Neoadjuvan tedavi alan rektum kanseri hastalarında tedavi yanıtını predikte eden parametreler var mı?

Öz

Amaç Lokal ileri rektum kanserlerinde neoadjuvan kemoradyoterapi(NAKRT) standart hale gelmiş olup patolojik tam yanıt (pCR) alınan hastalarda cerrahi yapılmadan izlem seçeneği tartışılmaktadır. Bu çalışmada NAKRT’ye yanıtı predikte edecek faktörleri araştırmayı amaçladık. Materyal ve metod 2011-2021 yılları arasındaki 18 yaş üstü rektum kanseri tanılı 184 hasta retrospektif olarak tarandı. Histopatolojik olarak rektum kanseri olduğu konfirme edilen ve lokal ileri evre olup neoadjuvan tedavi alan 79 hasta mevcuttu. 18 hasta çalışma dışı bıraklıdı, çalışmaya 61 hasta dahil edildi. TNM evrelemesi pelvik MRG (manyetik rezonans görüntüleme) ile yapıldı. Prediktif faktörleri belirlemek için SPSS’de lojistik regresyon modeli kullanıldı. Bulgular Çalışmaya 61 hasta dahil edildi. Median yaş 45 (44-89) idi. Hastaların 42(%68.9) si erkek idi. Klinik T evresi 34 (%55.7) hastada T3 ve 23 (%37.7) hastada T4 idi. Klinik N evresi 0, 1 ve 2 olan hastaların sayısı sırasıyla 5(%8.2), 28(%45.9) ve 28(%45.9) idi. Ortalama CEA(karsinoembriyojenik antijen) ve CA 19-9 değerleri sırasıyla 9.69 (std. Deviation:14.95) ve 12.32 (std. Deviation:12.61) idi. 49 (%80.3) hasta kapesitabin eşliğinde, 12 hasta 5-FU(5-Fluorourasil) eşliğinde RT(Radyoterapi) aldı. 40 (%65.6) hastaya LAR(Low anterior rezeksiyon) yapılmıştı. 57 (%93.4) hastanın patolojisi adenokarsinom idi. Patolojik yanıt durumuna bakıldığında 8 (%13.1) hastada tam yanıt ve 48 (%78.7) hastada kısmi yanıt varken 5 (%8.2) hasta tedaviye yanıtsız olarak görüldü. Sonuç Bazı çalışmalarda NAKRT ile tedavi yanıtını predikte edecek birtakım faktörler olduğu belirtilmiş olsa da henüz kılavuzlara yansımış ortak kabul edilmiş parametreler yoktur. Bizim çalışmamızda değerlendirilen parametreler arasında patolojik tam yanıtı predikte eden bağımsız bir faktör bulunamadı. ‘Neoadjuvan tedavi alan rektum kanseri hastalarında tedavi yanıtını predikte eden parametreler var mı?’ sorusuna cevap verecek daha çok sayıda ileri araştırmaya ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• kanser;
• kemoterapi;
• rektum

Is there any parameter for predicting tumur respose following neoadjvant chemoredaiotherapy for patients with rectal cancer?

Öz

Aim Nonoperative management of rectal cancer is an emerging treatment approach; neoadjuvant chemoradiotherapy (nCRT) has become the standard treatment for locally advanced rectal cancer. The aim of the present research was to examine the parameters that could better understand the response to nCRT for patients with rectal cancer. Material and Methods This is a retrospective study which enrolled 184 patients diagnosed with rectal cancer 2011-2021; only 79 of them received nCRT and 18 patients were excluded from the analysis. TNM staging of rectal cancer made by pelvic magnetic resonance imaging. Logistic regression models are used to evaluate predictor variables. Results Sixty one patients were included in the final analysis and 68.9% were males with a median age of 45 (44-89) years. T-stage 3 and 4 were: 34 (55.7%) and 23 (37.7%), respectively. The majority of patients had N-stage 1 (45.9%) and N-stage 2 (45,9%) disease at presentation. Median carcinoembryonic antigen level was 9.69±14.95 ng/mL whereas cancer antigen 19-9 level was 12.32±12.61 U/mL. Forty nine (80.3%) patients received concurrent capecitabine with preoperative radiation therapy. Patients undergoing low anterior resection were 40 (65.6%). Eight (13.1%) patients had a pathologic complete response (pCR) while the incomplete response group consisted of 48 (78.7%) patients and no response group had only 5 (8.2%) patients. Conclusion Although some studies have stated that there are some factors that will predict the treatment response with NACRT, there are no commonly accepted parameters reflected in the guidelines yet. No independent factor predicting pathological complete response was found among the parameters evaluated in our study.. Further research is needed to address the following question; is there any parameter for predicting tumour response following nCRT for patients with rectal cancer?

Anahtar Kelimeler

• predictors of treatment response in rectal cancer?
• predictors of treatment response in rectal cancer?

Kaynakça

1. 1. Yoon WH, Kim HJ, Kim CH, Joo JK, Kim YJ, Kim HR. Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer. Ann Surg Treat Res. 2015 Jan;88(1):15-20. PubMed PMID: 25553320. Pubmed Central PMCID: PMC4279989. Epub 20141226.
2. 2. Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014 May 20;32(15):1554-62. PubMed PMID: 24752056. Epub 20140421.
3. 3. Petrelli F, Trevisan F, Cabiddu M, Sgroi G, Bruschieri L, Rausa E, et al. Total Neoadjuvant Therapy in Rectal Cancer: A Systematic Review and Meta-analysis of Treatment Outcomes. Ann Surg. 2020 Mar;271(3):440-8. PubMed PMID: 31318794.
4. 4. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017;28(suppl_4):iv22-iv40.
5. 5. Li M, Xiao Q, Venkatachalam N, Hofheinz RD, Veldwijk MR, Herskind C, et al. Predicting response to neoadjuvant chemoradiotherapy in rectal cancer: from biomarkers to tumor models. Ther Adv Med Oncol. 2022;14:17588359221077972. PubMed PMID: 35222695. Pubmed Central PMCID: PMC8864271. Epub 20220221.
6. 6. Yilmaz Rakici S, Bedir R, Hatipoglu C. Are there predictors that can determine neoadjuvant treatment responses in rectal cancer? Turk J Gastroenterol. 2019 Mar;30(3):220-7. PubMed PMID: 30459135. Pubmed Central PMCID: PMC6428507.
7. 7. Fischer J, Eglinton TW, Frizelle FA. Clinical predictors of response to chemoradiotherapy for rectal cancer as an aid to organ preservation. ANZ J Surg. 2021 Jun;91(6):1190-5. PubMed PMID: 33404195. Epub 20210106.
8. 8. Al-Sukhni E, Attwood K, Mattson DM, Gabriel E, Nurkin SJ. Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. Ann Surg Oncol. 2016 Apr;23(4):1177-86. PubMed PMID: 26668083. Pubmed Central PMCID: PMC5295136. Epub 20151214.

9. 9. Shao K, Zheng R, Li A, Li X, Xu B. Clinical predictors of pathological good response in locally advanced rectal cancer. Radiat Oncol. 2021 Jan 13;16(1):10. PubMed PMID: 33436026. Pubmed Central PMCID: PMC7805032. Epub 20210113.
10. 10. Malekzadeh Moghani M, Alahyari S, Moradi A, Nasiri M. Pathological Predictors of Response to Neoadjuvant Treatment in Rectal Carcinoma. J Gastrointest Cancer. 2021 Jun;52(2):690-5. PubMed PMID: 32643115.