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. 2022 Nov;37(11):2321-2333.
doi: 10.1007/s00384-022-04268-7. Epub 2022 Oct 15.

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

Junbing Chen #  1 , Zhouqiao Wu #  1 , Xiaoyan Zhang  2 , Zining Liu  3 , Yiding Wang  1 , Fei Shan  1 , Yinkui Wang  1 , Shaojun Xia  2 , Yan Zhang  1 , Yingshi Sun  2 , Jiafu Ji  1 , Ziyu Li  4
Affiliations

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

Junbing Chen et al. Int J Colorectal Dis. 2022 Nov.

Abstract

Purpose: Reassessment 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.

Methods: Altogether, 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.

Results: Overall, 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).

Conclusion: The 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.

Keywords: Magnetic resonance imaging; Neoadjuvant chemoradiation; Rectal cancer; Response reassessment; Wait and watch strategy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The study workflow. The 364 patients were included and 250 patients were eligible to be analyzed. Abbreviation: nCRT: neoadjuvant chemoradiation therapy; pCR: pathological complete response
Fig. 2
Fig. 2
The schematic overview. The locally advanced rectal cancer patients received routine multimodal therapy consisting of assessment, nCRT, response reassessment, surgery or wait-and-watch. The patients with predictive cCR were recommended to accept wait-and-watch strategy. Reassessment tools of response includes MRI, endoscopy, biopsy, clinical symptom, DRE, assay of blood. Abbreviation: nCRT: neoadjuvant chemoradiation; TTM: time to MRI; TTE: time to endoscopy; TTB: time to biopsy; TTC: time to clinical symptom; TTD: time to digital rectal examination; TTA: time to assay of blood; TTS: time to surgery
Fig. 3
Fig. 3
The receiving operating curve of reassessment tools. (A) The ROC and AUC of endoscopy; (B) the ROC and AUC of biopsy; (C) the ROC and AUC of endoscopy combined biopsy; (D) the ROC and AUC of the tools’ combination of endoscopy, biopsy, and MRI. Abbreviation: ROC: receiving operating curve; AUC: area under the curve
Fig. 4
Fig. 4
True or false prediction in different timing of response reassessment tools. The patients were divided into two groups including true and false prediction group by tools response reassessment outcomes. The two groups’ distribution in time interval to reassessment were shown separately, but there was no difference in two group as time analysis as a whole. The correlation of prediction of CR with the time to reassessment of (A) MRI, (B) Endoscopy, (C) Examination of symptom, (D) Biopsy, (E) DRE. The value “1” and “2” were the groups’ categorical variables. The value of “1” indicated “False Prediction” and “2” indicated “True Prediction.” The difference of distribution would show as timing longer than 100 days in biopsy. There was no any distribution difference in any timepoint in the reassessment of MRI, DRE and examination of symptom. The p value in detail was shown in Table 4. Abbreviation: CR: complete response; DRE: digital rectal examination
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References

    1. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467–1480. doi: 10.1016/S0140-6736(19)32319-0. - DOI - PubMed
    1. Jimenez-Fonseca P, Salazar R, Valenti V, Msaouel P, Carmona-Bayonas A. Is short-course radiotherapy and total neoadjuvant therapy the new standard of care in locally advanced rectal cancer? A sensitivity analysis of the RAPIDO clinical trial. Ann Oncol. 2022;33(8):786–793. doi: 10.1016/j.annonc.2022.04.010. - DOI - PubMed
    1. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study G Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–1740. doi: 10.1056/NEJMoa040694. - DOI - PubMed
    1. Jin J, Tang Y, Hu C, Jiang LM, Jiang J, Li N, Liu WY, Chen SL, Li S, Lu NN, Cai Y, Li YH, Zhu Y, Cheng GH, Zhang HY, Wang X, Zhu SY, Wang J, Li GF, Yang JL, Zhang K, Chi Y, Yang L, Zhou HT, Zhou AP, Zou SM, Fang H, Wang SL, Zhang HZ, Wang XS, Wei LC, Wang WL, Liu SX, Gao YH, Li YX. Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR) J Clin Oncol. 2022;40(15):1681–1692. doi: 10.1200/JCO.21.01667. - DOI - PMC - PubMed
    1. Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, Allen PK, Lynch PM, Glober G, Wolff R, Rich TA, Skibber J (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 44(5):1027–1038. 10.1016/s0360-3016(99)00099-1 - PubMed

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