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Cancers
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Neoadjuvant Therapy for Locally-Advanced Rectal Cancer
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Neoadjuvant Therapy for Locally-Advanced Rectal Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 2521

Special Issue Editors

Dr. Carlo Aschele

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Guest Editor
Medical Oncology—Department of Oncology, Ospedale Sant’Andrea, 19121 La Spezia, Italy
Interests: rectal cancer; colon cancer; gastrointestinal tumors
Dr. Francesca Negri

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Guest Editor
Gastroenterology and Endoscopy Unit, University Hospital of Parma, 43121 Parma, Italy
Interests: colon cancer; rectal cancer; angiogenesis; biomarker; precision medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Silvia Marchetti

E-Mail Website
Guest Editor
Medical Oncology—Department of Oncology, Ospedale Sant’Andrea, 19121 La Spezia, Italy
Interests: colorectal cancer; gastrointestinal tumors; precision medicine

Special Issue Information

Dear Colleagues,

Locally advanced rectal cancers (LARC) are the subject of a rapidly evolving treatment paradigm. For many years, the standard therapy has been concurrent chemo-radiotherapy or short-course radiotherapy alone, followed by surgery and adjuvant post-operative chemotherapy. An alternative strategy, known as total neoadjuvant therapy (TNT), incorporates chemotherapy before (induction) or after (consolidation) neoadjuvant radiotherapy prior to surgery. Recent data from two randomized controlled trials have shown that TNT improves treatment compliance and disease-free survival (DFS) and reduces the risk of distant metastases. TNT also results in higher rates of clinical complete response, favoring organ preservation, and potentially represents a platform for modulated and tailored treatment strategies.

However, significant challenges remain to be overcome. For clinical utility, there is a great need to define the optimal duration of TNT, optimal chemotherapy, and radiotherapy regimens, and particularly factors allowing patients’ selection. Despite the widespread enthusiasm for this strategy, TNT is indeed unlikely to represent the optimal treatment modality for every LARC patient. Clinical factors along with imaging-based, blood-based, tissue-based, and molecular biomarkers are being investigated that can assist clinicians before and during TNT to assess treatment efficacy. The introduction of immunotherapy and tailored therapies in LARC treatment program is also under active development.

Dr. Carlo Aschele
Dr. Francesca Negri
Dr. Silvia Marchetti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • rectal cancer
  • total neoadjuvant therapy
  • induction chemotherapy
  • consolidation chemotherapy
  • organ preservation
  • immunotherapy
  • prognostic biomarkers
  • predictive biomarkers

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Published Papers (2 papers)

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Research

14 pages, 4602 KiB  
Article
Outcome of Patients with Locally Advanced Rectal Cancer Pursuing Non-Surgical Strategy in National Cancer Database
by Hanna Kakish, Fasih A. Ahmed, Lee M. Ocuin, Jennifer L. Miller-Ocuin, Emily Steinhagen, Richard S. Hoehn, Amit Mahipal, Christopher W. Towe and Sakti Chakrabarti
Cancers 2024, 16(12), 2194; https://doi.org/10.3390/cancers16122194 - 11 Jun 2024
Viewed by 735
Abstract
Background: Survival data on patients with locally advanced rectal cancer (LARC) undergoing non-operative management (NOM) in a real-world setting are lacking. Methods: We analyzed LARC patients from the National Cancer Database with the following features: treated between 2010 and 2020, age 18–65 years, [...] Read more.
Background: Survival data on patients with locally advanced rectal cancer (LARC) undergoing non-operative management (NOM) in a real-world setting are lacking. Methods: We analyzed LARC patients from the National Cancer Database with the following features: treated between 2010 and 2020, age 18–65 years, Charlson comorbidity index (CCI) ≤ 1, received neoadjuvant multiagent chemotherapy plus radiation ≥ 45 Gray, and underwent surgery or NOM. Patients were stratified into two groups: (A) clinical T1-3 tumors with positive nodes (cT1-3N+) and (B) clinical T4 tumors, N+/− (cT4N+/−). We performed a comparative analysis of overall survival (OS) with NOM versus surgery by the Kaplan–Meier method and propensity score matching. Additionally, a multivariable analysis explored the association between NOM and OS. Results: NOM exhibited significantly lower OS than surgery in both groups. In cT1-3N+ patients, NOM resulted in a 5-year OS of 73.9% (95% confidence interval [CI] = 69.7–77.6%) versus 84.5% (95% CI = 83.6–85.3%) with surgery (p < 0.001). In the cT4N+/− group, NOM yielded a 5-year OS of 44.5% (95% CI = 37.0–51.8%) versus 72.5% (95% CI = 69.9–74.8%) with surgery (p < 0.001). Propensity score matching and multivariable analyses revealed similar conclusions. Conclusion: Patients with LARC undergoing NOM versus surgery in real-world settings appear to have inferior survival. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy for Locally-Advanced Rectal Cancer)
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18 pages, 2102 KiB  
Article
Patient-Relevant Costs for Organ Preservation versus Radical Resection in Locally Advanced Rectal Cancer
by Georg W. Wurschi, Alexander Rühle, Justus Domschikowski, Maike Trommer, Simone Ferdinandus, Jan-Niklas Becker, Simon Boeke, Mathias Sonnhoff, Christoph A. Fink, Lukas Käsmann, Melanie Schneider, Elodie Bockelmann, David Krug, Nils H. Nicolay, Alexander Fabian and Klaus Pietschmann
Cancers 2024, 16(7), 1281; https://doi.org/10.3390/cancers16071281 - 26 Mar 2024
Cited by 2 | Viewed by 1160
Abstract
Total neoadjuvant therapy (TNT) is an evolving treatment schedule for locally advanced rectal cancer (LARC), allowing for organ preservation in a relevant number of patients in the case of complete response. Patients who undergo this so-called “watch and wait” approach are likely to [...] Read more.
Total neoadjuvant therapy (TNT) is an evolving treatment schedule for locally advanced rectal cancer (LARC), allowing for organ preservation in a relevant number of patients in the case of complete response. Patients who undergo this so-called “watch and wait” approach are likely to benefit regarding their quality of life (QoL), especially if definitive ostomy could be avoided. In this work, we performed the first cost-effectiveness analysis from the patient perspective to compare costs for TNT with radical resection after neoadjuvant chemoradiation (CRT) in the German health care system. Individual costs for patients insured with a statutory health insurance were calculated with a Markov microsimulation. A subgroup analysis from the prospective “FinTox” trial was used to calibrate the model’s parameters. We found that TNT was less expensive (−1540 EUR) and simultaneously resulted in a better QoL (+0.64 QALYs) during treatment and 5-year follow-up. The average cost for patients under TNT was 4711 EUR per year, which was equivalent to 3.2% of the net household income. CRT followed by resection resulted in higher overall costs for ostomy care, medication and greater loss of earnings. Overall, TNT appeared to be more efficacious and cost-effective from a patient’s point of view in the German health care system. Full article
(This article belongs to the Special Issue Neoadjuvant Therapy for Locally-Advanced Rectal Cancer)
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