Consolidation chemotherapy during neoadjuvant chemoradiation (CRT) for distal rectal cancer leads to sustained decrease in tumor metabolism when compared to standard CRT regimen

Imagem de Miniatura
Arquivos
art_HABR-GAMA_Consolidation_chemotherapy_during_neoadjuvant_chemoradiation_CRT_for_distal_2016.PDF (2.75 MB)
Citações na Scopus
41
Tipo de produção
article
Data de publicação
2016
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BIOMED CENTRAL LTD
Autores
JULIAO, Guilherme P. Sao
PROSCURSHIM, Igor
FERNANDEZ, Laura M.
FIGUEIREDO, Marleny N.
Citação
RADIATION ONCOLOGY, v.11, article ID 24, 8p, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Neoadjuvant CRT may lead to significant tumor regression in patients with rectal cancer. Different CRT regimens with consolidation chemotherapy may lead to increased rates of complete tumor regression. The purpose of this study was to understand tumor metabolic activity following two different neoadjuvant CRT regimens using sequential PET/CT imaging in two different intervals following RT. Methods: Patients with cT2-4 N0-2 M0 rectal cancer treated by standard CRT (54Gy and 2 cycles of 5FU-based chemotherapy) or extended CRT (54Gy and 6 cycles of 5FU-based chemotherapy) underwent sequential PET/CT imaging at baseline, 6 weeks and 12 weeks from radiation completion. Results: 99 patients undergoing standard CRT were compared to 12 patients undergoing CRT with consolidation chemotherapy. Patients treated with consolidation CRT had increased rates of complete clinical or pathological response (66 % vs. 23 %; p < 0.001). SUVmax variation between baseline and 6 weeks (88 % vs. 63 %; p < 0.001) and between baseline and 12 weeks (90 % vs. 57 %; p < 0.001) were significantly more pronounced among patients undergoing extended CRT with consolidation chemotherapy. An increase in SUVmax between 6 and 12 weeks was observed in 51 % of patients undergoing standard and 18 % of patients undergoing consolidation CRT (p = 0.04). Conclusions: Most of the reduction in tumor metabolism after neoadjuvant CRT occurs within the first 6 weeks from RT completion. In patients undergoing CRT with consolidation chemotherapy, tumors are less likely to regain metabolic activity between 6 and 12 weeks. Therefore, assessment of tumor response may be safely postponed to 12 weeks in patients undergoing extended CRT with consolidation chemotherapy.
Palavras-chave
Rectal cancer, Neoadjuvant chemoradiation, Consolidation chemotherapy, PET/CT, Response assessment
URI
https://observatorio.fm.usp.br/handle/OPI/13926
Referências
  1. Maas M, 2011, J CLIN ONCOL, V29, P4633, DOI 10.1200/JCO.2011.37.7176
  2. Perez RO, 2012, CANCER-AM CANCER SOC, V118, P3501, DOI 10.1002/cncr.26644
  3. Habr-Gama A, 2009, DIS COLON RECTUM, V52, P1927, DOI 10.1007/DCR.0b013e3181ba14ed
  4. Perez RO, 2012, INT J RADIAT ONCOL, V84, P1159, DOI 10.1016/j.ijrobp.2012.01.096
  5. Habr-Gama A, 2004, ANN SURG, V240, P711, DOI 10.1097/01.sla.0000141194.27992.32
  6. Cascini GL, 2006, J NUCL MED, V47, P1241
  7. Guillem JG, 2004, J AM COLL SURGEONS, V199, P1, DOI 10.1016/j.jamcollsurg.2004.02.024
  8. Capirci C, 2009, INT J RADIAT ONCOL, V74, P1461, DOI 10.1016/j.ijrobp.2008.10.064
  9. Maas M, 2010, LANCET ONCOL, V11, P835, DOI 10.1016/S1470-2045(10)70172-8
  10. Lambrecht M, 2010, ACTA ONCOL, V49, P956, DOI 10.3109/0284186X.2010.498439
  11. Smith JD, 2012, ANN SURG, V256, P965, DOI 10.1097/SLA.0b013e3182759f1c
  12. Habr-Gama A, 2013, DIS COLON RECTUM, V56, P1109, DOI 10.1097/DCR.0b013e3182a25c4e
  13. Perez RO, 2014, TECH COLOPROCTOL, V18, P699, DOI 10.1007/s10151-013-1113-9
  14. Kristiansen C, 2008, DIS COLON RECTUM, V51, P21, DOI 10.1007/s10350-007-9095-1
  15. Habr-Gama A, 2010, DIS COLON RECTUM, V53, P1692, DOI 10.1007/DCR.0b013e3181f42b89
  16. Melton GB, 2007, J GASTROINTEST SURG, V11, P961, DOI 10.1007/s11605-007-0170-7
  17. Garcia-Aguilar J, 2015, LANCET ONCOL, V16, P957, DOI 10.1016/S1470-2045(15)00004-2
  18. Sanghera P, 2008, CLIN ONCOL-UK, V20, P176, DOI 10.1016/j.clon.2007.11.013
  19. Sauer R, 2012, J CLIN ONCOL, V30, P1926, DOI 10.1200/JCO.2011.40.1836
  20. Sauer R, 2004, NEW ENGL J MED, V351, P1731, DOI 10.1056/NEJMoa040694
  21. Martoni AA, 2011, ANN ONCOL, V22, P650, DOI 10.1093/annonc/mdq433
  22. Smith FM, 2010, BRIT J SURG, V97, P1752, DOI 10.1002/bjs.7251
  23. Habr- Gama A, 2004, ANN SURG, V240, P7
  24. Melton GB, 2007, J GASTROINTEST SURG, V11, P9

Coleções
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - FM/MDR
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/43
Artigos e Materiais de Revistas Científicas - ODS/03