The combination of preoperative chemoradi-otherapy and surgery has become the standard treatment for locally advanced rectal cancer. Up to 30% of patients received pathologic complete response(pCR) after neoadjuvant therapy, for whom low rates of local recurrence and improved outcome after surgery were achieved. Given that, some authors have recommended local resection for clinical extensive response or non operative "wait and see" policy for clinical complete response(cCR) respectively, in which radical surgery-associated complication and dysfunction can be avoided. Current imaging can provide excellent accuracy in primary staging of rectal cancer, however, when used for restaging, the ability is less satisfactory, especially for pCR prediction, as a result of modification on tumor and surrounding tissue induced by neoadjuvant therapy. The question on how to identify patients with pCR before surgery has received more attention recently. On the basis of pathological findings after surgery, in this article, we review the reliability and predictive ability of current imaging for restaging and pCR after preoperative chemoradiotherapy in rectal cancer.
Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; pathology ; therapy ; Treatment Outcome

Neoadjuvant chemoradiation combined with radical surgery has been established as the standard care for locally advanced rectal cancer(T3-T4 and/or N1-N2). Approximately 20% patients who achieve complete pathological response have an improved prognosis. Appropriate patient selection may help avoid over-treatment. Evaluation of treatment response mostly with imaging study and pathology after neoadjuvant chemoradiation and following surgery is essential for the subsequent selection of treatment strategy.
Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Patient Selection ; Prognosis ; Rectal Neoplasms ; therapy

OBJECTIVETo analyze the association between the response of primary tumor to neoadjuvant chemoradiotherapy (CRT) and lymph node status in mid and low rectal cancer.

METHODSSeventy-one patients with locally advanced mid and low rectal cancer underwent preoperative CRT followed by surgery. Surgical specimens were examined by surgeons and pathologists to obtain more lymph nodes and the histological sections were examined. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to investigate the relationship between tumor regression and lymph node status.

RESULTSAll the patients completed the neoadjuvant CRT. Twelve patients achieved pathological complete response, of whom one was not operated and on surveillance. Pathological examination of the remaining 70 patients showed that the tumor was downstaged to T 0-2 group in 39 patients, among whom 5 patients (12.8%) had positive lymph nodes. Tumor was not downstaged in 31 patients, of whom 10 patients (32.3%) had positive nodes. The difference between the two groups was statistically significant (P=0.029).

CONCLUSIONTumor regression is consistent with the reduction of lymph node metastasis after preoperative CRT.

Chemoradiotherapy ; Humans ; Lymphatic Metastasis ; Neoadjuvant Therapy ; Rectal Neoplasms ; therapy

Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.
Asia ; Chemoradiotherapy ; Chemoradiotherapy, Adjuvant ; Europe ; Humans ; Neoadjuvant Therapy ; North America ; Prognosis ; Recurrence ; Stomach Neoplasms

OBJECTIVESTo investigate the regression pattern of mid and low rectal cancer treated with neoadjuvant chemoradiotherapy and then to provide the pathological proofs for reasonable resectional margin in rectal cancer surgery.

METHODSForty cases of mid and low rectal cancer patients received concurrent chemoradiotherapy and then underwent radical operation. The whole-mount serial sections of resected rectal cancer specimen were stained with cytokeratin antibody using immunohistochemical techniques to show the residual cancer cells under the mucosa. The microscopic measurement was performed to determine the reverse infiltration of cancer cells in the rectal wall and to describe the cancer cells scatter ways in the cancer mass. The Ki-67 immunohistochemical stain was also performed to show the proliferation activity of residual cancer cells after neoadjuvant chemoradiotherapy.

RESULTSThe length of specimen was shrinking continuously during the pathologic section production and the shrink rate was 18%. There were remanent cancer cells which showed positive Ki-67 expression and the chemoradiotherapy decreased the Ki-67 expression significantly. The lower edge of remaining ulcers or scars could be used as the reference point from which the cancer infiltration could be measured. According to our measurement, the average reverse infiltration of cancer cells in the whole-mount section was (6.1±4.7) mm, the deepest one was 11.0 mm in the section which could be converted into fresh bowel length of 12.98 mm. The pathology showed that the residual cancer cells scattered in the fibrous tissue of ulcers, scars and manifested a regression of spatial distribution.

CONCLUSIONSThe rectal cancers show regression in different degrees after neoadjuvant chemoradiotherapy. The residual cancer cells in the fiber tissues manifest proliferation activity. The distal end of resection should be at least 2 cm away from the lower edge of ulcers or scars of primary tumor in the rectal wall in patients after neoadjuvant chemoradiotherapy. The circumferential resection margin should include all the fibrous scar of the tumor area to ensure the remove of tumor cells completely.

Aged ; Chemoradiotherapy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Rectal Neoplasms ; pathology ; surgery ; therapy

The prognosis of patients with locally advanced esophageal cancer treated by surgery alone is poor. The neoadjuvant chemoradiotherapy is considered to improve the long-term survival of patients with locally advanced esophageal cancer. The combination of neoadjuvant chemoradiotherapy and surgery has been recommended to be the standard treatment for the locally advanced esophageal cancer in China even in Europe and America countries. However, available evidence suggests that only those who had histopathologic response seemed to benefit the most from neoadjuvant chemotherapy while non-responders even had rather worse outcome compared to patients with surgery alone. Therefore, predictive markers of response to neoadjuvant chemoradiotherapy in locally advanced esophageal cancer are highly significant and needed. These markers would allow a tailored treatment to guide non-responders to alternative preoperative therapies and ultimately avoid ineffective, costly and seriously cytotoxic treatments. Results of most studies on biomarkers for predicting response to neoadjuvant chemoradiotherapy in esophageal cancer are promising. The potential utilization of biomarkers in clinical practice is urgently expected and needed, which plays an important role in guiding and improving the individualization of multimodality therapy in locally advanced esophageal cancer.
Biomarkers, Tumor ; Chemoradiotherapy ; Esophageal Neoplasms ; drug therapy ; radiotherapy ; surgery ; Humans ; Neoadjuvant Therapy ; methods ; Treatment Outcome

Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for patients with locally advanced rectal cancer. Controversy on whether patients should receive radical surgery after pathological complete response (pCR) after neoadjuvant chemoradiotherapy has remained since pCR patients have shown favorable long-term outcome. Progress in multidisciplinary modalities has been made, including MRI, PET/CT imaging studies, genetic expression profiling, etc. The methods of predicting pCR response are inspiring. In this article, we review the methods for prediction and prognostic effect of pCR response when patients with locally advanced rectal cancer are treated with neoadjuvant chemoradiotherapy.
Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; therapy ; Remission Induction ; Treatment Outcome

Surgery is still the major treatment for esophageal cancer. It remains controversial, whether induction radiochemotherapy before resection can improve long-term survival for esophageal cancer patients. Researches have found that preoperative treatment only increases survival rates for patients who respond to induction therapy, but not for non-responders. Therefore, to identify the predictive biomarkers for induction therapy draw much attention. Although still far from satisfactory results, some have been obtained. Here, we summarize the potential biomarker candidates for reference.
Biomarkers ; Chemoradiotherapy ; Esophageal Neoplasms ; drug therapy ; Humans ; Neoadjuvant Therapy ; Survival Rate

INTRODUCTIONPreoperative chemoradiotherapy (CRT), followed by total mesorectal excision, has become the standard of care for patients with clinical stages II and III rectal cancer. Patients with pathologic complete response (pCR) to preoperative CRT have been reported to have better outcomes than those without pCR. However, the factors that predict the response to neoadjuvant CRT have not been well defined. In this study, we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.

METHODSA total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT, followed by curative surgery, between 2005 and 2013 were included. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR and non-pCR groups. The clinical parameters were analyzed by univariate and multivariate analyses, with pCR as the dependent variable.

RESULTSOf the 323 patients, 75 (23.2%) achieved pCR. The two groups were comparable in terms of age, sex, body mass index, tumor stage, tumor location, tumor differentiation, radiation dose, and chemotherapy regimen. On multivariate analysis, a pretreatment carcinoembryonic antigen (CEA) level of ≤ 5 ng/mL [odds ratio (OR) = 2.170, 95% confidence interval (CI) = 1.195-3.939, P = 0.011] and an interval of >7 weeks between the completion of chemoradiation and surgical resection (OR = 2.588, 95% CI = 1.484-4.512, P = 0.001) were significantly associated with an increased rate of pCR.

CONCLUSIONSThe pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR. These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.

Carcinoembryonic Antigen ; Chemoradiotherapy ; Humans ; Multivariate Analysis ; Neoadjuvant Therapy ; Prognosis ; Rectal Neoplasms ; Remission Induction ; Retrospective Studies

The concept that peri-operative treatment could improve long-term survival of esophageal cancer patients has been universally accepted, including radiation alone, chemotherapy alone, and chemoradiation. The most controversial therapy is perioperative chemotherapy. Here we review the published literatures for reference. The result shows that perioperative chemotherapy is effective for esophageal cancer patients, especially for the so-called chemo-sensitive patients, and the preferred delivering time is before surgery. According to the current data, it is still unclear whether the efficacy of neoadjuvant chemotherapy is inferior to that of neoadjuvant chemoradiation.
Chemoradiotherapy ; Esophageal Neoplasms ; drug therapy ; surgery ; Humans ; Neoadjuvant Therapy ; Survival Rate