Dataset Information

Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study.

ABSTRACT:

Introduction

Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC.

Method

Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed.

Results

The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively.

Conclusions

nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.

SUBMITTER: Liu H

PROVIDER: S-EPMC7658521 | biostudies-literature | 2020 Jan-Dec

REPOSITORIES: biostudies-literature

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Publications

Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study.

Liu Hengchang H Li Chunxiang C Zhao Zhixun Z Guan Xu X Yang Ming M Liu Zheng Z Tang Yuan Y Jiang Zheng Z Wang Xishan X

Technology in cancer research & treatment 20200101

<h4>Introduction</h4>Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC.<h4>Method</h4>Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients wer ...[more]

PMID: 33161830

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Project description:BackgroundPatients with locally advanced rectal cancer (LARC) have an improved prognosis if achieved a pathological complete response (pCR) on account of neoadjuvant chemoradiation therapy (nCRT). However, the proportion of patients achieving pCR is only 8-24%. The purpose of this study was to explore whether the addition of consolidation chemotherapy to nCRT could improve pCR rate in patients with LARC.Materials and methodsThe subjects were 144 individuals with clinical stage II (T3-4, N0) or III (any T, N1-2) LARC who had received neoadjuvant CRT followed by total mesorectal excision (TME). Eighty-three patients in the consolidation chemotherapy group received two cycles XELOX between CRT and TME, while 61 patients in the standard treatment group without consolidation chemotherapy. The pCR (ypT0N0), tumor downstaging (ypT0-2N0) after TME and adverse events (AEs) during and post treatment were compared between the treatment groups using multivariable logistic regression analysis. To adjust the unbalanced variables for the primary endpoint, logistic regression analysis and stratified analysis were performed.ResultsThe consolidation chemotherapy group improved pCR rate (19.3% vs 4.9%, p = 0.01) and tumor downstaging rate (45.8% vs 24.6%, p = 0.009) compared to the standard treatment group. After adjustment for clinical tumor stage, clinical nodal stage and time interval to surgery, patients with consolidation chemotherapy were more likely to reach pCR (adjusted odds ratio 4.91, 95% CI [1.01-23.79], p = 0.048). AEs during and post treatment in the two groups were 54.1% vs 49.3% (p = 0.57), respectively. In addition, the incidence of any grade 1-2 AEs in the two groups was 93.4% vs 95.1% (p = 0.93), while the incidence of grade 3 AEs was 1.6% versus 2.4% (p = 0.74), respectively. No grade 4 AEs occurred in two groups.ConclusionsThe addition of neoadjuvant consolidation chemotherapy after CRT significantly increased the pCR rate and did not increase the AEs during and post treatment and in patients with LARC.

Project description:Locally advanced rectal cancer (LARC) exhibits heterogeneous responses to neoadjuvant chemoradiotherapy (nCRT), patients resistant to nCRT failing to benefit from to nCRT. The aim of this pilot study is to identify proteins associated with LARC nCRT-resistance. This pilot study retrospectively enrolled 4 representative nCRT-resistant (stable disease/progressive disease) and 4 nCRT-sensitive (complete response/partial response) patients, of which a total of 15 formalin-fixed paraffin-embedded tumor tissues (before and after nCRT) were subjected to data-independent acquisition mass spectrometry for proteomic analysis. Spectronaut software was employed for protein identification and quantification. Principal component analysis (PCA) was used to visualize intergroup differences in detected proteins. Differently abundant proteins in resistant patients (fold change ≥ 1.2 or ≤ 0.83 compare to sensitive patients) were selected for analysis using hierarchical clustering, cluster of orthologous groups, subcellular location, gene ontology, and pathway enrichment assay. A total of 39052 peptides and 6006 proteins were identified. PCA showed PCA clear separation among four groups: pre-treatment sensitive (B_S), pre-treatment resistant (B_R), post-treatment sensitive (P_S), and post-treatment resistant (P_R). Intergroup comparisons revealed before nCRT, 133 proteins were upregulated in the resistant group compared to the sensitive group, mainly localized in cytoplasm (33.08%), secreted (24.81%), and nucleus (24.06%), with functions enriched in cell junctions and metabolic related pathways. Post nCRT, 290 proteins were upregulated in the resistant group compared to the sensitive group, mainly localized in the nucleus (36.55%) and cytoplasm (23.10%), with functions enriched in replication, transcription, translation, and metabolic pathways. This study characterized DAP signatures of LARC with nCRT resistance, specific DAPs in resistant tumor provide references for mechanistic studies on treatment resistance, could be potential biomarker for response and therapeutic targets after further validation in larger cohorts.

Dataset Information

Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study.

Introduction

Method

Results

Conclusions

Publications

Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study.

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