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Selecting patients for hyperthermia combined with preoperative chemoradiotherapy for locally advanced rectal cancer

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Abstract

Background

This study investigated the role of hyperthermia combined with preoperative concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer (LARC) according to hypoxic marker expression.

Methods

One hundred and nine LARC patients with tissue blocks available for immunohistochemical assessment of carbonic anhydrase 9 (CA9) expression were reviewed. CA9 expression was considered positive when the staining percentage of tumor cells was >25% (n = 31). Pelvic radiotherapy with a total dose of 39.6–45 Gy was delivered concurrently with fluorouracil-based chemotherapy. Hyperthermia was administered to 52 patients twice a week during CCRT. Treatment response and outcomes were compared between hyperthermochemoradiotherapy (HCRT) and CCRT groups.

Results

In patients with positive CA9 expression, the rates of downstaging (p = 0.060) and pathologic complete response (p = 0.064) tended to be higher in the HCRT group than in the CCRT group. Distant metastasis-free survival (p = 0.029) and cancer-specific survival (p = 0.020) were significantly worse in tumors with both positive CA9 expression and poor tumor response. Negative CA9 expression, presence of major tumor response, and the use of hyperthermia were significant favorable prognostic factors for cancer-specific survival after the first recurrence in multivariate analysis.

Conclusions

Hyperthermia might selectively enhance the preoperative treatment response in LARC with positive CA9 expression and offset the negative effect of hypoxia on prognosis. Pretreatment evaluation of hypoxia could aid in the selection of patients who might benefit from hyperthermia.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Konyang University College of Medicine, 158 Gwanjeodong-ro, Daejeon, 35365, Republic of Korea

    Sang-Won Kim

  2. Department of Radiation Oncology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea

    Ji Woon Yea

  3. Department of Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea

    Jae Hwang Kim

  4. Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea

    Mi Jin Gu

  5. Department of Radiation Oncology, Kyungpook National University School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea

    Min Kyu Kang

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  1. Sang-Won Kim
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  2. Ji Woon Yea
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  3. Jae Hwang Kim
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  5. Min Kyu Kang
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Correspondence to Min Kyu Kang.

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Kim, SW., Yea, J.W., Kim, J.H. et al. Selecting patients for hyperthermia combined with preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Clin Oncol 23, 287–297 (2018). https://doi.org/10.1007/s10147-017-1213-z

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  • DOI: https://doi.org/10.1007/s10147-017-1213-z

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