Research progress on response evaluation and prediction of neoadjuvant therapy for locally advanced rectal cancer_West China Medical Journal

Authors：

LIANG Yuwen ^1,2,3 ,  DU Xiaobo ^1,2,3

1. Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;
3. Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

DU Xiaobo, Email: duxiaobo2005@126.com

Keywords：

Rectal cancer; neoadjuvant therapy; response; assessment

DOI：

10.7507/1002-0179.202401286

Video：

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Abstract Full text Figures/Tables Video References Cited by

The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiotherapy combined with surgery, but patients after the same treatment regimen show a large difference in outcomes. For patients with good response to neoadjuvant therapy, the waiting & observation scheme can be selected to avoid surgery and other complications. Therefore, accurate assessment of the response of patients with locally advanced rectal cancer after neoadjuvant therapy can better develop personalized treatment strategies. Current studies have found that blood sample detection, endoscopy, imaging examination and artificial intelligence have their own advantages and disadvantages in evaluating the response of neoadjuvant therapy. Therefore, this article reviews the application of different clinical tools in evaluating and predicting the response of neoadjuvant therapy for locally advanced rectal cancer, and looks forward to the future development direction.

Citation： LIANG Yuwen, DU Xiaobo. Research progress on response evaluation and prediction of neoadjuvant therapy for locally advanced rectal cancer. West China Medical Journal, 2024, 39(5): 825-832. doi: 10.7507/1002-0179.202401286 Copy

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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Ali F, Keshinro A, WEISER MR. Advances in the treatment of locally advanced rectal cancer. Ann Gastroenterol Surg, 2021, 5(1): 32-38.
3. Lee M, Gibbs P, Wong R. Multidisciplinary management of locally advanced rectal cancer--an evolving landscape?. Clin Colorectal Cancer, 2015, 14(4): 251-261.
4. Nacion AJD, Park YY, Kim NK. Contemporary management of locally advanced rectal cancer: resolving issues, controversies and shifting paradigms. Chin J Cancer Res, 2018, 30(1): 131-146.
5. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol, 2006, 24(28): 4620-4625.
6. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med, 2006, 355(11): 1114-1123.
7. 中国直肠癌新辅助治疗后等待观察数据库研究协作组, 中国医师协会外科医师分会中国医师协会肛肠医师分会, 中华医学会外科学分会结直肠外科学组, 等. 直肠癌新辅助治疗后等待观察策略专家共识(2020 版). 中华胃肠外科杂志, 2020, 23(1): 1-9.
8. Vecchio FM, Valentini V, Minsky BD, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys, 2005, 62(3): 752-760.
9. Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol, 2005, 23(34): 8688-8696.
10. Glynne-Jones R, Glynne-Jones S. The concept and use of the neoadjuvant rectal score as a composite endpoint in rectal cancer. Lancet Oncol, 2021, 22(7): e314-e326.
11. Cui CL, Luo WY, Cosman BC, et al. Cost effectiveness of watch and wait versus resection in rectal cancer patients with complete clinical response to neoadjuvant chemoradiation. Ann Surg Oncol, 2022, 29(3): 1894-1907.
12. Dossa F, Chesney TR, Acuna SA, et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 2017, 2(7): 501-513.
13. Aires F, Rodrigues D, Lamas MP, et al. C-reactive protein as predictive biomarker for response to chemoradiotherapy in patients with locally advanced rectal cancer: a retrospective study. Cancers (Basel), 2022, 14(3): 491.
14. Das P, Skibber JM, Rodriguez-Bigas MA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer, 2007, 109(9): 1750-1755.
15. Ravenda P, Gregato G, Rotundo M, et al. P-300-predictive value of circulating tumor-derived DNA (ctDNA) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CT-RT): preliminary results. Annals of Oncology, 2018(Suppl 5): v85.
16. Kim HJ, Choi GS, Park JS, et al. Clinical significance of thrombocytosis before preoperative chemoradiotherapy in rectal cancer: predicting pathologic tumor response and oncologic outcome. Ann Surg Oncol, 2015, 22(2): 513-519.
17. Tawfik B, Mokdad AA, Patel PM, et al. The neutrophil to albumin ratio as a predictor of pathological complete response in rectal cancer patients following neoadjuvant chemoradiation. Anticancer Drugs, 2016, 27(9): 879-883.
18. Berardi R, Braconi C, Mantello G, et al. Anemia may influence the outcome of patients undergoing neo-adjuvant treatment of rectal cancer. Ann Oncol, 2006, 17(11): 1661-1664.
19. Hammarström S. The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Semin Cancer Biol, 1999, 9(2): 67-81.
20. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(Suppl 4): iv22-iv40.
21. Engel RM, Oliva K, Koulis C, et al. Predictive factors of complete pathological response in patients with locally advanced rectal cancer. Int J Colorectal Dis, 2020, 35(9): 1759-1767.
22. Song J, Huang X, Chen Z, et al. Predictive value of carcinoembryonic antigen and carbohydrate antigen 19-9 related to downstaging to stage 0-Ⅰ after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Cancer Manag Res, 2018, 10: 3101-3108.
23. Heo J, Chun M, Noh OK, et al. Sustaining blood lymphocyte count during preoperative chemoradiotherapy as a predictive marker for pathologic complete response in locally advanced rectal cancer. Cancer Res Treat, 2016, 48(1): 232-239.
24. Yeo SG, Kim DY, Kim TH, et al. Carbohydrate antigen 19-9 levels associated with pathological responses to preoperative chemoradiotherapy in rectal cancer. Asian Pac J Cancer Prev, 2014, 15(13): 5383-5387.
25. Yang J, Ling X, Tang W, et al. Analyses of predictive factors for pathological complete remission in neoadjuvant therapy for locally advanced rectal cancer. J BUON, 2019, 24(1): 77-83.
26. Cheong C, Shin JS, Suh KW. Prognostic value of changes in serum carcinoembryonic antigen levels for preoperative chemoradiotherapy response in locally advanced rectal cancer. World J Gastroenterol, 2020, 26(44): 7022-7035.
27. Dayde D, Tanaka I, Jain R, et al. Predictive and prognostic molecular biomarkers for response to neoadjuvant chemoradiation in rectal cancer. Int J Mol Sci, 2017, 18(3): 573.
28. Jang NY, Kang SB, Kim DW, et al. The role of carcinoembryonic antigen after neoadjuvant chemoradiotherapy in patients with rectal cancer. Dis Colon Rectum, 2011, 54(2): 245-252.
29. Choi E, Kim JH, Kim OB, et al. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: a single center experience. Radiat Oncol J, 2016, 34(2): 106-112.
30. Huang CM, Huang CW, Ma CJ, et al. Predictive value of FOLFOX-based regimen, long interval, hemoglobin levels and clinical negative nodal status, and postchemoradiotherapy CEA levels for pathological complete response in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy. J Oncol, 2020, 2020: 9437684.
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Research progress on response evaluation and prediction of neoadjuvant therapy for locally advanced rectal cancer

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