Tumor proliferation in rectal cancer following preoperative irradiation.

1995 ◽  
Vol 13 (6) ◽  
pp. 1417-1424 ◽  
Author(s):  
C G Willett ◽  
G Warland ◽  
M P Hagan ◽  
W J Daly ◽  
J Coen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Proliferative Activity ◽  
Rectal Wall ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Nuclear Antigen ◽  
High Dose ◽  
Preoperative Irradiation ◽  
Tumor Proliferation ◽  
Ki 67

PURPOSE This study examines the effect of preoperative irradiation on tumor proliferation in rectal cancer. PATIENTS AND METHODS One hundred twenty-two patients with locally advanced rectal cancer received 45 to 50 Gy of preoperative irradiation followed by surgery. Pretreatment tumor biopsies and postirradiation surgical specimens were scored for proliferative activity by assaying the extent of Ki-67 and proliferating-cell nuclear antigen (PCNA) immunostaining and the number of mitoses per 10 high-power fields (hpf). Preirradiation and postirradiation proliferative activity was determined and correlated to clinical outcome. RESULTS There was an overall reduction in the tumor proliferative activity of rectal cancer after irradiation compared with its preirradiation state. Decreases in the activity of all three markers of tumor proliferation (Ki-67 and PCNA immunostaining, and mitotic counts) were observed in irradiated tumors compared with pretreatment biopsies. Postirradiation tumor proliferative activity was associated with pathologic tumor stage. A high level of proliferative activity was observed in tumors downstaged to the rectal wall (T1-2) compared with tumors that retained transmural penetration (T3-4). Multivariate analysis indicated that postirradiation proliferative activity and stage were independently associated with survival following surgery. Patients with tumors that exhibited elevated proliferative activity postirradiation had improved survival compared with patients with tumors that showed less proliferative activity. CONCLUSION Moderate- to high-dose preoperative irradiation decreases both the tumor size and proliferative activity of rectal cancers. Elevated postirradiation tumor proliferative activity correlates strongly with improved survival. This may aid in identifying high-risk patients following preoperative irradiation and surgery.

Proliferating cell nuclear antigen and mitotic activity in rectal cancer: predictor of response to preoperative irradiation.

1994 ◽  
Vol 12 (4) ◽  
pp. 679-682 ◽  
Author(s):  
C G Willett ◽  
G Warland ◽  
R Cheek ◽  
J Coen ◽  
J Efird ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Mitotic Activity ◽  
Proliferating Cell Nuclear Antigen ◽  
Residual Disease ◽  
Tumor Regression ◽  
Rectal Wall ◽  
Clinical Stage ◽  
Nuclear Antigen ◽  
Preoperative Irradiation ◽  
Proliferating Cell

PURPOSE This study examines the association between the pathologic response of rectal cancer after irradiation and its pretreatment proliferative state as assayed by proliferating cell nuclear antigen (PCNA) and mitotic activity. PATIENTS AND METHODS Ninety patients with clinical stage T3 and T4 rectal cancer received preoperative irradiation followed by surgery. Pretreatment tumor biopsies were scored for PCNA activity (number of tumor cells staining immunohistochemically with an anti-PCNA monoclonal antibody) and the number of mitoses per 10 high-powered fields (hpf). Postirradiation surgical specimens were examined for extent of residual disease. RESULTS The tumors of 33 of 90 patients (37%) exhibited marked pathologic downstaging (no residual tumor or cancer confined to the rectal wall) after preoperative irradiation. Two features were independently associated with the likelihood of marked pathologic regression after preoperative irradiation: lesion size and PCNA/mitotic activity. When stratified by tumor size, marked tumor regression occurred most frequently in smaller tumors with high PCNA/mitotic activity compared with larger tumors with lower PCNA/mitotic activity. Intermediate downstaging rates were seen for small or large tumors with moderate PCNA/mitotic activity. CONCLUSION Tumor PCNA/mitotic activity predicts the likelihood of response to irradiation, which may aid in formulating treatment policies for patients with rectal cancer.

Analysis of fiducials implanted during endoscopic ultrasound (EUS) for locally advanced rectal cancer patients receiving high-dose rate endorectal brachytherapy (Endo-HDR).

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 655-655
Author(s):  
Shalini Moningi ◽  
Ashkan Malayeri ◽  
Susan Gearhart ◽  
Jonathan Efron ◽  
Elizabeth C. Wick ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Dose Rate ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
High Dose Rate ◽  
High Dose ◽  
The Mean

655 Background: Rectal cancer affects over 40,000 patients in the US per year. The current standard of care for patients with localized rectal cancer is neoadjuvant radiation therapy with concurrent chemotherapy (NCRT) followed by surgery; however, it has shown no proven survival benefit for locally advanced rectal cancer patients. Preliminary results show that a short course of radiation therapy, using high-dose rate endorectal brachytherapy (Endo-HDR), may be as effective with less toxicity and delay to time of surgery. This requires the placement of fiducial markers, using an endoscopic ultrasound guided method (EUS), into the tumor for accurate source placement and treatment. Our aim is to compare three different types of fiducials in terms of visibility and migration. Methods: 12 patients with locally advanced rectal cancer that received Endo-HDR and EUS guided fiducial placement were retrospectively evaluated at JHH. Results: 12 patients underwent EUS guided placement of 42 fiducials. For 11 of our 12 patients, the mean number of fiducials placed per patient was 3.63 (SD 1.03) using a 19-gauge needle. One patient received 2 fiducials using a 22- gauge needle. Of the 12 patients that received fiducials, 3 received traditional fiducials (TF), 8 received segmented fiducials (SF) and 1 received foldable fiducials. All fiducials were clearly visible. The mean number of fiducials that detached from implanted site before surgery for patients with TFs was 0.667, and for patients with SFs was 0.875 (p=0.744). The median migration distance, as measured by interfiduciary distance, for segmented fiducials was significantly larger when compared to traditional fiducials (0.45 cm for SF compared to 0.1 cm for TF; p=0.049) Conclusions: SFs appear to be less stable, with regards to migration, in the rectum when compared to traditional fiducials in our patient population. These differences could be due to placement difficulty or operator dependent differences. Improvement in fiducial structure is required in order to help decrease migration and detachment and maximize visualization, which will lead to more accurate administration of Endo-HDR.

Preoperative endorectal high-dose-rate brachytherapy: Pathologic downstaging in locally advanced rectal cancer

Brachytherapy ◽  
2009 ◽  
Vol 8 (2) ◽  
pp. 133
Author(s):  
Maged Ghaly ◽  
Jenny Li ◽  
Kenneth Satchwill ◽  
Donna Serviss ◽  
Carol Giorello ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Dose Rate ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
High Dose Rate ◽  
High Dose ◽  
High Dose Rate Brachytherapy
Sign in / Sign up

Export Citation Format

Share Document