Neoadjuvant Concomitant Chemoradiotherapy Research Articles

Is There any Benefit of Addition of Neo-Adjuvant Chemotherapy (FOLFOX4) to Standard Preoperative Treatment of Rectal Cancer? A Randomized Clinical Trial.

Total neoadjuvant therapy (TNT) before surgical intervention represents a unique therapeutic approach for the management of locally advanced rectal cancer (LARC) and has witnessed a notable rise in utilization within recent years. However, the efficacy and safety of this treatment remain subjects of ongoing debate and investigation. This randomized controlled trial aimed to evaluate the potential impact of administering induction chemotherapy (IC) before the conventional neoadjuvant concomitant chemoradiotherapy (nCRT) in LARC patients. patients with resectable stage II-III LARC were randomly allocated to receive either biweekly 6 cycles of FOLFOX4 regimen as IC followed by CRT and total mesorectal excision (TME) (experimental group) or nCRT followed by TME (control group). The primary endpoint was the rate of pathological complete response (pCR). The secondary endpoints encompassed the evaluation of treatment-related adverse events as well as the assessment of survival outcomes. 67 patients were enrolled in this study (32 in the experimental group and 35 in the control group). The median age of the patients was 45 years. Stage IIIB was observed in 46.3% of the patients. The patients who underwent induction chemotherapy demonstrated a notably higher rate of achieving pCR in comparison to the control group (28.1% vs 8.6%; P=0.001). There were no statistically significant differences observed in terms of their toxicity profile and survival outcomes. Implementation of induction chemotherapy utilizing the FOLFOX4 regimen has demonstrated a notable enhancement in the rate of pathological complete response. However, this improvement does not appear to translate into significant advancements in overall survival outcomes.

Preferred neoadjuvant therapy for gastric and gastroesophageal junction adenocarcinoma: a systematic review and network meta-analysis.

Currently, the standard treatment for gastric and gastroesophageal junction (GEJ) adenocarcinoma, including distal esophagus, consists of perioperative chemotherapy (CT) according to FLOT schedule (5FU/leucovorin/oxaliplatin and docetaxel), or of concomitant chemoradiotherapy (CTRT) based on CROSS regimen. However, due to the relatively lack of direct comparisons between perioperative CT and neoadjuvant CTRT, the effectiveness of these new combinations is unknown. Therefore, we performed a network meta-analysis (NMA) to compare the efficacy of different neoadjuvant treatments for gastric and GEJ adenocarcinoma in terms of overall and disease-free survival (OS and DFS). We searched MEDLINE, Embase, and Cochrane from database inception until February 1st 2022 for randomized clinical trials that enrolled adults with gastric and GEJ carcinomas and provided data about OS and/or DFS. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (95% CrIs). Surface under the cumulative rank (SUCRA) curve plots were produced. The primary outcome was OS, secondary endpoint DFS. A total of 1247 citations were screened; 14 randomized clinical trials were included. In Bayesian comparisons, FLOT-based CT ranked as one of the better regimens with a probability of 41%, both with induction CT followed by CTRT (P = 0.45). For DFS analysis, the FLOT regimen was the preferred option (P = 0.62). In conclusion, this NMA adds further evidence to the optimization of treatment strategies for gastric and GEJ adenocarcinomas and confirms that incorporation of perioperative triplet-based CT improved both OS and DFS compared to surgery alone and other preoperative strategies.

P-149 Impact of COVID-19 pandemic and total neoadjuvant therapy (TNT) implementation in pathological complete response (pCR) rates in patients (pts) with locally advanced rectal cancer (LARC)

Strategies for locally advanced rectal cancer LARC usually consisted of neoadjuvant concomitant chemoradiotherapy (CRT) followed by adjuvant chemotherapy, or short-course radiotherapy (SCRT). TNT is a novel approach for LARC, with several randomized clinical trials exploring its role and paving the way for implementation in clinical practice. Nevertheless, the COVID-19 pandemic represented a challenge for a timely diagnosis, implementation and follow-up of new treatment strategies in these pts.

The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes.

Simple SummaryAround 15% of locally advanced rectal cancer patients have positive lateral pelvic lymph-nodes at diagnosis, with a worse prognosis due to the high incidence of distant metastasis. The best treatment modality for these patients is still a challenge. The aim of our retrospective study was to analyze the efficacy of the Simultaneous Integrated Boost—Intensity Modulated Radiation Therapy technique and determine the optimal dose of radiotherapy on clinically positive lateral pelvic lymph-nodes in locally advanced rectal cancer patients. Excellent results in terms of all the analyzed oncological outcomes have been observed. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years.Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years.

395P Randomized control trial to assess radiological and pathological response after neo adjuvant concomitant chemo radiotherapy vs. sequential short course radiotherapy (SCRT) followed by chemotherapy in locally advanced rectal cancer (LARC)

Incidence of rectal cancer and disease at younger age is increasing. Unlike colon cancer, only age and gender are the strong associated risk factors of rectal cancer. Surgical resection remains main stay of treatment for rectal carcinoma which appears to be inadequate in case of LARC (stage II/III) necessitating multi-modality approach using chemotherapy and radiotherapy with various sequences, allowing better tumor control.

Monitoring of Early Changes of Circulating Tumor DNA in the Plasma of Rectal Cancer Patients Receiving Neoadjuvant Concomitant Chemoradiotherapy: Evaluation for Prognosis and Prediction of Therapeutic Response.

Introduction: Patients with locally advanced rectal cancer (LARC) are undergoing neoadjuvant chemoradiotherapy (NCRT) prior to surgery. Although in some patients the NCRT is known to prevent local recurrence, it is also accompanied by side effects. Accordingly, there is an unmet need to identify predictive markers allowing to identify non-responders to avoid its adverse effects. We monitored circulating tumor DNA (ctDNA) as a potential liquid biopsy-based biomarker. We have investigated ctDNA changes plasma during the early days of NCRT and its relationship to the overall therapy outcome.Methods and Patients: The studied cohort included 36 LARC patients (stage II or III) undergoing NCRT with subsequent surgical treatment. We have detected somatic mutations in tissue biopsies taken during endoscopic examination prior to the therapy. CtDNA was extracted from patient plasma samples prior to therapy and at the end of the first week. In order to optimize the analytical costs of liquid-biopsy testing, we have utilized a two-level approach in which first a low-cost detection method of denaturing capillary electrophoresis was used followed by examination of initially negative samples by a high-sensitivity BEAMING assay. The ctDNA was related to clinical parameters including tumor regression grade (TRG) and TNM tumor staging.Results: We have detected a somatic mutation in 33 out of 36 patients (91.7%). Seven patients (7/33, 21.2%) had ctDNA present prior to therapy. The ctDNA positivity before treatment reduced post-operative disease-free survival and overall survival by an average of 1.47 and 1.41 years, respectively (p = 0.015, and p = 0.010). In all patients, ctDNA was strongly reduced or completely eliminated from plasma by the end of the first week of NCRT, with no correlation to any of the parameters analyzed.Conclusions: The baseline ctDNA presence represented a statistically significant negative prognostic biomarker for the overall patient survival. As ctDNA was reduced indiscriminately from circulation of all patients, dynamics during the first week of NCRT is not suited for predicting the outcome of LARC. However, the general effect of rapid ctDNA disappearance apparently occurring during the initial days of NCRT is noteworthy and should further be studied.

Survival benefits from concomitant chemoradiotherapy before radical surgery in stage IVA sinonasal mucosal melanoma?

BackgroundThe aim of the study was to review a local treatment protocol for sinonasal mucosal melanoma (SNMM) focusing on triple modality treatment (TMT), that is, neoadjuvant concomitant chemoradiotherapy (CRT) and surgery.MethodsIn a retrospective design, data on clinical presentation, treatment, and survival were retrieved for 22 consecutive patients from a tertiary referral center.ResultsThe mean overall survival (OS) for all patients (3 stage III, 16 stage IVA, and 3 stage IVB) was 62 months, and the 5‐year OS rate 50%. Four of the 22 patients received treatment with palliative intention. Of the 18 patients who received treatment with curative intention, patients with stage IVA disease who received TMT (n = 10) had a 5‐year OS of 70% and 10‐year OS of 20%. The median disease‐free survival for these patients was 51 months compared with 9 months for stage IVA not receiving TMT (n = 4).ConclusionA seemingly favorable survival outcome for a disease with characteristically poor prognosis was observed. The lead finding was a high survival rate (70% 5‐year OS) for stage IVA patients who received neoadjuvant TMT. The observations suggest the possibility that patients with advanced SNMM (stage IVA) might benefit from concomitant CRT before surgery by delaying the onset of local recurrences and distant metastases.Level of EvidenceLevel 4, case series (with or without comparison).

Clinical analysis of neck node metastasis in oral cavity cancer.

ObjectivesThe purpose of this study was to evaluate the neck node metastasis pattern and related clinical factors in oral cavity cancer patients.Materials and MethodsIn total, 76 patients (47 males, 29 females) with oral squamous cell carcinoma (OSCC) who had no previous malignancies and were not undergoing neoadjuvant concomitant chemoradiotherapy or radiotherapy were selected for analysis.ResultsOccult metastases were found in 8 of 52 patients with clinically negative nodes (cN0, 15.4%). Neck node metastases were found in 17 patients (22.4%). There was a statistically significant relationship between neck node metastasis and T stage (P=0.014) and between neck node metastasis and distant metastasis (Fisher's exact test, P=0.019).ConclusionNeck node metastasis was significantly related to tumor size and distant metastasis during follow-up.

Sphincter Saving Surgery in Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiotherapy

AbstractAim: To evaluate the feasibility of sphincter saving surgery in locally advanced low rectal cancer after neoadjuvant concomitant chemoradiotherapy (CCRT) by assessing the effect of CCRT on downstaging of primary tumor, hence sphincter preservation rate and outcome.Patients and Methods: Patients presenting to the National Cancer Institute-Cairo University from May 2014 to October 2014; with locally advanced low (3-6m from the anal verge) rectal cancer received long-course CCRT and the response was evaluated, then they were subjected to APR or sphincter saving surgery.Results: The study started by 60 patients; 33/60 (55%) underwent APR, 25/60 (41.7%) underwent sphincter saving surgery and 2/60 patients (3.3%) lost follow-up.The clinical response was assessed by the status of the distance from the anal verge: It increasedin 23/60 patients (38.33%), stationary in 17/60 patients (28.33%) and decrea-sedin 20/60 patients. The radiological response showed: downstaging occurred in 27/60 (45%). Pathological response revealed: Down-staging in 28/58 patients (48.3%).Negative distal margin was obtained in all patients had sphincter saving surgery with one case only had positive radial margin.Conclusion: Sphincter saving surgery is an oncologically safe alternative to the standard APR in low rectal cancer, with the added benefit of avoiding a permenant stoma. The use of preoperative concomitant chemoradiotherapy (CCRT) enhances the rate of sphincter saving surgery by downsizing and down-staging of the tumors.

Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in locally advanced rectal carcinoma

Background Evaluation of the safety and efficacy of neoadjuvant chemoradiation containing oxaliplatin in locally advanced cancer rectum.Patients and methods A prospective, single-arm, phase-II study, carried out on 40 patients with locally advanced (T3, T4, N+) rectum cancer from June 2013 to June 2015. Patients received 2 months induction FOLFOX4 chemotherapy, followed by concomitant chemoradiotherapy (CRT) consisted of oxaliplatin 100 mg/m2 D1, 29 of radiotherapy (RT), folinic acid 20 mg/m2 D1: 29, and 5-FU 300 mg/m2 D1: 5, 29: 33 continuous infusion (during the first and fifth week of RT), with three-dimensional conformal pelvic RT 45 Gy by conventional fractionation. Surgery was done 4–6 weeks after end of the CRT course. Adjuvant treatment consisted of 2 months FOLFOX4 chemotherapy. A booster dose of RT 9 Gy/5 fractions was added in cases with positive margin or persistent T4 tumors after surgery.Results In all, 95% of the patients ended neoadjuvant CRT course with 75% receiving full treatment doses. Overall response occurred in 86% of patients; 16% of them showed pathological complete response; initial failure occurred in only 5% of patients; sphincter sparing surgery was done in 43% of patients. CRT course passed with tolerable and reversible toxicity; grade III toxicity occurred in only 10% of patients, and no grade IV toxicity was reported.Conclusion Adding oxaliplatin to neoadjuvant CRT in locally advanced cancer rectum cases was feasible, tolerable, with satisfactory response rates, thus encouraging more studies with larger number of patients and longer follow-up periods.

Management of Thymic Neoplasms: Egyptian NCI Experience

Background: Thymic tumors are rare entity with little information regarding outcomes after therapy with curative intent. They are heterogeneous group of neoplastic lesions with wide spectrum of morphologic appearances. They show different presentations with a variable & unpredictable evolution ranging from indolent attitude to highly infiltrative and metastasizing one. The optimal treatment includes surgical resection, chemotherapy, and radiotherapy. Objectives: To analyze, to report & to better understand the clinico-pathologic features, results of treatment, and prognostic factors of these tumors. Materials and Methods: From 2008 to 2014, 13 patients (8 men, 5 women) underwent surgical resection of thymic tumor at a mean age of 47 years. Patient demographics, extent of surgical resection, and outcomes were compiled. Demographic variables, use of chemotherapy or radiotherapy, peri-operative variables, recurrence rates, and long term survival were analyzed retrospectively. The Masaoka stage and tumor diameter were recorded along with other variables that potentially influenced survival such tumor grade, site & number of metastatic disease. Results: The mean age of our patients was 47 years (range: 21 to 58 years) & 8 cases (61.5%) were men. The distribution of patients according to the Masaoka staging at presentation was, stage I (6 cases, 47%), stage II (3 cases, 23%), stage III in (1 patient, 7%), and stage IV (3 cases, 23%). Neoadjuvant chemotherapy was administered to 3 patients (23%) whose tumors were deemed to be more locally advanced precluding R0 resection from the start & 2 patients (15%) received neoadjuvant concomitant chemo-radiotherapy. No patient demonstrated an associated immunologic disorder such as myasthenia gravis. In all patients (13 cases, 100%) pathologic confirmation of thymic tumor was by CT guided fine needle aspiration/biopsy. Surgical resection was done for all our cases (13 patients, 100%) through median sternotomy approach in (11 cases, 86%), cervical approach (1 patient, 7%) & transverse sternotomy with clamshell incision in 1 patient (7%) with a large thymic carcinoma whose postoperative pathology revealed a close margin of resection (R1). Resection of nearby structures was done in our cohort to fulfill R0 resection; pulmonary wedge resection in (2 cases, 15%), pleural resection in (5 cases, 38%), lobectomy in (1 patient, 7%) & unilateral phrenic nerve resection was performed in (2 patients, 15%). None patients with phrenic nerve injury underwent diaphragmatic plication to improve respiratory insufficiency No superior vena cava resection was done in any of our cases. There were no perioperative deaths, tracheostomy, or postoperative respiratory failure occurred. Complete R0 resection was achieved in 12 cases (92.3%), and of these patients, only 1 patient (7.7%) experienced local recurrence whose primary resection was R1. 4 patients received adjuvant chemotherapy or radiotherapy or both. Mean duration of survival in the entire group was 22.7 months (range: 14 to 36 months). At the last follow-up, (8 patients, 61.5%) were alive without disease, (1 case, 7.5%) was alive with disease, and (4 cases, 31%) were dead. Conclusions: Thymic tumors are amenable to surgical therapy, with increased use of computed tomography imaging. Patients with early stage disease are being identified more frequently. Complete surgical resection appears to have favorable cure rates in these patients. Patients with locally advanced disease can experience long term survival with a multimodality approach.

Role of Staging Laparoscopy and Diversion Stoma in Locally Advanced CA Rectum with Impending Obstruction and Planned for Neoadjuvant Concomitant Chemoradiotherapy (NACTRT)

Role of Staging Laparoscopy and Diversion Stoma in Locally Advanced CA Rectum with Impending Obstruction and Planned for Neoadjuvant Concomitant Chemoradiotherapy (NACTRT)

Neoadjuvant Chemoradiation in Patient with Localy Advanced Rectal Cancer

Abstract Introduction. Neoadjuvant (preoperative) concomitant chemoradiotherapy (CRT) has become a standard treatment of locally advanced rectal adenocarcinoma. Aim of the study is to analyze efficacy of neoadjuvant CRT and survival rates in patients with locally advanced rectal cancer. Materials and methods. Retrospective study of 60 locally advanced rectal cancer patients who underwent neoadjuvant radiotherapy with or without addition of neoadjuvant chemotherapy in Clinic of Oncology of Pauls Stradiņš Clinical University Hospital from 2007 to 2012 was done. Results. Long-course radiotherapy (45-50.4 Gy) received 52 patients. Median time from diagnosis to radiotherapy was 35.8 days. Median time to surgery was 47.7 days. Pathological complete remission (pCR) of the primary rectal cancer was not observed. Distribution by pathologic staging was as follows: 28.8% Stage I (7.7% T1N0M0), 32.7% Stage II and 38.5% Stage III. Downstaging occurred in 93.7% in concomitant chemoradiation with Ftorafur, 61.9% in combination with 5FU/LV, and 53.3% in radiation without chemotherapy. Median PFS and OS were not met. In median follow up of 22.6 month overall survival was 90.3%, and PFS - 88%. Conclusions. Addition of chemotherapy to neoadjuvant radiotherapy is increasing tumor downstaging rate. Ftorafur in concomitant neoadjuvant chemoradiation showed increased downstaging compared to standard 5FU therapy. Response to preoperative therapy improves survival in patient with locally advanced rectal cancer.

Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum – Toxicity and complications of the treatment

Aims The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. Methods We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. Results All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4–8 weeks following the concomitant chemoradiotherapy – in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. Conclusions We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.

Patterns of Care for Lung Cancer in Radiation Oncology Departments of Turkey

To determine the patterns of care for lung cancer in Turkish radiation oncology centers. Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated. The most frequent histology was non-small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were ">/= IB" disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1-3, completion of CHT to cycles 4-6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities. There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.

Re-anastomosis above a Preceding Anastomosis Made by a Low Anterior Resection

Periodic colonoscopic checkup is needed for patients suffering from colorectal cancer, based on the property that a colorectal neoplasm often recurs synchronously or metachronously. Surgical management appropriate to the occasion should be taken in recurrent colorectal cancer. Particularly, recurring colorectal cancer closely above the prior anastomosis for a low anterior resection should be eliminated by using an abdomino-perineal resection, including the preceding anastomotic site or a new anastomotic creation. Under the latter instance, ample possibility exists for postoperative anastomotic stenosis or leakage by reason of insufficient blood supply to the segment between the earlier anastomosis and the later one. The authors report two cases of re-anastomosis for colorectal cancer just above a previous anastomosis taken by a low anterior resection for rectal cancer. In a 52-year-old male with a history of neoadjuvant concomitant chemo-radiotherapy (CCRT) and low anterior resection for rectal cancer located at 6 cm from the anal verge, a new adenocarcinoma was detected 7 cm from the previous anastomotic site and 3 cm from the anal verge. Considering anal sphincter preservation, the re-anastomosis was made at the upper part of the preceding anastomosis. The patient experienced no surgical complications, such as anastomotic stenosis or leakage and functional defecation difficulty. In another patient, a 50-year-old male with a low anterior resection and adjuvant CCRT for rectal cancer 8 cm from anal verge, a new adenocarcinoma was detected in the colon. The new adenocarcinoma was located 10 cm from the anal verge and 8 cm from the previous anastomosis. The same surgical management was applied to this case, with the same postoperative result.

Sentinel node biopsy is reliable in early-stage cervical cancer but not in locally advanced disease

Sentinel lymph node (SN) biopsy based on dual labeling with blue dye and radiocolloid can reliably determine lymph node status in early-stage cervical cancer, but few data are available on its accuracy in more advanced disease. We examined the influence of tumor stage on the accuracy of SN biopsy in patients with cervical cancer. Between July 2001 and June 2004, 33 patients (mean age 52 years) with early-stage or locally advanced cervical cancer underwent laparoscopic SN biopsy based on dual labeling with patent blue and radiocolloid. Patients with early-stage cervical cancer (stages IA and IB1, 23 patients) underwent complete laparoscopic pelvic lymphadenectomy after the SN procedure. Patients with locally advanced cervical cancer (stage IB2, IIA or IIB, 10 patients) underwent laparoscopic pelvic and para-aortic lymphadenectomy after SN biopsy and prior neoadjuvant concomitant chemoradiotherapy. The SN identification rates and false-negative rates of patients with early-stage and locally advanced disease were compared. The mean numbers of SNs identified per patient with early-stage and locally advanced cervical cancer were 2.3 (range 0-4) and 1.9 (range 0-4), respectively. SNs were identified in 86.9% (20/23) of patients with early-stage disease and in 80% (8/10) of patients with locally advanced disease. When analyzed according to the side of dissection, the identification rate was lower, especially in the patients with locally advanced disease (55% compared with 67.4%). The false-negative rate per patient was zero in early-stage disease and 20% (1/5) in locally advanced disease (no significant difference). When the side of dissection was taken into account, the false-negative rate improved to 42.9% (3/7) in patients with locally advanced disease and remained at zero in early-stage disease (P=0.038). Isolated blue dye was taken up in 53.3% of SNs in patients with locally advanced disease, compared with only 6.4% in patients with early-stage disease. This study suggests that the SN biopsy technique with dual labeling is less accurate in locally advanced cervical cancer than in early-stage cervical cancer.

Interpretation of Magnetic Resonance Imaging for Locally Advanced Rectal Carcinoma After Preoperative Chemoradiation Therapy

Neoadjuvant concomitant chemoradiotherapy has been used in cases of locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. Preoperative staging is essential for planning and providing optimal therapy. The purpose of this study is to determine the accuracy of staging with magnetic resonance imaging and to define any factors that interfere in interpretation of images obtained after preoperative chemoradiation therapy. Thirty-six patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative concomitant 5-fluorouracil-based chemotherapy and radiation, followed six to eight weeks later by radical surgery. Preoperative magnetic resonance images were reinterpreted by one radiologist and the results compared with histopathologic staging. T-level downstaging occurred in 10 of 36 patients (28 percent), and N-level downstaging occurred in 29 of 36 patients (80 percent) after completion of chemoradiation therapy. Pathologic complete remission after chemoradiotherapy occurred in five patients (12 percent). Of the 36 patients, 17 (47 percent) were overstaged and 2 (6 percent) were understaged in T-level, whereas 10 patients (28 percent) were overstaged and 3 patients (8 percent) were understaged in N-level. The accuracy of magnetic resonance imaging for determining depth of wall invasion was 47 percent, with 64 percent accuracy for nodal staging. Magnetic resonance imaging is commonly used in staging of pelvic malignancies because of its fine resolution, but chemoradiotherapy may decrease its accuracy. Thickening of the rectal wall after radiation by marked fibrosis, and peritumoral infiltration of inflammatory cells and vascular proliferation may contribute to overestimation of stage. By contrast, pathologic residual cancer beneath normal mural structure after chemoradiation therapy may result in understaging of rectal cancer.

Concomitant chemo-radiotherapy with continuous infusion cisplatin and 5-fluoruracil in locally advanced cervical carcinoma (LACC): A single institution experience

5073 Background: The primary aim of this analysis was to evaluate the resecability of LACC (stage IIA-IIIB) and the relationship between downstaging, progression-free-survival (PFS) and overall survival (OS) after neoadjuvant concomitant chemo-radiotherapy (CT-RT). Secondary aim was the assessment of activity and tolerability of such approach. Methods: Pts affected by LACC were planned to receive 50.4 Gy external beam RT (EBRT, boost included) plus concomitant CT with cisplatin (DDP) 5 mg/m2/day i.v. and 5-fluorouracil (5FU) 200 mg/m2/day i.v., day 1–5, for scheduled 5 weeks. After restaging, patients not suitable for curative resection were treated with additional 25 Gy EBRT. Scheduled surgical procedures were radical hysterectomy plus pelvic lymphadenectomy (PIVER II/III), according to clinical response. Results: Forty-nine pts with LACC referred to our Institution; pts characteristics: median age 55 (range 32–78); stage IIA/IIB/IIIA/IIIB 3pts/34pts/2pts/9pts; squamous cell LACC/adenocarcinoma 45/4. Thirty-two pts (65.3%) received 4–5 weeks of concurrent CT-RT (median RT dose 50.4 Gy, range 46–57.6) and underwent surgical resection. Twelve pts obtained CR (37.4%, 95% CI 20.7–54.3), 14 pts PR (43.8%, 95% CI 26.6–60.9), and 6 pts NC (18.8%, 95% CI 5.2–32.3). Seventeen pts (34.7%) received additional 2–3 weeks of concurrent CT-RT (median RT dose 25 Gy) without surgery. Of these, 3 pts had RC (17.6%, 95% CI 0–35.8), 6 pts PR (35.3%, 95% CI 12.6–58), 4 pts NC (23.5%, 95% CI 3.4–43.7), 3 pts PD (17.6%, 95% CI 0–35.7), and 1 pts NV. No CTC Grade 4 toxicity was observed; only 3 pts had G3 diarrhea. At a median follow-up of 18 months (range 3–84), 5-yrs-PFS in all pts was 60.5%, and 5 yrs-OS 56.9%. Five-yrs PFS and survival rate were significantly greater in pts undergone surgery (respectively p=0.03 and p=0.0001). Conclusions: Neoadjuvant concurrent CT-RT is tolerable, active and affect resecability owing to tumor shrinking. Moreover, the data seems to indicate that curative surgery improves 5-yrs OS. No significant financial relationships to disclose.