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Predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review
Author(s) -
Ryan J. E.,
Warrier S. K.,
Lynch A. C.,
Ramsay R. G.,
Phillips W. A.,
Heriot A. G.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13207
Subject(s) - medicine , colorectal cancer , chemoradiotherapy , neoadjuvant therapy , pathological , complete response , oncology , medline , radiation therapy , cancer , chemotherapy , breast cancer , political science , law
Aim Approximately 20% of patients treated with neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer achieve a pathological complete response (p CR ) while the remainder derive the benefit of improved local control and downstaging and a small proportion show a minimal response. The ability to predict which patients will benefit would allow for improved patient stratification directing therapy to those who are likely to achieve a good response, thereby avoiding ineffective treatment in those unlikely to benefit. Method A systematic review of the English language literature was conducted to identify pathological factors, imaging modalities and molecular factors that predict p CR following chemoradiotherapy. PubMed, MEDLINE and Cochrane Database searches were conducted with the following keywords and Me SH search terms: ‘rectal neoplasm’, ‘response’, ‘neoadjuvant’, ‘preoperative chemoradiation’, ‘tumor response’. After review of title and abstracts, 85 articles addressing the prediction of p CR were selected. Results Clear methods to predict p CR before chemoradiotherapy have not been defined. Clinical and radiological features of the primary cancer have limited ability to predict response. Molecular profiling holds the greatest potential to predict p CR but adoption of this technology will require greater concordance between cohorts for the biomarkers currently under investigation. Conclusion At present no robust markers of the prediction of p CR have been identified and the topic remains an area for future research. This review critically evaluates existing literature providing an overview of the methods currently available to predict p CR to nCRT for locally advanced rectal cancer. The review also provides a comprehensive comparison of the accuracy of each modality.