Project details


Predictors of pathologic complete response after neoadjuvant chemoradiotherapy for rectal cancer

colorectal cancer neoadjuvant chemoradiotherapy pathological complete response

F.J. van der Sluis
H.L. van Westreenen

Type of project:
Stage Wetenschap / Research project

Nature of the research:
retrospective cohort study

Fields of study:
surgery oncology

Background / introduction
The treatment of locally advanced rectum carcinoma has changed fundamentally in the past decades. Historically treatment consisted of surgery according to total mesorectal excision principles. More recently advances in neoadjuvant therapy have demonstrated beneficiary effects on local control and possibly survival. Through these developments, the standard of care for locally advanced rectum carcinoma has become a multimodality treatment.
Current conventional fractionation neoadjuvant chemoradiotherapy (nCRT) protocols have demonstrated high pathologic complete response (pCR) rates ranging between 14 and 25%. In turn pCR has been associated with fewer local recurrences and an improved five years survival. These favorable results have raised the question whether radical surgery related morbidity can be avoided in patients that are likely to have pCR. In selected patients a watch and wait approach might be feasible provided that the risk on local recurrence is low and recurrent disease is detected at an early stage.
Before incorporating strategies that avoid radical surgery as standard practice a clear description of patient selection criteria is needed.
In order to adequately select patients that might benefit from more conservative treatment a reliable prediction should be made whether the individual patient is likely to have a complete response after nCRT.
Research question / problem definition
To identify a set of independent predictors for pCR in patients after nCTR for rectal cancer that might aid in the decision whether to perform radical surgery or adept a more conservative approach. Furthermore; to assess the relation between pCR and surgery related complications like anastomotic leakage.
Week 0 - 1 inlezen
Week 1 – 2 bekend raken met de database, exact definiëren van parameters
Week 3 – 10 database controleren dubbele patiënten, aanvullen missende parameter
waarden, aanvullen database met evt nieuwe in week 2 gedefinieerde parameters.
Week 11 - 14 data analyse
Week 15 - 16; resultaten opschrijven
Week 17 - 20; afronding, verslag schrijven
Roh MS, Colangelo LH, O'Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009; 27(31): 5124-30.

O'Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM. Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 2007; 8(7): 625-33.

Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010; 11(9): 835-44.

Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Annals of surgery 2004; 240(4): 711-7; discussion 7-8.
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