Laboratory Blood Data Have a Significant Impact on Tumor Response and Outcome in Preoperative Chemoradiotherapy for Adva
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ORIGINAL ARTICLE
Laboratory Blood Data Have a Significant Impact on Tumor Response and Outcome in Preoperative Chemoradiotherapy for Advanced Rectal Cancer Koji Yasuda & Eiji Sunami & Kazushige Kawai & Hirokazu Nagawa & Joji Kitayama
Published online: 3 March 2011 # Springer Science+Business Media, LLC 2011
Abstract Introduction Although neoadjuvant chemoradiotherapy (CRT) is the standard treatment for advanced rectal cancer (RC), markers predicting response have not been adequately defined. Patients and Methods In 73 cases with advanced RC, we evaluated the tumor response with the reduction rate of the longitudinal size of RC using barium enema image taken before and after CRT. Then, we retrospectively examined the association with various blood values taken before CRT. The tumor size reduction rate was significantly greater in ten CR cases than in 63 non-CR cases (p1,800/mm3) had an independent association with disease-free survival. Conclusions Blood data have a major impact on the tumor response to CRT. Control of host condition may improve the effectiveness of CRT in advanced RC. Keywords Rectal cancer . Chemoradiation . Response . Hemoglobin . Platelet . Lymphocyte
K. Yasuda : E. Sunami : K. Kawai : H. Nagawa : J. Kitayama (*) Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113–8655, Japan e-mail: [email protected]
Introduction Preoperative chemoradiotherapy (CRT) is currently recognized as the standard treatment for locally advanced rectal cancer (RC). Many clinical studies have demonstrated that CRT can produce down-staging in approximately half of patients with advanced RC, resulting longer survival, a reduced rate of postoperative local recurrence, and a higher rate of sphincter-preserving surgery [1–3]. However, in unresponsive cases, it may have disadvantages such as delaying surgery or immune suppression therapy. Therefore, the selection of patients for preoperative CRT as well as accurate assessment of the tumor response after CRT is clinically important for improving the outcomes of the patients with advanced RC. In RC, tumor responses cannot be appropriately evaluated by the conventional RECIST method, because the sizes calculated using computed tomography (CT) images differ markedly among scanning slices. Previous reports have indicated that morphological studies using CT scanning [4] or magnetic resonance imaging (MRI) [5, 6] have only limited accuracy in assessing tumor responses. Recently, fluorodeoxyglucose-positron emission tomography (PET) combined with CT scanning [7]; [8] has been used to evaluate CRT, and improved accuracy has been noted. We evaluated rectal tumors employing the barium enema (BE) approach, which is useful for measuring the longitudinal dimension of these tumors. One of the first aims of this study was to assess the accuracy of this method for evaluating tumor responses to CRT. More importantly, it is still difficult to predict treatment outcomes due to the lack of appropriate markers predicting clinica
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