rectum and anus cancer highlights -...
TRANSCRIPT
![Page 1: Rectum and anus cancer Highlights - AIOMmedia.aiom.it/userfiles/files/doc/AIOM-Servizi/20160206...Protective effect of RT against 2nd pelvic tumors (prov: will the same apply to oxa?)](https://reader033.vdocuments.mx/reader033/viewer/2022053018/5f1f43f41958f70d46138126/html5/thumbnails/1.jpg)
Carlo Aschele
La Spezia
Rectum and anus cancer
Highlights
AIOM post ASCO GI review, Roma 5-6 Febbraio 2016
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• PREOP CRT POTENTIATION
• MAINTENANCE / CONSOLIDATION CHEMO
• INCIDENCE OF RT-INDUCED SECOND PELVIC
TUMORS
• RT schedule
• Role of chemo
• Optimal imaging / staging
TOPICS
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Slide 4
Presented By Claus Roedel at TBD
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Disease Free Survival (ITT analysis) : 5 year follow-up
Presented By Eric Francois at TBD
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Overall Survival (ITT analysis) : 5 year follow-up
Presented By Eric Francois at TBD
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Causes of death
Presented By Eric Francois at TBD
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Cumulative local recurrence (5 year follow-up)
Presented By Eric Francois at TBD
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Prognostic factors for DFS<br />(multivariate Cox proportional-hazards model)
Presented By Eric Francois at TBD
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Conclusions
Presented By Eric Francois at TBD
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PHASE III trials : neoadjuvant RCT with oxaliplatin
Presented By Eric Francois at TBD
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Slide 14
Presented By Claus Roedel at TBD
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• Negative also for 2ries endpoints (1ry ep=pCR)
… but effect on DFS seen and similar to other studies
• Apparent difference in deaths unrelated to rectal K
… could this balance the increased acute toxicity?
• Pay attention to LR
• pN stage strongly prognostic
ACCORD 12 (& co)
THM
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WEEKLY OXA + FP-based CRT
PRO
4-5% DFS
early mts
Less late mortality
CONTRA
No impact on pCR
Increased acute toxicity
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WEEKLY OXA + FP-based CRT
US rejected
FRANCE rejected
GERMANY RETAINED
ITALY ………
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Slide 16
Presented By Claus Roedel at TBD
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Inclusion criteria
Presented By Krzysztof Bujko at TBD
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Slide 4
Presented By Krzysztof Bujko at TBD
5% ineligible!!!
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Acute toxicity
Presented By Krzysztof Bujko at TBD
???
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Postoperative complications
Presented By Krzysztof Bujko at TBD
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Late toxicity
Presented By Krzysztof Bujko at TBD
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Pathology
Presented By Krzysztof Bujko at TBD
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Primary endpoint – R0 resections
Presented By Krzysztof Bujko at TBD
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Cumulative incidence of local failure
Presented By Krzysztof Bujko at TBD
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Cumulative incidence of distant metastases
Presented By Krzysztof Bujko at TBD
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Disease-free survival
Presented By Krzysztof Bujko at TBD
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Overall survival
Presented By Krzysztof Bujko at TBD
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• Confirms the interest for consolidation chemo
• Major study limitations:
• heterogenous pop (loc adv + recurr)
• unusual endpoint
• staging
• unconventional control arm (with OXA)
• unusual OXA regimen (monotherapy)
• Roughly similar outcome and toxicity
• Implications for other studies of consolidation chemo?
POLISH II
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Slide 19
Presented By Claus Roedel at TBD
Will this become an OXA vs non-OXA study?
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The Incidence of Secondary Pelvic Tumors after Previous Radiation for Rectal Cancer<br />
Presented By Anouk Rombouts at TBD
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Results
Presented By Anouk Rombouts at TBD
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Standardized incidence ratios (SIR)
Presented By Anouk Rombouts at TBD
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Cumulative incidence risk of second pelvic tumors
Presented By Anouk Rombouts at TBD
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Cumulative incidence risk of second tumors - Prostate
Presented By Anouk Rombouts at TBD
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Cumulative incidence risk of second tumors - Rectosigmoid
Presented By Anouk Rombouts at TBD
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Cumulative incidence risk of second tumors - other locations
Presented By Anouk Rombouts at TBD
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Results
Presented By Anouk Rombouts at TBD
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Conclusion
Presented By Anouk Rombouts at TBD
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Slide 23
Presented By Claus Roedel at TBD
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Slide 24
Presented By Claus Roedel at TBD
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THM
Modest DFS > with OXA (stat sig in 1 of 3 studies
so far reported)
No evident benefit for SCRT with maintenance
FOLFOX compared to OXA-based pre-op CRT
(major study limitations)
Protective effect of RT against 2nd pelvic tumors
(prov: will the same apply to oxa?)
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GRAZIE
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TME RT
FP FP
EORTC
CNR
PROCTOR/SCRIPT
Chronicle
CAO-ARO-AIO 04
PETACC
ADORE
CT vs obs
FP +/- OXA
2014
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CNR EORTC Chronicle Proctor/Script
Random preop preop postop postop
Compliance 55% 43% 48% 73%
Accrual
duration 9-y 10-y 4-y 13-y
completed yes yes 113/780 437/840
Included in analysis 245/634 473/1011 75/113 403/437
ONLY yp stage II and III included
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Slide 1
Presented By Claus Roedel at TBD
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Slide 2
Presented By Claus Roedel at TBD
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Slide 13
Presented By Claus Roedel at TBD
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Slide 19
Presented By Claus Roedel at TBD
Will this become an OXA vs non-OXA study?
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Slide 20
Presented By Claus Roedel at TBD
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Slide 23
Presented By Claus Roedel at TBD
![Page 53: Rectum and anus cancer Highlights - AIOMmedia.aiom.it/userfiles/files/doc/AIOM-Servizi/20160206...Protective effect of RT against 2nd pelvic tumors (prov: will the same apply to oxa?)](https://reader033.vdocuments.mx/reader033/viewer/2022053018/5f1f43f41958f70d46138126/html5/thumbnails/53.jpg)
Slide 24
Presented By Claus Roedel at TBD
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CRT TME CT
CRT/RT TME CT
(CRT) TME CT
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Chemotherapy for Rectal Cancer: When Is It Needed? <br />
Presented By Bengt Glimelius at TBD
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Conclusions <br />(adding chemotherapy to radiation preoperatively)
Presented By Bengt Glimelius at TBD
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Slide 16
Presented By Bengt Glimelius at TBD
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Adjuvant chemotherapy in rectal cancer
Presented By Bengt Glimelius at TBD
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Adjuvant chemotherapy in rectal cancer<br />- pragmatic conclusions
Presented By Bengt Glimelius at TBD
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TME RT
FP FP
EORTC
CNR
PROCTOR/SCRIPT
Chronicle
CAO-ARO-AIO 04
PETACC
ADORE
CT vs obs
FP +/- OXA
2014
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CNR EORTC Chronicle Proctor/Script
Random preop preop postop postop
Compliance 55% 43% 48% 73%
Accrual
duration 9-y 10-y 4-y 13-y
completed yes yes 113/780 437/840
Included in analysis 245/634 473/1011 75/113 403/437
ONLY yp stage II and III included
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Endoscopic Ultrasonography vs MRI for Staging and Response Evaluation
Presented By Gina Brown at TBD
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Randomised trial evidence unimportance of nodal status
Presented By Gina Brown at TBD
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mrEMVI is associated with pelvic sidewall tumour deposits
Presented By Gina Brown at TBD
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MRI as a gold standard – why we need to go beyond TNM
Presented By Gina Brown at TBD
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MDT choices and making best use of high resolution MRI
Presented By Gina Brown at TBD
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Reporting Minimum Standards
Presented By Gina Brown at TBD