Neoadjuvant Chemoradiation Treatment Research Articles

Exercise During Neoadjuvant Chemoradiation Treatment To Improve Rectal And Esophageal Cancer Outcome (EXENTRO) Pilot Trial

Exercise During Neoadjuvant Chemoradiation Treatment To Improve Rectal And Esophageal Cancer Outcome (EXENTRO) Pilot Trial

Dosimetric Predictors of Acute Diarrhea in Locally Advanced Rectal Cancer Patients Treated with Neoadjuvant Chemoradiation with Capecitabine and Irinotecan: A Discovery and Validation Study

Additional irinotecan can increase the pCR rate from 15% to 30% compared with capecitabine-based neoadjuvant chemoradiotherapy in locally advanced rectal cancer, while more acute diarrhea was induced and predictors of diarrhea have yet to be fully elucidated. In this analysis, we report the incidence of and factors associated with grade 3+ acute diarrhea in LARC patients treated with the CaplriRT regimen in the CinClare trial. We identified the dosimetric markers with a lasso-Cox risk scoring model tested on CaplriRT group patients in the CinClare trial at our institution from 2015 to 2017 (CinClare, NCT02605265), and then independently validated according to a predefined protocol in patients treated with neoadjuvant chemoradiation with capecitabine and irinotecan from 2019 to 2022 (NCT05688033). Clinical documentation and patient-reported outcomes were reviewed to determine grade 3+ acute diarrhea events. A total of 116 patients from Cinclare trial treated with CaplriRT regimen were used as a training cohort to obtain dosimetric prediction model and 168 patients were used for independent validation. The majority received 50 Gray (Gy) in 25 fractions with concurrent capecitabine and irinotecan. Median number of concurrent chemotherapy cycles received was 4 (IQR: 3-4). Seventeen (23.6%) patients treated with the CaplriRT regimen in the CinClare trial experienced grade 3+ acute diarrhea. Dosimetric predictors of acute diarrhea included peritoneal space volume receiving 25 Gy or greater (V25Gy). The single multivariate Cox regression, and receiver operating characteristic (ROC) curve analysis showed that the model had good predictive ability (p<0.05). It was also validated using the validation cohort. Patients with peritoneal space V25Gy>950 cm3 were associated with a higher risk of 3+ acute diarrhea compared with those without constraints of V25Gy (p = 0.002). Peritoneal space V25Gy as an important predictor of acute diarrhea during capecitabine and irinotecan neoadjuvant chemoradiation treatment. Peritoneal space V25Gy < 950 cm3 may reduce acute diarrhea toxicity.

Radiomics for the Prediction of Pathological Complete Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Prospective Observational Trial.

(1) Background: An increasing amount of research has supported the role of radiomics for predicting pathological complete response (pCR) to neoadjuvant chemoradiation treatment (nCRT) in order to provide better management of locally advanced rectal cancer (LARC) patients. However, the lack of validation from prospective trials has hindered the clinical adoption of such studies. The purpose of this study is to validate a radiomics model for pCR assessment in a prospective trial to provide informative insight into radiomics validation. (2) Methods: This study involved a retrospective cohort of 147 consecutive patients for the development/validation of a radiomics model, and a prospective cohort of 77 patients from two institutions to test its generalization. The model was constructed using T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI to understand the associations with pCR. The consistency of physicians' evaluations and agreement on pathological complete response prediction were also evaluated, with and without the aid of the radiomics model. (3) Results: The radiomics model outperformed both physicians' visual assessments in the prospective test cohort, with an area under the curve (AUC) of 0.84 (95% confidence interval of 0.70-0.94). With the aid of the radiomics model, a junior physician could achieve comparable performance as a senior oncologist. (4) Conclusion: We have built and validated a radiomics model with pretreatment MRI for pCR prediction of LARC patients undergoing nCRT.

Treatment patterns and outcomes in patients with Pancoast tumors: a national cancer database analysis.

Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymph node involvement are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation treatment, followed by surgical resection, as the standard of care. But many institutions choose upfront surgery. Our goal was to identify the treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB). The NCDB was queried from 2004 through 2017 to identify all patients who had undergone surgery for a Pancoast tumor. Treatment patterns, including the percentage of patients who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on the cohort who received upfront surgery. A total of 2,910 patients were included in the study. Overall 30- and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation treatment prior to surgery. Patients who received neoadjuvant chemoradiation treatment experienced significantly improved 90-day survival (P<0.01) and overall survival (P<0.01). When analyzing the cohort who received upfront surgery, there was a statistically significant difference in survival based on adjuvant treatment pattern (P<0.01). Patients in this group who received adjuvant chemoradiation had the best survival, whereas patients who received adjuvant radiation only or no treatment had the worst outcomes. Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases nationally. Patients who received neoadjuvant chemoradiation treatment had improved survival compared to patients who had upfront surgery. Similarly, when surgery is performed first, adjuvant chemoradiation treatment improved survival compared to other adjuvant strategies. These results suggest underutilization of neoadjuvant treatment for patients with node-negative Pancoast tumors. Future studies with a more clearly defined cohort are needed to assess the treatment patterns being utilized on patients with node-negative Pancoast tumors. It will be beneficial to see whether neoadjuvant treatment for Pancoast tumors has increased in recent years.

Treatment Patterns and Outcomes in Patients with Pancoast Tumors: A National Cancer Database Analysis

INTRODUCTION: Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymphadenopathy are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation followed by surgery as standard of care. But many institutions choose upfront surgery. Our goal was to identify treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB). METHODS: The NCDB was queried from 2004 through 2017 for all patients who had undergone surgery for Pancoast tumors. Treatment patterns, including the percentage who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on patients who received upfront surgery. RESULTS: A total of 2,910 patients were included in the study. Overall 30-day and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation before surgery. Patients who received neoadjuvant chemoradiation experienced improved 90-day survival (OR 0.63, p < 0.01) and overall survival (OR 0.94, p < 0.01; Fig. 1). When analyzing patients who received upfront surgery, adjuvant chemoradiation treatment was associated with improved survival compared to no treatment after surgery (OR 0.87, p < 0.01).CONCLUSION: Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases. Neoadjuvant chemoradiation is associated with improved survival compared to upfront surgery. When surgery is performed first, adjuvant chemoradiation treatment improves survival. These results suggest significant underutilization of standard of care for patients with Pancoast tumors.

Optimized tools and timing of response reassessment after neoadjuvant chemoradiation in rectal cancer.

PurposeReassessment tools of response to long-course neoadjuvant chemoradiation treatment (nCRT) in patients with locally advanced rectal cancer (LARC) are important in predicting complete response (CR) and thus deciding whether a wait-and-watch strategy can be implemented in these patients. Choosing which routine reassessment tools are optimal and when to use them is still unclear and will be researched in the study.MethodsAltogether, 250 patients with LARC who received nCRT from 2013 to 2021 and were followed up were retrospectively reviewed. Common reassessment tools of response included digital rectal examination (DRE), clinical examination and symptoms, endoscopy, biopsy, magnetic resonance imaging (MRI), and blood biomarkers.ResultsOverall, 27.20% (68/250) patients had a complete response and 72.80% (182/250) did not. The combination of MRI, endoscopy, and biopsy showed the best performance in terms of accuracy of 74% and area under the curve (AUC, 0.714, 95% CI 0.546–0.882). Reassessing through DRE and presence of symptoms failed to improve the efficacy of response reassessment. After 100 days, biopsy as an assessment tool would obtain a substantial rise in accuracy from 51.28 to 100% (p = 0.003).ConclusionThe combination of MRI, endoscopy, and biopsy is suitable as the reassessment tool of response for applying a wait-and-watch strategy after long-course nCRT in patients with LARC. The accuracy of biopsy as reassessment tools would be improved if they were used over 100 days after nCRT in patients with rectal cancer.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00384-022-04268-7.

1232P CROSS protocol for esophageal cancer in India: Reality or pipe dream?

CROSS(Chemoradiotherapy for Oesophageal cancer followed by surgery study) published in 2012 proved to be a practice changing study for treatment of locally advanced esophageal cancer located at the middle and lower third of esophagus. When chemoradiotherapy followed by surgery became the standard of care for the treatment of locally advanced esophageal cancer, we, at the tertiary care centers of India struggled to bring this concept home because of various obstacles in low middle income countries like ours. Limited infrastructure, overpopulation, financial issues, ignorance and the lack of a strong multidisciplinary team are the various stumbling blocks. Most ardous task is to convince patients to go for surgery of the so called food pipe, specially after symptomatic relief by the neoadjuvant chemoradiation treatment. Retrospective study done in Department of Radiotherapy, at tertiary centre in Northern India. All histopathology proven cases of carcinoma esophagus registered in our department from january 2019 to December 2021, eligible for the CROSS protocol were taken for this study. Total 246 patients of carcinoma esophagus were registered in our department from January 2019 to December 2021 of which 85 were non metastatic, locally advanced disease involving the middle or lower third of esophagus and were eligible for the CROSS protocol. 47(55.3%) patients denied any form of surgical intervention at the begining of the treatment and were given definitive chemoradiation. 29(34%) refused surgery after neoadjuvant treatment, only 9(10%) patients completed the whole treatment. We found that out of all the patients eligible for surgery only 10% could complete the whole treatment including chemoradiotherapy and surgery. CROSS trial established a benchmark in treatment of esophageal cancer, but real-world data of tertiary care centre in India shows that providing optimal treatment to patients of esophageal cancer is still a tough row to hoe because of reasons extending from unwillingness to undergo major surgery to economic crisis and lack of MDT in several centres. Better and acceptable treatment protocols with organ preservation needs to be studied and adopted in low middle income countries which have high burden and low infrastructure.

Genomic Correlates of Unfavorable Outcome in Locally Advanced Cervical Cancer Treated with Neoadjuvant Chemoradiation.

PurposeNeoadjuvant therapy modality can increase the operability rate and mitigate pathological risks in locally advanced cervical cancer, but treatment response varies widely. It remains unclear whether genetic alterations correlate with the response to neoadjuvant therapy and disease-free survival (DFS) in locally advanced cervical cancer.Materials and MethodsA total of 62 locally advanced cervical cancer (stage IB–IIA) patients who received neoadjuvant chemoradiation plus radical hysterectomy were retrospectively analyzed. Patients’ tumor biopsy samples were comprehensively profiled using targeted next generation sequencing. Pathologic response to neoadjuvant treatment and DFS were evaluated against the association with genomic traits.ResultsGenetic alterations of PIK3CA were most frequent (37%), comparable to that of Caucasian populations from The Cancer Genome Atlas. The mutation frequency of genes including TERT, POLD1, NOS2, and FGFR3 was significantly higher in Chinese patients whereas RPTOR, EGFR, and TP53 were underrepresented in comparison to Caucasians. Germline mutations were identified in 21% (13/62) of the cohort and more than half (57%) had mutations in DNA damage repair genes, including BRCA1/2, TP53 and PALB2. Importantly, high tumor mutation burden, TP53 polymorphism (rs1042522), and KEAP1 mutations were found to be associated with poor pathologic response to neoadjuvant chemoradiation treatment. KEAP1 mutations, PIK3CA-SOX2 co-amplification, TERC copy number gain, and TYMS polymorphism correlated with an increased risk of disease relapse.ConclusionWe report the genomic profile of locally advanced cervical cancer patients and the distinction between Asian and Caucasian cohorts. Our findings highlight genomic traits associated with unfavorable neoadjuvant chemoradiation response and a higher risk of early disease recurrence.

An Unsupervised Learning Approach to 3D Rectal MRI Volume Registration

Accurate alignment of multi-session medical imaging is essential to the analysis of disease progression. By comparing the magnetic resonance imaging (MRI) data captured before and after a course of neoadjuvant chemoradiation (nCRT) treatment, physicians are able to evaluate the tumor response for further treatment of the disease. However, rectal MRI data captured in multi-session are often misaligned and not guaranteed to have one-to-one correspondence, making it challenging for physicians to observe the treatment response of tumor. To address this issue, we propose an unsupervised learning based volume registration framework, which enables accurate alignment even under a high degree of deformation between multi-session rectal data. Moreover, it works without the assumption of one-to-one correspondence between multi-session data, and hence is a general solution to rectal MRI volume registration. The experimental results show that the proposed registration framework accurately aligns rectal cancer images and outperforms other state-of-the-art methods in medical image registration. By providing accurate registration, it can potentially increase the efficiency and reduce the workload for physicians to evaluate the rectal tumor response to nCRT.

31: The Use of Proton Pump Inhibitors Does Not Adversely Influence Pathological and Clinical Outcomes When Used with Capecitabine in the Neo-Adjuvant Chemo-Radiation Treatment of Locally Advanced Rectal Cancers

31: The Use of Proton Pump Inhibitors Does Not Adversely Influence Pathological and Clinical Outcomes When Used with Capecitabine in the Neo-Adjuvant Chemo-Radiation Treatment of Locally Advanced Rectal Cancers

Concomitant Use of Proton Pump Inhibitors With Capecitabine Based Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: Is it Safe?

Capecitabine (Cape) is routinely used for the neoadjuvant chemoradiation treatment (NACRT) of locally advanced rectal cancers (LARCs). Previous reports have suggested that the concomitant use of proton pump inhibitors (PPIs) may affect the efficacy of Cape, although the true effect of PPIs when used with Cape as a radiosensitizer for neoadjuvant radiation is unclear. The aim of our study was to evaluate the impact of concurrent PPI use along with fluorouracil (FU) and Cape based NACRT in terms of pathologic and oncological outcomes, in patients with LARC. LARC patients treated at our center with NACRT from 2010 to 2016 were identified. Postoperative pathology and follow-up outcomes were examined for any differences with relation to the use of PPIs concurrently with FU and Cape based NACRT and adjuvant chemotherapy regimens. Three hundred four and 204 patients received treatment with FU and Cape based NACRT. No difference in pathologic complete response rate was noted between the 2 arms with the concurrent use of PPIs (25.8% and 25%, respectively, P=0.633); or with and without the use of PPIs in the Cape-NACRT arm specifically (20% and 20.7%, P=0.945). At a median follow-up of 5 years, no statistical difference in local or distant control was noted in the Cape-NACRT patients, with and without concomitant PPI use (P=0.411 and 0.264, respectively).Multivariate analysis showed no association of PPI use and NACRT with Cape, in terms of local control (hazard ratio=0.001, P=0.988) or overall survival (hazard ratio=1.179, confidence interval=0.249-5.579, P=0.835). Our study revealed that there was no adverse pathologic or oncological outcome with the concurrent use of PPIs along with Cape-NACRT in the treatment of LARC. We report that it may be safe to use PPIs if essential, in this clinical setting, although it would be wise to exercise caution.

Impact of Neoadjuvant Chemoradiation on Adverse Events After Bronchial Sleeve Resection

We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with the incidence of postoperative pulmonary and airway complications. After instructional review board approval we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, and pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. We analyzed 136 patients (18 underwent neoadjuvant chemoradiation), 77 (57%) of whom had non-small cell lung cancer. Postoperative pulmonary complications were observed in 44 of 136 patients (32%). Incidences of pulmonary complications were higher in the neoadjuvant chemoradiation group compared with the non-neoadjuvant radiation group (15/18 patients [83%] vs 29/118 patients [25%], respectively; P< .001). Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, bronchopleural fistula, and completion pneumonectomy (2/18 [11%]) were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both P < .05) CONCLUSIONS: Patients who undergo neoadjuvant chemoradiation before sleeve resection are at an increased risk of pulmonary and airway complications.

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer.

BackgroundApparent diffusion coefficient (ADC) values achieve promising results in treatment response prediction in patients with several types of cancers.PurposeTo determine whether ADC values predict neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC).Material and MethodsForty-four patients with LARC who underwent magnetic resonance imaging scans before and after nCRT followed by delayed surgery were enrolled retrospectively. The sample was distributed as follows: responders (R), n = 8; and non-responders (Non-R), n = 36. Three markers of treatment response were considered: post-nCRT measures; ΔADC; and Δ%ADC. Statistical analysis included a Wilcoxon test, a Mann–Whitney U test, and a receiver operating characteristic (ROC) analysis in order to evaluate the diagnostic accuracy for each ADC value marker to differentiate between R and Non-R.ResultsBoth minimum and mean ADC values were significantly higher after nCRT in the R group, while non-significant differences between basal and control ADC values were found in the non-R group. In addition, ΔADC and Δ%ADC exhibited increased values after nCRT in R when compared with non-R. ROC analysis revealed the following diagnostic performance parameters: post-nCRT: ADCmin = 1.05 × 10−3 mm2/s (sensitivity 61.1% and specificity 66.7%), ADCmean = 1.50 × 10−3 mm2/s (sensitivity 72.2% and specificity 83.3%), ΔADC: ADCmin = 0.35 (sensitivity 66.7% and specificity 83.3%), ADCmean = 0.50 (sensitivity 72% and specificity 83%); and Δ%ADC: ADCmin = 44% (sensitivity 66.7% and specificity 83.3%) and ADCmean = 60% (sensitivity 83% and specificity 99%).ConclusionOur findings suggest that post-treatment rectal tumor ADC values, as well changes between pre- and post-treatment values, may be biomarkers for predicting treatment response in patients with LARC who underwent nCRT.

Baseline MR Staging of Rectal Cancer: A Practical Approach

As therapeutic options to treat rectal cancers have advanced over the last several decades, MRI has become the standard of care for baseline local tumor and nodal staging of rectal cancers. An understanding of the technique, anatomy, tumor appearance, and elements of staging on MRI is essential to provide prognostic information and to guide neoadjuvant chemoradiation and surgical treatment. We provide a framework for imaging the rectum on MRI followed by a practical case-based approach to interpretation of pre-treatment MRI of the rectum in evaluation of rectal cancers, with examples and illustrations of the range of local tumor (T) stage and nodal (N) disease involvement. This approach can be paired with standardized reporting templates to support clear, accurate and clinically relevant imaging assessment of rectal cancers.

Short term outcomes of minimally invasive selective lateral pelvic lymph node dissection for low rectal cancer.

Pelvic recurrence after rectal cancer surgery is still a significant problem despite the introduction of total mesorectal excision and chemoradiation treatment (CRT), and one of the most common areas of recurrence is in the lateral pelvic lymph nodes. Hence, there is a possible role for lateral pelvic lymph node dissection (LPND) in rectal cancer. To evaluate the short-term outcomes of patients who underwent minimally invasive LPND during rectal cancer surgery. Secondary outcomes were to evaluate for any predictive factors to determine lymph node metastases based on pre-operative scans. From October 2016 to November 2019, 22 patients with stage II or III rectal cancer underwent minimally invasive rectal cancer surgery and LPND. These patients were all discussed at a multidisciplinary tumor board meeting and most of them received neoadjuvant chemoradiation prior to surgery. All patients had radiologically positive lateral pelvic lymph nodes on the initial staging scans, defined as lymph nodes larger than 7 mm in long axis measurement, or abnormal radiological morphology. LPND was only performed on the involved side. Majority of the patients were male (18/22, 81.8%), with a median age of 65 years (44-81). Eighteen patients completed neoadjuvant CRT pre-operatively. 18 patients (81.8%) had unilateral LPND, with the others receiving bilateral surgery. The median number of lateral pelvic lymph nodes harvested was 10 (3-22) per pelvic side wall. 8 patients (36.4%) had positive metastases identified in the lymph nodes harvested. The median pre-CRT size of these positive lymph nodes was 10mm. Median length of stay was 7.5 d (3-76), and only 2 patients failed initial removal of their urinary catheter. Complication rates were low, with only 1 lymphocele and 1 anastomotic leak. There was only 1 mortality (4.5%). There have been no recurrences so far. Chemoradiation is inadequate in completely eradicating lateral wall metastasis and there are still technical limitations in accurately diagnosing metastases in these areas. A pre-CRT lymph node size of ≥ 10 mm is suggestive of metastases. LPND may be performed safely with minimally invasive surgery.

Deep learning-based radiomic features for improving neoadjuvant chemoradiation response prediction in locally advanced rectal cancer

Radiomic features achieve promising results in cancer diagnosis, treatment response prediction, and survival prediction. Our goal is to compare the handcrafted (explicitly designed) and deep learning (DL)-based radiomic features extracted from pre-treatment diffusion-weighted magnetic resonance images (DWIs) for predicting neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). 43 Patients receiving nCRT were included. All patients underwent DWIs before nCRT and total mesorectal excision surgery 6–12 weeks after completion of nCRT. Gross tumor volume (GTV) contours were drawn by an experienced radiation oncologist on DWIs. The patient-cohort was split into the responder group (n = 22) and the non-responder group (n = 21) based on the post-nCRT response assessed by postoperative pathology, MRI or colonoscopy. Handcrafted and DL-based features were extracted from the apparent diffusion coefficient (ADC) map of the DWI using conventional computer-aided diagnosis methods and a pre-trained convolution neural network, respectively. Least absolute shrinkage and selection operator (LASSO)-logistic regression models were constructed using extracted features for predicting treatment response. The model performance was evaluated with repeated 20 times stratified 4-fold cross-validation using receiver operating characteristic (ROC) curves and compared using the corrected paired t-test. The model built with handcrafted features achieved the mean area under the ROC curve (AUC) of 0.64, while the one built with DL-based features yielded the mean AUC of 0.73. The corrected paired t-test on AUC showed P-value < 0.05. DL-based features extracted from pre-treatment DWIs achieved significantly better classification performance compared with handcrafted features for predicting nCRT response in patients with LARC.

Neoadjuvant chemoradiation versus adjuvant chemotherapy for locally advanced adenocarcinoma of the rectosigmoid junction.

The optimal treatment approach for adenocarcinoma of the rectosigmoid junction remains unclear. The aim of this work was to compare outcomes of neoadjuvant chemoradiation (NCR) and adjuvant chemotherapy (AC) treatment for cancer of the rectosigmoid junction. This was a nationwide, retrospective cohort study (2004-2015) using hospital-based cancer outcomes data (National Cancer Database). All patients who underwent resection with curative intent for locally advanced [American Joint Committee on Cancer (AJCC) Stages II and III] adenocarcinoma of the rectosigmoid junction were included. Exclusion criteria were age less than 18 or over 75years, Charlson-Deyo score > 2, AJCC Stages I and IV and unstaged tumours. Treatment with NCR was compared with treatment with AC, the primary outcome being overall survival. Other end-points were resection margin status, the presence of lymphovascular invasion and postoperative length of stay. A total of 2828 patients were included in this study, of whom 1701 (59.7%) received NCR. NCR was more frequently utilized in patients who were black (10.3% vs 7.6%, P<0.05) and underwent treatment at academic institutions (37.9% vs 22.5%, P<0.05). Treatment with NCR did not differentially influence survival following risk adjustment (hazard ratio 1.17, CI 0.98-1.40; P=0.085). NCR was independently associated with a decreased likelihood of a positive resection margin (OR 0.44, CI 0.33-0.58; P<0.001) and lymphovascular invasion (OR 0.51, CI 0.40-0.67; P<0.001). However, treatment with NCR was associated with the need for prolonged hospitalization compared with AC (7.3 days vs 6.5days; P=0.015). The study was limited by its retrospective design, external validity and risk of tumour misclassification. NCR currently seems to be favoured over AC for the management of locally advanced adenocarcinoma of the rectosigmoid junction. This approach may not be justified as NCR is associated with prolonged hospitalization needs without a clear survival benefit when compared with AC. Prospective studies are warranted to definitively compare outcomes of NCR and AC in this patient population.

Radiomics features on radiotherapy treatment planning CT can predict patient survival in locally advanced rectal cancer patients

This retrospective study was to investigate whether radiomics feature come from radiotherapy treatment planning CT can predict prognosis in locally advanced rectal cancer patients treated with neoadjuvant chemoradiation followed by surgery. Four-hundred-eleven locally advanced rectal cancer patients which were treated with neoadjuvant chemoradiation enrolled in this study. All patients’ radiotherapy treatment planning CTs were collected. Tumor was delineated on these CTs by physicians. An in-house radiomics software was used to calculate 271 radiomics features. The results of test-retest and contour-recontour studies were used to filter stable radiomics (Spearman correlation coefficient > 0.7). Twenty-one radiomics features were final enrolled. The performance of prediction model with the radiomics or clinical features were calculated. The clinical outcomes include local control, distant control, disease-free survival (DFS) and overall survival (OS). Model performance C-index was evaluated by C-index. Patients are divided into two groups by cluster results. The results of chi-square test revealed that the radiomics feature cluster is independent of clinical features. Patients have significant differences in OS (p = 0.032, log rank test) for these two groups. By supervised modeling, radiomics features can improve the prediction power of OS from 0.672 [0.617 0.728] with clinical features only to 0.730 [0.658 0.801]. In conclusion, the radiomics features from radiotherapy CT can potentially predict OS for locally advanced rectal cancer patients with neoadjuvant chemoradiation treatment.

The Role of Diffusion Weighted MRI in Assessment of Rectal Cancer

Background: Magnetic resonance imaging has become the most accurate technique in local staging of rectal cancer. The identification and staging of rectal cancers at MR imaging is largely based on differences in T2 signal intensity between the tumor, the mucosa and submucosal layers, the muscular layer, the perirectal fat, and the mesorectal fascia. Objective: Was to assess the role of Diffusion Weighted MRI in assessment of rectal cancer and correlation of these findings with available histopathological findings. Patients and Methods: A total of 30 patients, proved by colonoscopy to have rectal carcinoma, were included in this retrospective study wich was carried out in the Radiology Department of Al-Azhar University Hospitals. The work took place during the period between June 2018 and Januray 2019.written consent was taken from each patient. The study was carried out after approval of the ethical committee of scientific research, faculty of medicine, Al-Azhar University. Results: we found that DW MRI measurement increased the specificity of the rectal MRI in characterizing different rectal cancers especially when it is combined with conventional MRI.Also the use of additional DW MR imaging yields better diagnostic accuracy than does use of conventional MR imaging alone in the evaluation of complete response (CR) to neoadjuvant chemoradiation treatment (CRT) in patients with locally advanced rectal cancer. Conclusion: DW MRI has a growing role in rectal cancer staging either primary staging or evaluating the post chemo radiotherapy state.

PS02.107: OUTCOMES FOLLOWING DIFFERENT NEOADJUVANT CHEMORADIATION REGIMENS FOR LOCALLY ADVANCED ESOPHAGEAL CANCER

Abstract Background The objective of this study was to analyze the induction therapy regimens employed since publication of CROSS Trial in patients treated with locally advanced EGJ cancer in terms of toxicity, complications, survival and recurrence. Methods Retrospective chart review all patients in single institution prospective database who had neoadjuvant CRT→Surgery 2012–2015. Complications during CRT and after surgery graded using National Cancer Institute CTCAE. Cox-proportion hazard ratios were used to compare the primary outcomes of overall survival (OS) and disease-free survival (DFS). Results 288 patients, 237 men and 51 women were identified. 246 were adenocarcinoma, 38 squamous cell carcinoma, and 4 had other histologic types. 4 distinct neoadjuvant regimens were observed: 50.4 Gy radiation with 5-fluorouracil and cisplatin (N = 22), CROSS regimen (41.4 Gy with carboplatin &amp; paclitaxel) (N = 44), 50.4 Gy with carboplatin and paclitaxel (N = 152), and ‘Other’ which include 27 distinct regimens (N = 70). There were no differences in treatment related complications or postoperative complications between regimens. There was no difference in pathologic complete response rate, OS, or DFS between regimens. Conclusion Since the publication of the CROSS Trial, there is a significant heterogenity in the neoadjuvant chemoradiation treatment regimen employed for patients with locally advanced EGJ tumors. Does not appear to be any differences in treatment related complications or postoperative complications between regimens. There was also no difference in pCR, overall survival or disease-free survival. Disclosure All authors have declared no conflicts of interest.