancer. The main inclusion criteria were: histologically verified gastric cancer, cT3-4N0, cT2-4N1-3; M0. Before starting neoadjuvant therapy, all patients underwent thoracic and abdominal CT and laparoscopy to exclude peritoneal carcinomatosis. A total dose of radiation therapy was 45 Gy (1 + 1.5 Gy/fraction/day with a 4–5 hour interval) concurrently with the modified CAPOX chemotherapy regimen. Gastrectomy or subtotal resection of the stomach was planned 4-6 weeks after the completion of chemoradiotherapy. The toxicity assessment of neoadjuvant chemoradiotherapy was performed using the NCI CTC scale, version 3.0. The assessment of hematological, hepatic and pancreatic toxicities was done.Results.Among the toxicity during and after completion of neoadjuvant chemoradiotherapy, thrombocytopenia, neutropenia and leukopenia (grade 1–2) were the most common, requiring no additional symptomatic therapy. Radiation therapy was completed in 45 (98 %) patients. Chemotherapy was completed in 42 (91 %) patients. The median time between the completion of chemoradiotherapy and surgery was 44 days. Surgery following chemoradiotherapy was performed in 100 % of patients, including R0 resection in 93 % of patients.Conclusion.Preoperative chemoradiotherapy was well tolerated by patients, could be completed in most cases and did not prevent subsequent surgical treatment.

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Selection of Adjuvant Treatment Without Neoadjuvant Chemoradiotherapy for Patients With Rectal Cancer: Room for Further Investigation

Selection of Adjuvant Treatment Without Neoadjuvant Chemoradiotherapy for Patients With Rectal Cancer: Room for Further Investigation

Adenocarcinoma of the oesophagus: neoadjuvant chemoradiation and radical surgery

To retrospectively evaluate long-term treatment results following neoadjuvant chemoradiation (CRT) and radical surgery in patients with advanced adenocarcinoma (AC) of the oesophagus. Between 2005 and 2015, atotal of 102 consecutive patients with amedian age of 64years (range, 44-86years) and AC of the oesophagus were evaluated of whom 84 received afull CRT. Agroup of 51patients was treated with neoadjuvant intent followed by radical surgery. Atotal dose of 50.4 Gy with mostly weekly paclitaxel/fluorouracil chemotherapy was administered. Six to eight weeks following CRT, atransthoracic subtotal oesophageal and proximal gastric resection was performed. Survival curves for overall survival and no evidence of disease (NED) survival (primary endpoints) were calculated according to Kaplan-Meier, and possible prognostic factors were evaluated by the log-rank test as well as by aCox regression analysis. Median follow-up time of the surviving patients was 48months (range, 14-134 months). Overall and NED survival rates for patients of the study group (n = 51) were 40 and 32%, respectively, at 5years. Age (p = 0.04), ypT category (p = 0.1) and the development of distant metastases (p = 0.05) were identified as (marginally) independent prognostic variables with impact on survival. Median survival time for patients of the study group (n = 51) was 45 ± 18months (95%CI 9-81months). Clear resection margins were achieved in 46/51 patients (92%). Regression rates with complete regression rare residual cancer and increased number of residual cells, but predominantly fibrosis were 33, 41, and 10%, respectively. Patterns of failure revealed local with distant recurrence in 2/51 (4%), regional recurrence alone in 2/51 (4%), and distant metastases in 27/51 (53%) patients. Neoadjuvant CRT in patients with AC of the oesophagus followed by thoracoabdominal surgery is alocally very effective concept. Asignificant tumour regression in almost 75% of the patients may stimulate prospective trials on the omission of radical surgery for some elderly patients. Due to ahigh rate of distant metastases further investigations in terms of effective systemic therapy may be warranted.

Neoadjuvant Chemoradiotherapy for Patients with cT3/Nearly T4 Esophageal Cancer: Is Sarcopenia Correlated with Postoperative Complications and Prognosis?

Since the clinical impact of sarcopenia on multimodal therapy for patients with esophageal cancer is not well understood, this study was conducted to determine the influence of sarcopenia on the efficacy of neoadjuvant chemoradiotherapy (NACRT) for locally advanced esophageal cancer. The skeletal muscle index was quantified at the level of the third lumbar vertebra on computed tomography images, and sarcopenia was defined as a skeletal muscle index that was less than the average for each gender. We compared treatment outcomes in patients with cT3 and nearly T4 thoracic esophageal squamous cell carcinoma between the sarcopenia group (n=85) and the non-sarcopenia group (n=72). The 5-year survival rates were 33.4% in the non-sarcopenia group and 31.5% in the sarcopenia group; these differences were not significant. The prognosis of the patients with sarcopenia was worse than that of the patients without sarcopenia in the surgery-alone group, but there was no difference between patients with and without sarcopenia in the NACRT group. NACRT could be a useful option for patients with locally advanced esophageal squamous cell carcinoma, even for those with sarcopenia, without increasing the incidence of morbidity and mortality.

Incidence and Predictors of Unsuspected Recurrent Laryngeal Nerve Lymph Node Metastases After Neoadjuvant Chemoradiotherapy in Patients with Esophageal Squamous Cell Carcinoma.

Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)-treated esophageal cancer patients remains unclear. This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN-RLN(-) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors. A total of 56 patients (53 males and 3 females; mean age: 55years) were included. The upper mediastinum-including the bilateral RLN area-was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN-RLN(-), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre-nCRT RLN LN(cN-RLN) status as the only independent predictor of ypN-RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN-RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN-RLN(-) patients who had positive and negative cN-RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection. Nearly one-fifth of ESCC patients who were judged to be ycN-RLN(-) unexpectedly had positive ypN-RLN. The pre-nCRT cN-RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.

Additional 4-week capecitabine during the resting periods after 6-week neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: long-term oncologic outcomes.

PurposeThe aim of this study was to evaluate the long-term outcome of additional 4-week chemotherapy with capecitabine during the resting periods following a 6-week neoadjuvant chemoradiotherapy (NCRT) regimen, in patients with locally advanced rectal cancer.MethodsRadiotherapy was delivered to the whole pelvis at a total dose of 50.4 Gy for 6 weeks. Oral capecitabine was administered at a dose of 825 mg/m2 twice daily for 10 weeks. Surgery was performed 2–4 weeks following the completion of chemotherapy.ResultsBetween January 2010 and September 2011, 41 patients completed the scheduled neoadjuvant therapy and surgery. The pathologic complete response rate, 5-year overall survival, and 5-year disease-free survival rates were 22%, 85.4%, and 78.0%, respectively. The 5-year systemic recurrence and 5-year local recurrence rates were 22% and 0%, respectively.ConclusionAdditional 4-week chemotherapy with capecitabine, during the resting periods following a 6-week NCRT regimen, has favorable long-term oncologic outcomes. Further randomized controlled trials are however necessary to evaluate if substantial improvement in local control is achieved with this additional chemotherapy modality for locally advanced rectal cancer.

The Advisability of Neoadjuvant Chemoradiotherapy of Rectal Cancer in Geriatric Patients

A comparative analysis of the efficacy and safety of neoadjuvant chemoradiotherapy (CRT) in colorectal- cancer patients older and younger than 60 years was performed. It has been determined that the risk of complications of neoadjuvant CRT, as well as the degree of its adverse effect on the outcomes of subsequent surgical treatment, does not significantly depend on the age of the patients. However, the application of preoperative CRT in geriatric patients is associated with a less significant increase in disease-free survival compared with younger patients. Thus, the factor of age should not restrict the use of neoadjuvant CRT in patients with satisfactory general somatic status and the absence of severe complications of the tumor process.

Evaluating the expression of cyclooxygenase-2 enzyme by immunohistochemistry in normal and tumoral tissue before and after neoadjuvant chemoradiotherapy in patients with esophageal cancer in Khorasan Province

Esophageal cancer is the third most common cancer in Iran. Neoadjuvant chemoradiotherapy (NCRT) is the appropriate treatment for esophageal cancer. This study investigated the expression of cyclooxygenase (COX)-2 enzyme in normal and tumoral tissues before any treatment in patients with esophageal cancer, this study also assessed the effect of NCRT on the expression of COX-2 enzyme in normal and tumoral tissue in samples derived by surgery furthermore, and this study investigated the relationship between expression of COX-2 enzyme and the pathologic tumor regression grade (PTRG) patients. In this study, a total of 120 patients admitted to Omid Hospital, Imam Reza Hospitals, and Reza-Mashhad Medical Center, who were treated with NCRT, were recruited and the expression of the COX-2 enzyme in normal and tumoral tissues was assessed by immunohistochemistry before and after treatment by an expert pathologist between zero and 300. PTRG was determined by a pathologist after treatment. The mean levels of COX-2 expression, obtained from tumoral and normal tissue baseline biopsy in patients, were 177.69 and 64.29, respectively, while in surgical specimen were 177.25 and 49.84, respectively. A significant association was found between PTRG of surgical specimen and COX-2 expression in normal tissue (baseline biopsy) at diagnosis (P = 0.034). The results indicated that expression of COX-2 in tumoral tissues exceeds the expression of COX-2 in normal tissue of the baseline biopsy. Patients with a high expression of COX-2 in baseline tumor biopsies had less response to treatment of pathology compared to patients with lower expression of COX-2 in baseline tumor biopsies.

MRI texture analysis in predicting treatment response to neoadjuvant chemoradiotherapy in rectal cancer.

To evaluate the importance of MRI texture analysis in prediction and early assessment of treatment response before and early neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). This retrospective study comprised of 59 patients. The tumoral texture parameters were compared between pre- and early nCRT. Area Under receiver operating characteristic (ROC) Curves [AUCs] were used to compare the diagnostic performance of statistically significant difference parameters and logistic regression analysis predicted probabilities for discriminating responders and nonresponders. The Standard Deviation (SD), kurtosis and uniformity were statistically significantly difference between pre- and early nCRT (p = 0.0012, 0.0001, and < 0.0001, respectively). In pathological complete response (pCR) group, pre-uniformity and pre-Energy were significantly higher than that of nonresponders (p = 0.03 and p < 0.01, respectively), while the pre-entropy in nonresponder was reverse (p = 0.01). The diagnostic performance of pre-kurtosis and pre-Energy were higher in tumor regression grade (TRG) and pCR group (AUC = 0.67, 0.73, respectively). Logistic regression analysis showed that diagnostic performance for prediction responder and nonresponder did not significantly improve compared with to pre-uniformity, energy and entropy in pCR group (AUC = 0.76, p = 0.2794, 0.4222 and 0.3512, respectively). Texture parameters as imaging biomarkers have the potential to prediction and early assessment of tumoral treatment response to neoadjuvant chemoradiotherapy in patients with LARC.

MRI texture analysis in prediction of treatment response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

Objective To evaluate the value of MRI texture analysis (TA) in prediction of treatment response neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer patients. Methods Fifty nine histopathologically-proven rectal adenocarcinoma patients through biopsy treated with nCRT before total mesorectal excision were enrolled in this retrospective study. The first MRI examination (pre-nCRT MRI) was performed before nCRT, and the second one (early nCRT MRI) was performed at the third week of nCRT. The texture parameters values were measured, including mean value, standard deviation, skewness, kurtosis, uniformity, energy, and entropy. Tumoral downstaging was determined by comparing the pre-nCRT clinical T stage(cT stage) with the ypT stage. The patients were divided into downstaging and non downstaging group based on postoperative T staging. Parameters were compared between pre-and early nCRT in terms of averages using Wilcoxon signed-rank test. Downstaging and non downstaging groups were analyzed using Mann-Whitney U test. Multivariate logistic regression analysis was performed using the statistically significant parameters between the two groups as independent variables. ROC analysis was performed on the new independent variables obtained by multi-parameter logistic regression analysis and the single parameter independent variables. The diagnostic efficiency of the parameters were evaluated. Results T-downstaging were found in 28 patients after nCRT. The stdDeviation, kurtosis, and uniformity were significantly different between pre-and early nCRT (P 0.05). The pre-nCRT, uniformity, energy, entropy and the early nCRT mean value, entropy were significantly different in patients with downstaging vs. non downstaging (P<0.05). For the pre-nCRT stdDeviation, uniformity, energy, entropy and the early nCRT mean value, entropy, ROC analysis showed an area under curve(AUC) of 0.69, 0.76, 0.68, 0.67 and 0.65, 0.68, respectively. The multivariate logistic regression analysis for the four pre-nCRT independent variables (stdDeviation, uniformity, energy, entropy) achieved logical variable 1, and the logical variable 1 achieved an AUC of 0.78 to discriminate patients with T-downstaging from patients with non downstaging. The multivariate logistic regression analysis for the two early nCRT independent variables (mean value, entropy) achieved logical variable 2, and the logical variable 2 achieved an AUC of 0.69 to predict T-downstaging. Conclusion Pre-and early nCRT MRI TA in rectal cancer have the efficacy to predict treatment response. Key words: Rectal neoplasms; Magnetic resonance imaging; Treatment outcome; Texture analysis

Radiomics Analysis for Evaluation of Pathological Complete Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer.

Purpose: To develop and validate a radiomics model for evaluating pathologic complete response (pCR) to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer (LARC).Experimental Design: We enrolled 222 patients (152 in the primary cohort and 70 in the validation cohort) with clinicopathologically confirmed LARC who received chemoradiotherapy before surgery. All patients underwent T2-weighted and diffusion-weighted imaging before and after chemoradiotherapy; 2,252 radiomic features were extracted from each patient before and after treatment imaging. The two-sample t test and the least absolute shrinkage and selection operator regression were used for feature selection, whereupon a radiomics signature was built with support vector machines. Multivariable logistic regression analysis was then used to develop a radiomics model incorporating the radiomics signature and independent clinicopathologic risk factors. The performance of the radiomics model was assessed by its calibration, discrimination, and clinical usefulness with independent validation.Results: The radiomics signature comprised 30 selected features and showed good discrimination performance in both the primary and validation cohorts. The individualized radiomics model, which incorporated the radiomics signature and tumor length, also showed good discrimination, with an area under the receiver operating characteristic curve of 0.9756 (95% confidence interval, 0.9185-0.9711) in the validation cohort, and good calibration. Decision curve analysis confirmed the clinical utility of the radiomics model.Conclusions: Using pre- and posttreatment MRI data, we developed a radiomics model with excellent performance for individualized, noninvasive prediction of pCR. This model may be used to identify LARC patients who can omit surgery after chemoradiotherapy. Clin Cancer Res; 23(23); 7253-62. ©2017 AACR.

Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan.

Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed. Preoperative pelvic radiotherapy was delivered. Total of 46 Gray were delivered concurrently with 5- fluorouracil (5-FU) on the first and last week of radiation. Total mesorectal excision of the rectal tumour either by anterior or abdominoperineal resections was planned at 6-8 weeks from completion of preoperative treatment. The pathological response to therapy was assessed by histopathology examination of the surgical specimen. Initial clinical staging of patients revealed 58.3% of them were stage T3/T4N2M0 and 41.7% were stage T3N0M0. Down-staging to stage T1/T2N0M0 was found in 36.1% and stage T3N0M0 in 30.6%. No response was seen in 8.3% of cases with stage T3/T4N2M0 while complete clinical response (no residual) was seen in 25.0%. Complete histological response was observed in 13.8%. Positive lymph-nodes metastasis was confirmed in 8.3% of cases. Neoadjuvant chemoradiation is a reasonable option for cases of rectal cancer and deserves further evaluation.

An analysis of factors affecting the accuracy of endoscopic biopsy after neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma

PurposeThe accuracy of endoscopic esophageal biopsy after neoadjuvant chemoradiotherapy (nCRT) remains suboptimal. We retrospectively examined the factors that may affect the diagnostic accuracy of post-nCRT endoscopic biopsy in patients with esophageal squamous cell carcinoma (ESCC). Materials and methodsA total of 213 ESCC patients were enrolled. Biopsy findings were cross-checked against the final pathology outcomes (ypT0 versus non-ypT0) to assess their accuracy. The independent predictors of diagnostic accuracy were identified by multivariate logistic regression analysis. ResultsPost-nCRT endoscopic biopsy results were diagnostically consistent with the final pathology outcomes in 116 (54.5%) patients. Multivariate logistic regression analysis identified a long time interval between the completion of nCRT and the endoscopic examination as the only factor independently associated with a higher diagnostic accuracy. Receiver operating characteristic curve analysis showed that the optimal cutoff value for the time interval between nCRT completion and endoscopic biopsy was 45 days. The estimated diagnostic accuracies of biopsies performed before and after the optimal cutoff time were 49.1% and 72.9%, respectively. ConclusionsEndoscopic biopsies performed ≥45 days after nCRT are associated with a higher diagnostic accuracy. This time cutoff may serve as a reference to inform the choice of the optimal treatment strategy following nCRT, especially among complete responders in whom surgery withholding is being considered.

MiR-194 as predictive biomarker of responsiveness to neoadjuvant chemoradiotherapy in patients with locally advanced rectal adenocarcinoma

AimsCurative surgery remains the primary form of treatment for locally advanced rectal cancer (LARC). Recent data support the use of preoperative chemoradiotherapy (pCRT) to improve the prognosis of LARC with...

1448P - Effect of rural residence (RD) and distance travel to the cancer center (DTC) on neoadjuvant chemoradiation (NCRT) in localized rectal cancer

Background: Neoadjuvant chemoradiation therapy (NCRT) has been associated with a lower rate of local recurrence and represents an accepted standard of care. Yet, access to treatment or decisions about treatment can be affected by contextual factors such as rural residence (RD) and distance travel to cancer center (DTC). In the current study, we evaluated relationship between RD and DTC and NCRT. Methods: A cohort of patients diagnosed with localized rectal cancer during 2009-2013 in the province of Saskatchewan was studied. The logistic regression analyses were performed to assess relationship between RD and DTC and lack of NCRT. Results: Total 279 patients were identified with median age of 66 yrs (IQR:59-76) and M:F of 1:0.71. 94 (33.6) had a major comorbid illness. 183 (65%) were rural resident. The median DTC was 141 km (IQR 7-233). Of 279 patients, 116 (41%) were referred for NCRT, 161 (58%) underwent upfront surgery, and 2 declined surgery. The mean DTC for group treated with NCRT was 111.5 ±122km compared with 169.0±176km if they did not receive NCRT (p = 0.001). Of urban resident, 52/96 (54%) were referred for NCRT compared with 64/183 (35%) of rural resident (p = 0.002). After excluding 33 (12%) patients who had clinical stage I disease and underwent upfront surgery, a univariate regression analysis revealed that both DTC (OR 1.92, 95% CI: 1.15-3.20) and RD (OR 2.51, 95%CI: 1.46-4.32) were significantly correlated with lack of NCRT. On multivariate analysis following relationships were noted with lack of NCRT. Age ≥ 70 yrs (OR 1.45, 95%CI: 0.84-2.45), comorbid illness (OR 1.52, 0.86-2.67), ECOG performance status of > 1 (OR 1.25, 0.49-3.17), DTC (OR 1.07, 0.51-2.23), and RD (OR 2.56, 1.17-5.57). Conclusions: Our results revealed that RD but not DTC is associated with a lower rate of NCRT in patients with localized rectal cancer. Future studies are required to explore the underlying cause of differential referral. Legal entity responsible for the study: Saskatchewan Cancer Agency Funding: None Disclosure: All authors have declared no conflicts of interest.

Neoadjuvant chemoradiotherapy in combined treatment of patients with rectal cancer

OBJECTIVE. The article analyzed an efficacy and safety of application of neoadjuvant chemoradiotherapy (CRT) in elderly and senile patients with rectal cancer. MATERIAL AND METHODS. An analysis of treatment results was made in 267 patients, who were divided into two groups. The first group (n = 142) underwent combined treatment that included prolonged course of neoadjuvant CRT followed by surgery. The second group of 125 patients underwent surgery without application of CRT. The patients of both groups were subdivided according their age. The subgroup “A” consisted of young and middle age patients. The subgroup “B” included geriatric patients. Comparative analysis was made between the same age subgroups. RESULTS. The age factor didn’t significantly influence on the risk of complications of neoadjuvant CRT and its adverse effects on subsequent outcome of surgery. The application of preoperative CRT in geriatric patients accompanied by less significant growth of recurrence-free survival compared with young patients. CONCLUSIONS. The age factor shouldn’t restrict the application of neoadjuvant CRT in patients with satisfactory general health status and absence of tumor complication process.

Predictive factors in the evaluation of treatment response to neoadjuvant chemoradiotherapy in patients with advanced esophageal squamous cell cancer.

Neoadjuvant therapy before esophagectomy is evidence-based, and is a standard-of-care for locally advanced and operable esophageal cancer. However response to such treatment varies in individual patients, from no clinical response to pathological complete response. It has been consistently shown that a good pathological responses is of prognostic value, but perhaps in the expense of those who do not. It is important to identify suitable predictive factors for response, so that patients are not exposed to potentially harmful chemotherapy and/or radiotherapy without benefits. Alternative management strategies can be devised. Various clinical, radiological, serological and potential molecular markers have been studied. None has been shown to be sufficiently reliable to be used in daily practice. Certainly more understanding of the molecular basis for response to chemotherapy/radiotherapy is needed, so that patient treatment can be tailored and individualized.

P-290 - Capecitabine and oxaliplatin versus 5-fluorouracil in the neoadjuvant chemoradiation for patients with locally advanced rectal carcinoma: A comparative study

P-290 - Capecitabine and oxaliplatin versus 5-fluorouracil in the neoadjuvant chemoradiation for patients with locally advanced rectal carcinoma: A comparative study