Cancer Research and Treatment

Original Article

Gastrointestinal cancer

Radiofrequency Ablation versus Stereotactic Body Radiation Therapy in the Treatment of Colorectal Cancer Liver Metastases: Jesang Yu, Dong Hwan Kim, Jungbok Lee, Yong Moon Shin, Jong Hoon Kim, Sang Min Yoon, Jinhong Jung, Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Tae Won Kim, Yong Sang Hong, Sun Young Kim, Jeong Eun Kim, Jin-hong Park, So Yeon Kim; Cancer Res Treat. 2022;54(3):850-859. Published online October 13, 2021; DOI: https://doi.org/10.4143/crt.2021.674

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Purpose
This study aimed to compare the treatment outcomes of radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) for colorectal cancer liver metastases (CRLM) and to determine the favorable treatment modality according to tumor characteristics.
Materials and Methods
We retrospectively analyzed the records of 222 colorectal cancer patients with 330 CRLM who underwent RFA (268 tumors in 178 patients) or SBRT (62 tumors in 44 patients) between 2007 and 2014. Kaplan–Meier method and Cox models were used by adjusting with inverse probability of treatment weighting (IPTW).
Results
The median follow-up duration was 30.5 months. The median tumor size was significantly smaller in the RFA group than in the SBRT group (1.5 cm vs 2.3 cm, p<0.001). In IPTW-adjusted analysis, difference in treatment modality was not associated with significant differences in 1-year and 3-year recurrence-free survival (35% vs 43%, 22% vs 23%; p=0.198), overall survival (96% vs 91%, 58% vs 56%; p=0.508), and freedom from local progression (FFLP; 90% vs 72%, 78% vs 60%; p=0.106). Significant interaction effect between the treatment modality and tumor size was observed for FFLP (p=0.001). In IPTW-adjusted subgroup analysis of patients with tumor size >2 cm, the SBRT group had a higher FFLP compared with the RFA group (HR, 0.153; p<0.001).
Conclusion
SBRT and RFA showed similar local control in the treatment of patients with CRLM. Tumor size was an independent prognostic factor for local control and SBRT may be preferred for larger tumors.

Citations

Citations to this article as recorded by

Ablative techniques in colorectal liver metastases: A systematic review, descriptive summary of practice, and recommendations for optimal data reporting
Wee Han Ng, Catarina Machado, Alice Rooney, Robert Jones, Jonathan Rees, Samir Pathak
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Effects of maximum dose on local control after stereotactic body radiotherapy for oligometastatic tumors of colorectal cancer
Su Jin Kang, Jongmoo Park, Gyu-Seog Choi, Jong Gwang Kim, Jun Seok Park, Hye Jin Kim, Jin Ho Baek, Byung Woog Kang, An Na Seo, Shin-Hyung Park, Bong Kyung Bae, Min Kyu Kang, Soo Yeun Park, Devarati Mitra
PLOS ONE.2025; 20(1): e0313438. CrossRef
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Erratum

ERRATUM: Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location: Chan Wook Kim, Jihun Kim, Yangsoon Park, Dong-Hyung Cho, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Cancer Res Treat. 2021;53(3):893-893. Published online June 8, 2021; DOI: https://doi.org/10.4143/crt.2018.392.E; Corrects: Cancer Res Treat 2019;51(3):1135

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Original Articles

Association of Body Composition with Long-Term Survival in Non-metastatic Rectal Cancer Patients: Jin Soo Han, Hyoseon Ryu, In Ja Park, Kyung Won Kim, Yongbin Shin, Sun Ok Kim, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim; Cancer Res Treat. 2020;52(2):563-572. Published online December 3, 2019; DOI: https://doi.org/10.4143/crt.2019.249

Abstract PDF PubReader ePub

Purpose
We evaluated the association of body composition with long-term oncologic outcomes in non-metastatic rectal cancer patients.
Methods
We included 1,384 patients with stage(y)0-III rectal cancer treated at Asan Medical Center between January 2005 and December 2012. Body composition at diagnosis was measured using abdomino-pelvic computed tomography (CT). Sarcopenia, visceral obesity (VO), and sarcopenic obesity (SO) were defined using CT measured parameters such as skeletal muscle index (total abdominal muscle area, TAMA), visceral fat area (VFA), and VFA/TAMA. Inflammatory status was defined as a neutrophil-lymphocyte ratio of ≥3. Obesity was categorized by body mass index (≥ 25 kg/m²).
Results
Among the 1,384 patients, 944 (68.2%) had sarcopenia and 307 (22.2%) had SO. The 5-year overall survival (OS) rate was significantly lower in sarcopenic patients (no sarcopenia vs. sarcopenia; 84% vs. 78%, p=0.003) but the 5-year recurrence-free survival (RFS) rate was not different (77.3% vs. 77.9% p=0.957). Patients with SO showed lower 5-year OS (79.1% vs. 75.5% p=0.02) but no difference in 5-year RFS (p=0.957). Sarcopenia, SO, VO, and obesity were not associated with RFS. However, obesity, SO, age, sex, inflammatory status, and tumor stage were confirmed as independent factors associated with OS on multivariate analysis. In subgroup analysis, association of SO with OS was more prominent in patients with (y)p stage 0-2 and no inflammatory status.
Conclusion
The presence of SO and a low body mass index at diagnosis are negatively associated with OS in non-metastatic rectal cancer patients.

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Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location: Chan Wook Kim, Jihun Kim, Yangsoon Park, Dong-Hyung Cho, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Cancer Res Treat. 2019;51(3):1135-1143. Published online November 29, 2018; DOI: https://doi.org/10.4143/crt.2018.392; Correction in: Cancer Res Treat 2021;53(3):893

Abstract PDF PubReader ePub

Purpose
Extranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers.
Materials and Methods
The medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed.
Results
ENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p<0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients.
Conclusion
ENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.

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Landscape of Actionable Genetic Alterations Profiled from 1,071 Tumor Samples in Korean Cancer Patients: Se-Hoon Lee, Boram Lee, Joon Ho Shim, Kwang Woo Lee, Jae Won Yun, Sook-Young Kim, Tae-You Kim, Yeul Hong Kim, Young Hyeh Ko, Hyun Cheol Chung, Chang Sik Yu, Jeeyun Lee, Sun Young Rha, Tae Won Kim, Kyung Hae Jung, Seock-Ah Im, Hyeong-Gon Moon, Sukki Cho, Jin Hyoung Kang, Jihun Kim, Sang Kyum Kim, Han Suk Ryu, Sang Yun Ha, Jong Il Kim, Yeun-Jun Chung, Cheolmin Kim, Hyung-Lae Kim, Woong-Yang Park, Dong-Young Noh, Keunchil Park; Cancer Res Treat. 2019;51(1):211-222. Published online April 23, 2018; DOI: https://doi.org/10.4143/crt.2018.132

Abstract PDF Supplementary Material PubReader ePub

Purpose
With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data.
Materials and Methods
To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared.
Results
We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration.
Conclusion
In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.

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Paired Primary and Metastatic Tumor Analysis of Somatic Mutations in Synchronous and Metachronous Colorectal Cancer: Kyu-pyo Kim, Jeong-Eun Kim, Yong Sang Hong, Sung-Min Ahn, Sung Min Chun, Seung-Mo Hong, Se Jin Jang, Chang Sik Yu, Jin Cheon Kim, Tae Won Kim; Cancer Res Treat. 2017;49(1):161-167. Published online July 4, 2016; DOI: https://doi.org/10.4143/crt.2015.490

Abstract PDF Supplementary Material PubReader ePub

Purpose
Although the mutation status of KRAS is highly concordant in primary and metastatic lesions, it has not been generalized to other major pathway genes.
Materials and Methods
In this study, 41 genes were evaluated and the mutational profiles were compared in 46 colorectal cancer patients with paired surgical specimens of primary and metastatic lesions: synchronous (n=27) and metachronous (n=19) lesions. A high-throughput mass spectrometry-based genotyping platform validated by orthogonal chemistry, OncoMap v.4.4, was used to evaluate the formalin-fixed, paraffin-embedded surgical specimens. The patients’ demographics, tumor characteristics, and microsatellite instability status were analyzed by a retrospective chart review.
Results
In this study,with OncoMap, mutationswere identified in 80.4% of patientswith the following frequency: KRAS (39.1%), TP53 (28.3%), APC (28.3%), PIK3CA (6.5%), BRAF (6.5%), and NRAS (4.3%). Although 19.6% (9/46) of the patients showed no gene mutations, 43.5% (20/46) and 37.0% (17/46) had mutations in one and two or more genes, respectively. The synchronous and metachronous lesions showed similar mutational profiles. Paired samples between primary and metastatic tumors differed in 7.4% (2/27) and 10.5% (2/19) for synchronous and metachronous according to OncoMap.
Conclusion
These findings indicate the major pathway genes, including KRAS, TP53, APC, PIK3CA, BRAF, and NRAS, are often concordant between the primary and metastatic lesions regardless of the temporal relationship of metastasis.

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Preliminary Suggestion about Staging of Anorectal Malignant Melanoma May Be Used to Predict Prognosis: Won Young Chae, Jong Lyul Lee, Dong-Hyung Cho, Chang Sik Yu, Jin Roh, Jin Cheon Kim; Cancer Res Treat. 2016;48(1):240-249. Published online March 6, 2015; DOI: https://doi.org/10.4143/crt.2014.305

Abstract PDF PubReader ePub

Purpose
Anorectal malignant melanomas (AMM) are rare and have poor survival. The study aims to evaluate the clinicopathologic characteristics and outcomes of patients with AMM, and to devise a staging system predictive of survival outcome.
Materials and Methods
This was a retrospective study of 28 patients diagnosed with, and treated for AMM. Patients classified by clinical staging of mucosal melanoma (MM) were reclassified via rectal and anal TNM staging. Survival outcomes were compared among patients grouped by the three different staging systems.
Results
The three staging systems were equated with similar figures for 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients diagnosed with stage I disease. Patients (n=19) diagnosed with MM stage II disease were reclassified by rectal TNM staging into three subgroups: IIIA, IIIB, and IIIC. For these patients, both 5-year OS and 5-year DFS differed significantly between the subgroups IIIA and IIIC (OS: IIIA vs. IIIC, 66.7% vs. 0%, p=0.002; DFS: IIIA vs. IIIC, 51.4% vs. 0%, p < 0.001).
Conclusion
The accuracy of prognosis in patients diagnosed with AMM and lymph node metastasis has improved by using rectal TNM staging, which includes information regarding the number of lymph node metastases.

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Hernando Marulanda Fernández, Felipe Vera-Polanía, Juan Antonio Trejos Naranjo, Julian Ernesto Parga Bermudez, William Otero Regino
Revista colombiana de Gastroenterología.2023; 38(4): 504. CrossRef
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Human Pathology.2018; 79: 77. CrossRef

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Clinicopathologic Characteristics, Surgical Treatment and Outcomes for Splenic Flexure Colon Cancer: Chan Wook Kim, Ui Sup Shin, Chang Sik Yu, Jin Cheon Kim; Cancer Res Treat. 2010;42(2):69-76. Published online June 30, 2010; DOI: https://doi.org/10.4143/crt.2010.42.2.69

Abstract PDF PubReader ePub

Purpose

This current study examined the clinicopathologic characteristics of patients with splenic flexure (SF) colon cancer and the association with the surgical outcomes to find the optimal procedure to treat this malady.

Materials and Methods

A total of 167 operated patients with SF colon cancer were consecutively recruited between 1993 and 2003. The clinicopathological, operative and survival data was reviewed and analyzed.

Results

For the SF colon cancer patients, the proportion of males was higher than that for the right-sided colon patients or the sigmoid-descending junction & sigmoid (SD & S) colon patients (p≤0.05, respectively) and the age at the time of diagnosis was younger (p≤0.05). Obstruction was more frequent in the patients with SF colon cancer than that for the patients with colon cancer at other sites (p≤0.001). The incidence of mucinous adenocarcinoma for the SF patients was similar to that for the patients with right-sided colon cancer, but it was higher than that for the patients with SD & S colon cancer (11.4% vs. 6.5%, p=0.248 or 2.5%, respectively, p=0.001). Disease-free and overall survival did not differ between the patients who underwent a left hemicolectomy and extended surgery such as combined splenectomy or subtotal colectomy. Multivariate analysis showed that old age (≥60 years) and a N1-2 and M1 status were the independent risk factors for overall survival.

Conclusion

The SF colon cancers exhibited exclusively different characteristics as compared to colon cancers at other site colon cancers. It appears that left hemicolectomy was generally sufficient for a satisfactory oncological outcome, obviating concurrent splenectomy.

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Jin Cheon Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, In Ja Park, Seok‐Byeong Lim
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Annals of Surgical Treatment and Research.2017; 93(1): 35. CrossRef
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Aleix Martínez-Pérez, Francesco Brunetti, Giulio C. Vitali, Solafah Abdalla, Frédéric Ris, Nicola de’Angelis
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Optimal Timing for the Administration of Capecitabine with Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Young Ju Noh, Won Sik Choi, Jong Hoon Kim, Jin Cheon Kim, Chang Sik Yu, Hee Cheol Kim, Tae Won Kim, Heung Moon Chang, Min Hee Ryu, Seung Do Ahn, Sang-wook Lee, Seong Soo Shin, Jung Eun Lee, Eun Kyung Choi; Cancer Res Treat. 2006;38(1):30-34. Published online February 28, 2006; DOI: https://doi.org/10.4143/crt.2006.38.1.30

Abstract PDF PubReader ePub

Purpose

Capecitabine is an oral fluoropyrimidine carbamate and it is known as an effective radiosensitizer. Capecitabine and its metabolite reach their peak concentration in the plasma at 1~2 hours after a single oral administration of capecitabine and the levels fall rapidly thereafter. To verify the radiosensitizing effect of capecitabine that is based on such pharmacokinetic characteristics, we performed a retrospective analysis on the optimal timing of capecitabine administration with performing preoperative chemoradiation for locally advanced rectal cancer.

Materials and Methods

Among 171 patients who were treated with preoperative radiotherapy and concurrent capecitabine administration for rectal cancer, 56 patients were administered capecitabine at 1~2 hours before radiotherapy (group A), and at other time in the other 115 patients (group B). Total mesorectal excision was done at 4 to 6 weeks after the completion of chemoradiation. The radiosensitizing effect of capecitabine was evaluated on the basis of the pathological response.

Results

Complete pathological regression of the primary tumor was observed in 12 patients (21.4%) for group A and in 11 patients (9.6%) for group B (p=0.031). Residual disease less than 0.5 cm (a good response) was observed in 19 patients (33.9%) for group A and in 23 patients (20.0%) for group B (p=0.038). On multivariate analysis, the capecitabine ingestion time showed marginal significance.

Conclusion

When performing preoperative chemoradiation for locally advanced rectal cancer, the radiosensitizing effect of capecitabine was enhanced when it was administered 1 hour before radiotherapy.

Citations

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Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer
R Clifford, N Govindarajah, J L Parsons, S Gollins, N P West, D Vimalachandran
British Journal of Surgery.2018; 105(12): 1553. CrossRef

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Case Report

Lymph Node Metastases of Prostatic Adenocarcinoma in the Mesorectum in Patients with Rectal Cancer: In Ja Park, Hee Cheol Kim, Chang Sik Yu, Choung Soo Kim, Jung Sun Kim, Jin Cheon Kim; Cancer Res Treat. 2005;37(2):129-132. Published online April 30, 2005; DOI: https://doi.org/10.4143/crt.2005.37.2.129

Abstract PDF PubReader ePub

Lymph node involvement is the most important prognostic factor of rectal cancer. Cancer originating from sites other than the rectum rarely metastasizes to the mesorectal lymph node. We report a rectal cancer patient with a synchronous metastatic prostatic carcinoma to the mesorectal lymph node.

Citations

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A Case of Prostate Cancer Diagnosed by the Discovery of Pararectal Lymph Node Metastases during Sigmoid Colon Cancer Surgery
Daiki KATO, Chieko KITAMURA, Jun YAMADA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(9): 1515. CrossRef
A Case of Rectal Cancer with Lymph Node Metastasis of Prostate Cancer in the Mesorectum after Radical Prostatectomy
Teruhisa UDAGAWA, Yu SUZUKI, Yasushi ITO, Yoshihisa TAMATE, Naoki YANAGAWA, Takashi KAMEI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2022; 83(4): 775. CrossRef
Two Cases of Colorectal Cancer with Mesenteric Lymph Node Metastasis Derived from Prostatic Cancer
Fumitaka Asahara, Hirotoshi Hasegawa, Shutaro Suda, Emima Bekku, Kazuhiko Hashimoto, Aya Sasaki, Junichi Matsui
The Japanese Journal of Gastroenterological Surgery.2020; 53(1): 61. CrossRef
Metastasization of mesorectal lymph nodes by a prostatic adenocarcinoma
J.J. Arenal, A. Torres, C. Tinoco, M.A. Citores, C. Benito, B. Madrigal, A. Vara
Human Pathology: Case Reports.2015; 2(2): 42. CrossRef

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Original Articles

Responsiveness of CPT-11 in Respect to hMLH1 and hMSH2 Protein Expression in the Primary Colorectal Cancer: In Ja Park, Hee Cheol Kim, Chang Sik Yu, Heung Moon Chang, Jea Hwan Lee, Jong Hoon Kim, Tae Won Kim, Jung Sun Kim, Jin Cheon Kim; Cancer Res Treat. 2004;36(6):360-366. Published online December 31, 2004; DOI: https://doi.org/10.4143/crt.2004.36.6.360

Abstract PDF PubReader ePub: Purpose
The aim of this study was to evaluate the responsiveness to CPT-11 with respect to hMLH1 and hMSH2 protein expressions in primary colorectal tumors.
Materials and Methods
91 patients with colorectal cancer treated having undergone surgery and postoperative CPT-11-based adjuvant chemotherapy, between 1997 and 2002, were prospectively recruited. Tumor samples were immunohistochemically analyzed for the expressions of hMLH1, hMSH2, p53 and CEA proteins.
Results
Of the 91 tumors, 6 (6.6%) and 4 (4.4%) showed loss of hMLH1 and hMSH2 protein expressions, respectively. The response rate of patients with tumors not expressing either hMLH1 or hMSH2 was higher than that of those expressing either of these proteins (p=0.026). Patients with tumors not expressing hMLH1 showed a significantly better response to CPT-11 (p=0.04). The responsiveness was not associated with the expressions of hMSH2, p53 or CEA. There were no correlations between drug toxicity and the expressions of hMLH1, hMSH2 or p53. The overall survival was better in patients responsive to CPT-11-based chemotherapy compared to non-responders.
Conclusion
The immunohistochemical determination of loss of hMLH1 and hMSH2 expressions may be used in determining the responsiveness to CPT-11-based chemotherapy. Our results suggest that hMLH1 protein expression may be a predictor for CPT-11 responsiveness in patients with colorectal cancer.

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Prospective Phase II Study of Preoperative Chemoradiation with Capecitabine in Locally Advanced Rectal Cancer: Jin-hong Park, Jong Hoon Kim, Seung Do Ahn, Sang-wook Lee, Seong Soo Shin, Jin Cheon Kim, Chang Sik Yu, Hee Cheol Kim, Yoon-Koo Kang, Tae Won Kim, Heung Moon Chang, Min Hee Ryu, Eun Kyung Choi; Cancer Res Treat. 2004;36(6):354-359. Published online December 31, 2004; DOI: https://doi.org/10.4143/crt.2004.36.6.354

Abstract PDF PubReader ePub

Purpose

Capecitabine is an attractive oral chemotherapeutic agent that has a radiosensitizing effect and tumor-selectivity. This study was performed to evaluate the efficacy and toxicity of preoperative chemoradiation therapy, when used with oral capecitabine, for locally advanced rectal cancer.

Materials and Methods

A prospective phase II trial of preoperative chemoradiation for locally advanced adenocarcinomas of the lower two-thirds of the rectum was conducted. A radiation dose of 50 Gy over five weeks and a daily dose of 1650 mg/m² capecitabine in two potions was administered during the entire course of radiation therapy. Surgery was performed with standardized total mesorectal excision four to six weeks after completion of the chemoradiation.

Results

Between January 2002 and September 2003, 61 patients were enrolled onto this prospective phase II trial. The pretreatment clinical stages were T3 in 64% (n=39), T4 in 36% (n=22) and N1-2 in 82% (n=50) of these patients. Fifty-six (92%) patients completed the chemoradiation as initially planned and a complete resection performed in 58 (95%). Down-staging was observed in 45 patients (74%) and a pathologic complete response in 6 (10%). Among the 37 patients with tumors located within 5 cm from the anal verge on colonoscopy, 27 (73%) underwent a sphincter-preserving procedure. No grade 3 and 4 proctitis or hematological toxicities were observed.

Conclusion

Preoperative chemoradiation therapy with capecitabine achieved encouraging rates of tumor downstaging and sphincter preservation, with a low toxicity profile. This combined modality can be regarded as a safe and effective treatment for locally advanced rectal cancer.

Citations

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MRI for Rectal Cancer: Staging, mrCRM, EMVI, Lymph Node Staging and Post-Treatment Response
David D.B. Bates, Maria El Homsi, Kevin J. Chang, Neeraj Lalwani, Natally Horvat, Shannon P. Sheedy
Clinical Colorectal Cancer.2022; 21(1): 10. CrossRef
MRI of Rectal Cancer: An Overview and Update on Recent Advances
Kartik S. Jhaveri, Hooman Hosseini-Nik
American Journal of Roentgenology.2015; 205(1): W42. CrossRef
Current Controversies in Neoadjuvant Chemoradiation of Rectal Cancer
P. Terry Phang, Xiaodong Wang
Surgical Oncology Clinics of North America.2014; 23(1): 79. CrossRef
Tailored rectal cancer treatment – a time for implementing contemporary prognostic factors?
A. Wibe, W. L. Law, V. Fazio, C. P. Delaney
Colorectal Disease.2013; 15(11): 1333. CrossRef
Oncologic Outcome After Preoperative Chemoradiotherapy in Patients With Pathologic T0 (ypT0) Rectal Cancer
Tae Young Jang, Chang Sik Yu, Yong Sik Yoon, Seok-Byung Lim, Seung-Mo Hong, Tae Won Kim, Jong Hoon Kim, Jin Cheon Kim
Diseases of the Colon & Rectum.2012; 55(10): 1024. CrossRef
Phase II study of concurrent chemoradiotherapy with capecitabine and cisplatin in patients with locally advanced squamous cell carcinoma of the head and neck
J G Kim, S K Sohn, D H Kim, J H Baek, S B Jeon, Y S Chae, K B Lee, J S Park, J H Sohn, J C Kim, I K Park
British Journal of Cancer.2005; 93(10): 1117. CrossRef
Preoperative Concurrent Chemoradiotherapy with Oral Fluoropyrimidine in Locally Advanced Rectal Cancer: How Good Is Good Enough?
Hyun Cheol Chung
Cancer Research and Treatment.2004; 36(6): 341. CrossRef

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Case Report

Isolated Diaphragmatic Metastasis Originated from Adenocarcinoma of the Colon: Kang Hong Lee, Chang Sik Yu, Hwan Namgung, Hee Cheol Kim, Jin Cheon Kim; Cancer Res Treat. 2004;36(2):157-159. Published online April 30, 2004; DOI: https://doi.org/10.4143/crt.2004.36.2.157

Abstract PDF PubReader ePub

Isolated diaphragmatic metastasis arising from colorectal cancer has been reported only one case in the literature presently. Here, we presented a new case and discussed the possible pathogenesis and the treatment options. A 42-year-old male patient had received anterior resection for sigmoid colon cancer. Although the increased serum CEA level was detected 20 months after the surgery, metastatic lesion could not be detected by repeated colonoscopy, CT scan, bone scan or PET scan for 35 months. We could detect a suspicious metastatic lesion on the liver by CT scan at 56 month after the surgery. During a second-look operation, we found a solitary metastasis on the diaphragm and removed it along with the 1 cm tumor-free resection margin. Although the prognosis associated with skeletal metastasis is poor, the complete resection of isolated diaphragmatic metastasis and subsequent appropriate adjuvant chemotherapy may achieve a cure the disease provided that other metastatic lesions are absent.

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Takahide Toyoda, Hidemi Suzuki, Takahiro Nakajima, Takekazu Iwata, Ayumu Matsuoka, Kyoko Nishikimi, Yoko Yonemori, Makio Shozu, Yukio Nakatani, Ichiro Yoshino
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Hiroaki FUJI, Yoshio KADOKAWA, Takafumi MACHIMOTO, Yoshito ASAO, Hiroaki FURUYAMA, Tsunehiro YOSHIMURA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2014; 75(1): 128. CrossRef
A Case of a Solitaly Metastatic Diaphragmatic Tumor Resected from Rectal Cancer
Kazuhiro FUJII, Kunio KAMEDA, Yasuhiro SHIMIZU, Hidetaka SHIMA, Kentarou SEKIZAWA, Akira KUBO, Yoshinori TAKEKAWA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2013; 74(10): 2829. CrossRef
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Kazuo MOTOYAMA, Kenta KOBAYASHI, Naoki ENOMOTO, Yoshihiro UEDA, Ryo OHNO
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2012; 73(5): 1080. CrossRef

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Original Articles

Patterns of Failure and Prognostic Factors in Anal Cancer Treated with Radiotherapy: Kyoung Ju Kim, Jong Hoon Kim, Eun Kyung Choi, Seung Do Ahn, Sang Wook Lee, Jin Cheon Kim, Chang Sik Yu, Hee Cheol Kim, Je Hwan Lee, Tae Won Kim; Cancer Res Treat. 2003;35(2):141-147. Published online April 30, 2003; DOI: https://doi.org/10.4143/crt.2003.35.2.141

Abstract PDF: PURPOSE
To analyze the patterns of failure and prognostic factors affecting the local control and survivals in anal cancer treated with definitive radiotherapy, and to find the most effective treatment modality. MATERIALS AND METHODS: Thirty consecutive patients, with primary cancers of the anal canal, were treated using radiotherapy, both with and without 5-FU based concurrent chemotherapy. According to the AJCC tumor stage, six patients hadwere stage I, 11 had stage II, 2 had stage IIIA, and 11 had stage IIIB tumors. The median radiation dose was 45 Gy (30-72 Gy), and with 23 patients receivinged concurrent chemotherapy (5-FU and mitomycin C in 12 patients, 5-FU and cisplatin in 7, and other drugs in 4). The Mmedian follow up period was 43 months, (ranginge, from 8- to 99 months). RESULTS: Among the 1630 patients who16 were treated without surgical resection beforeprior to the radiotherapy, and a complete remission was observed in 12 patients (75%), a partial remission in 3 (19%), and a local progression in the other one patient. The Llocal failures, including persistent disease, were observed in 10 (33%), and the patients with higher T-stages (T3-4) had higher rates of local failure rates (T1-2, 21% vs. T3-4, 72%, p=0.03). Distant metastases were found in 4 patients (13%). The five year survival and disease free survival rates were 64% and 53%, respectively. The factors which affectinged the 5 year local relapse free survival were T-stage (74.9% in T1-2 vs. 28.6% in T3-4, p=0.01), and the existence of a gross tumor beforeprior to radiotherapy (84.6%, no residual vs. 45.1% with residual, p=0.03).
CONCLUSION
A Llocal recurrence was the major failure pattern in anal cancers, and the factors affecting a local failure were the T-stage and tumor volume beforeprior to radiotherapy. A Rradiation dose around 45 Gy was sufficient to control tumors of the earlier T stage tumors, but a higher dose should be considered for with more advanced lesions.

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Somatic Mutations of APC Presenting Polymorphisms in the Hamartomatous Polyps of the Colon: Jin Cheon Kim, Seon Ae Roh, Hee Cheol Kim, Chang Sik Yu, Nichoias E Beck, Walter F Bodmer; J Korean Cancer Assoc. 1999;31(6):1288-1296.

Abstract PDF: No abstract available.

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Treatment of Hepatic Metastasis of Colorectal Cancer: A Retrospective Analysis of the Outcome in 99 Patients: Jin Cheon Kim, Chang Nam Kim, Chang Sik Yu, Han Il Lee, Sang We Kim, Je Hwan Lee, Woo Kun Kim, Gyeong Hoon Kang, Moon Kyu Lee; J Korean Cancer Assoc. 1998;30(6):1175-1183.

Abstract PDF: PURPOSE
Among various modalities of treatment in hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to determine important prognostic parameters and to understand clinically significant factors during hepatic resection and follow-up period in patients with hepatic metastasis from colorectal cancer.
MATERIALS AND METHODS
Among 1,022 colorectal cancer patients treated at Asan Medical Center from July 1989 to December 1995, 99 patients were found to have liver metastasis at the time of first diagnosis or during follow-up period. These 99 patients were the subject of analysis in this retrospective clinical study. Surgical resection with curative intent was done in 35 patients and chemotherapy in 46 patients. Eighteen patients were with no treatment or misssed during follow-up. Survival rate was analysed according to clinicopathological parameters: sex, age, location of primary tumor, preoperative serum CEA level, TNM staging of primary tumor, number of hepatic metastasis, distribution, synchronous or metachronous lesions, diesase free interval, mode of treatment, type of resection, tumor free resection margin.
RESULTS
Overall survival of the patients with hepatic metastasis was significantly related with numbers of metastasis (<4 vs. >4), distribution (unilobar vs. bilobar), synchronous or metachronous lesions, disease free interval ( < 12 vs. > 12 months), mode of treatment (hepatic resection vs. chemotherapy vs, no treatment, p<0.01. A multivariate analysis showed a significant association of survival with mode of treatment (p<0.01). Survival of patients with hepatic resection was significantly related with resection margin (positive vs. < 1 cm vs. > 1 cm), TNM staging of primary tumor (II vs. III), number of hepatic metastasis (p<0.01), disease free interval (p<0.05). A multivariate analysis showed a significant correlation with survival for tumor free resection margin (p<0.01).
CONCLUSION
An aggressive approach of hepatic resection in the colorectal liver metastasis will improve survival, if the lesion pennits. In patients with hepatic resection, tumor free resection margin was the most important prognostic parameter by the uniand multivariate analysis. Therefore, every effort should be made to ensure that the clear margin be kept at least more than 1 cm during hepatic resection.

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Multiple Primary Malignant Neoplasm with Colorectal Cancer: Hee Chul Kim, Chang Nam Kim, Chun Sik Jung, Chang Sik Yu, Jin Cheon Kim; J Korean Cancer Assoc. 1998;30(4):668-674.

Abstract PDF: PURPOSE
The incidence of multiple primary malignant neoplasm has increased in recent decades. The etiologies and epidemiologies of multiple primary malignant neoplasm are still remained to be verified. A group of patients with multiple primary malignant neoplasms accompanied by colorectal cancer was analyzed to determine the relationship between certain cancers and colorectal cancer.
MATERIALS AND METHODS
From Jan. 1989 to Jun 1997, there were 56 patients with colorectal cancers accompanied by cancers of another organs. The retrospective analysis was done on the basis of cancer origin and intervals between the cancers.
RESULTS
The male-to-female ratio was 25 to 31. The characteristics of colorectal cancers in multiple primary malignant neoplasm were similar to the colorectal cancers without other cancers. Among 56 patients, 50 patients had the double primaries and 6 had the triple primaries. In the patients with double primaries, extracolonic cancers were found in the stomach(16), hepatobiliary system(12), urologic system(6), gynecologic organ(6) and others. In the patients with triple primaries, extracolic cancers were found in the stomach(5), uterus(2), lung(2) and others. The patients with family history of malignancy were 10 cases and the rate in the triple primaries seemed to be higher than double primaries.
CONCLUSION
It could be desirable to follow-up and work-up the patients with colorectal cancer keeping in mind that the malignancy in other organs especially stomach might be present.

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Primary Signet Ring Cell Carcinoma of the Colon and Rectum: Hee Chul Kim, Chang Nam Kim, Choon Sik Jeong, Chang Sik Yu, Byung Sik Kim, Hun Kyung Lee, Jin Cheon Kim; J Korean Cancer Assoc. 1998;30(3):521-526.

Abstract PDF: PURPOSE
Signet ring cell carcinoma is a rare type of adenocarcinoma in the colon and rectum. We evaluated the differences of clinical features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma.
MATERIALS AND METHODS
The clincopathologic data of 13 cases with primary colorectal signet ring cell carcinoma were reviewed. The primary colorectal signet ring cell carcinoma was diagnosed when following criteria were met: 1) the tumor was primary; 2) histologic material was adequate; 3) signet ring cells represented more than 50% of the cancer.
RESULTS
Patients ranged in age from 20 to 68 (median, 45) years; 7 were male, and 6 were female. Three tumors were located in the proximal colon, 3 in the distal colon, and 7 in the rectum. There was no case that had family history. Most cases (77%) were stage III, one was stage II, and two were stage IV with peritoneal seeding. There were 9 cases that showed local recurrence or distant metastases during follow-up periods 6 cases with peritoneal seeding, 3 with bone metastases, 2 with brain metastases and 1 with pelvic recurrence (two cases had either bone and brain metastasis, and one case had bone and peritoneal seeding). Prognosis was extremely poor, and overall two years survival rate was 25%. CONCLUSION: Early onset, mode of metastasis and poor prognosis may imply the different biologic behavior of signet ring cell carcinoma, compared with ordinary adenocarcinoma. To improve outcome, early diagnosis and radical operation should be stressed.

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Microvessel Count and Overexpression of p53 in Early Colorectal Cancer: Young Min Kim, Gyeong Hoon Kang, Suk Kyun Yang, Chang Sik Yu, Jin Cheon Kim; J Korean Cancer Assoc. 1998;30(1):80-88.

Abstract PDF: PURPOSE
Angiogenesis, playing a critical role in tumor growth, development, and metastatic process, is alleged to be related to the prognostic factors and patient's survival of the colo-rectal cancer. The p53 gene, present in short arm of chromosome 17, is involved in multistep colo-rectal carcinogenesis. The correlation of p53 gene and angiogenesis has been recently reported. So, we designed to assess (1) the rate of p53 overexpression, (2) the prognostic significance of microvessel count, and (3) the relationship of p53 overexpression and angiogenesis in early colo-rectal cancer(ECC) patients. MATERIAL AND METHODS: The study material included 68 ECC from 65 patients, 40 mucosal (m-ECC) and 28 submucosal ECCs (sm-ECC). Immunostainings against p53 and factor VIII-related antigen were done and the results were analyzed with respect to tumor depth, site, and differentiation. And also the correlation between p53 overexpression and microvessel counts(MVC) was performed.
RESULT
The rate of p53 overexpression was higher in sm-ECC than in m-ECC (p < 0.05). The rate of p53 overexpression was highest in sigmoid colon and statistically significantly different compared with other sites. The differentiation of the tumor was closely correlated with p53 overexpression and the poorer the differentiation, the more overexpression of p53 (p<0.05). There was no significant difference between MVCs of m-ECC and sm-ECC (27.2+/-5.5 and 29.8 +/-6.0,respectively). However, MVC were higher in sigmoid colon than in any other sites (p<0.05). MVC did not show significant correlation with tumor differentiation or p53 overexpression.
CONCLUSION
These data indicate that p53 overexpression is correlated with tumor depth and differentiation but not MVC. The significance of higher MVC and p53 overexpression in sigmoid colon are reserved for further studies.

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A Case of the Pancreatic Pseudocyst due to Metastatic Malignant Melanoma: Bong Soo Chung, Jin Cheon Kim, Chang Sik Yu, Han Il Lee, Chang Nam Kim, Duck Jong Han, Gyeong Hoon Kang; J Korean Cancer Assoc. 1997;29(3):528-533.

Abstract PDF: Malignant melanoma constitutes approximately 1% of all cancer (1,2). As the biologic behavior seems to be unpredictable, variation in the metastatic spread are not infrequently met. The common sites of metastasis are lymph nodes, lung, liver, brain, bone, heart, adrenal glands, and gastrointestinal tract in descending order (2). However multiple organ involvement is a common feature at the advanced stage. A 38-year-old male had developed pancreatic pseudocyst during the course of malignant melanoma at right sole. It was proven to be from matastatic malignant melanoma.

2,666 View
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Hepatic Intraarterial Chemotherapy in Unresectable Hepatic Metastases of Colorectal Cancer: Jin Cheon Kim, Han Il Lee, Chang Sik Yu, Hee Won Chung, Sang Wee Kim, Jeong Sin Lee, Kun Choon Park; J Korean Cancer Assoc. 1997;29(2):227-234.

Abstract PDF: PURPOSE
Unresectable hepatic metastases of colorectal cancer does not seem to be amenable to the various treatment modalities. We modified hepatic intraarterial chemotherapy by different installation of port and regimen.
MATERIALS AND METHODS
Between July 1989 to December 1995, 27 patients of colorectal cancer with unresectable liver metastases were randomly allocated into either hepatic intraarterial (HA, 11 patients) or systemic intravenous (IV, 16 patients) chemotherapy after primary tumor resection. Chemo-port was installed with preservation of hepatic arterial flow. One cycle of HA regimen included 5-fluorouracil (5-FU) and mitomycin-C (MMC) with or without leucovorin (LV) for 14 days every month. The IV regimen included 5-FU and LV for 5 days every month. Both HA and IV chemotherapy were continued from 6 to 12 cycles.
RESULTS
The response exceeding partial remission was experienced in six patients (55%) among 11 patients in the HA group, while only two (13%) patients showed response among sixteen patients in the IV group. One year survival was not different between two groups. Although lethal toxicity was not found, patients showed marked increase of the performance scale (ECOG) in both groups.
CONCLUSION
Although survival benefit was not prominent, higher response rate with tolerable complication was found in the HA group. Prudent selection of effective drugs and combination of systemic chemotherapy are needed to improve the survival with minimal complication.

2,748 View
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