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Year : 2021  |  Volume : 58  |  Issue : 4  |  Page : 590--591

MCQs on “Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients”

HS Darling 
 Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bangalore, Karnataka, India

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bangalore, Karnataka
India




How to cite this article:
Darling H S. MCQs on “Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients”.Indian J Cancer 2021;58:590-591


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Darling H S. MCQs on “Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients”. Indian J Cancer [serial online] 2021 [cited 2022 May 29 ];58:590-591
Available from: https://www.indianjcancer.com/text.asp?2021/58/4/590/334635


Full Text



Q 1. Statement 1 – NACCRT for Carcinoma Rectum downstages the disease and facilitates sphincter preservation

Statement 2 – NACCRT in Carcinoma Rectum is associated with both disease specific survival and overall survival

Which of the following is true for above statements as per this study?

  1. Statement 1 is true
  2. Statement 2 is true
  3. Both statements are true
  4. Both statements are false


Q 2. As per tumor regression grade (TRG) as described by Rodel and Fokas a grade 2 response is described as

  1. Complete regression (No viable tumor)
  2. Morderate regression (26-50% fibrosis in tumor)
  3. Good regression (>50% fibrosis in tumor)
  4. None of the above


Q 3. Which of the following statements is true regarding MRI evaluation post NACCRT in this study?

  1. MRI response corelated well with pathological response
  2. Good MRI response was associated with improvement in DFS/OS
  3. Post treatment MRI was not of much value in planning surgical treatment
  4. None of the above


Q 4. The modified Ryan scheme for tumor regression score '2' suggests-

  1. No viable cancer cells
  2. Single cells or rare small groups of cancer cells
  3. Residual cancer with evident tumor regression, but more than single cells or rare small groups of cancer cells
  4. Extensive residual cancer with no evident tumor regression


Q 5. The dose of radiation used in Swedish Rectal Cancer Trial was

  1. 50 Gy in 25 fractions
  2. 5040 Gy in 28 fractions
  3. 25 Gy in 5 fractions
  4. 60 Gy in 30 fractions


Q 6. In RAPIDO trial of short course radiotherapy followed by chemotherapy before total mesorectal excision, for how many weeks was chemotherapy given post short course radiotherapy

  1. 10 weeks
  2. 18 weeks
  3. 24 weeks.
  4. 12 weeks


Q 7. Which of the following are the components of modified Glasgow prognostic score (mGPS) for cancer outcomes?

  1. C-reactive protein and serum albumin
  2. C-reactive protein and depth of invasion of tumor
  3. Serum albumin and neutrophil-lymphocyte ratio
  4. C-reactive protein and erythrocyte sedimentation rate


Q 8. In this study by Aktan et al., which of the following was associated with better outcomes in terms of both overall survival (OS) and disease-free survival (DFS)?

  1. Perineural invasion
  2. Moderate tumor differentiation on histology
  3. Normal platelets-lymphocyte ratio (PLR)
  4. High CRP


Q 9. After nCRT, complete response was seen in

  1. 10% patients
  2. 30% patients
  3. 50% patients
  4. 70% patients


Q 10. Radiologic downstaging was correlated in this study with

  1. good OS
  2. good DFS
  3. good pathologic response
  4. all of the above


Answers, Explanations

1 (c) Both statements are true

The development of surgical and treatment techniques such as three- dimensional conformal radiotherapy (3D- CRT), intensity- modulated radiotherapy (IMRT) and dynamic IMRT, treatment-related complications decreased and treatment efficacy increased for rectal cancer.The standardization of nCRT may lead to downstage the tumor and this strategy provides better locoregional control and potentially increases sphincter preservation. Also, studies suggest that nCRT is associated with improvements in both overall survival (OS) and cancer-specific survival.[1]

2 (b) Morderate regression (26-50% fibrosis in tumor)

Each grade was defined as follows: grade 0 (no 1 regression), grade 1 (minor regression: <25% of fibrosis in the tumor mass), grade 2 (moderate regression: 26–50% fibrosis within the tumor mass), grade 3 (good regression: >50% fibrosis vs the tumor mass), grade 4 (complete regression: no evidence of viable tumor mass).[1]

3 (a) MRI response corelated well with pathological response

Radiologic downstaging was correlated with a good pathologic response in this study, but authors did not find any correlation with OS or DFS.[1]

4 (c) Residual cancer with evident tumor regression, but more than single cells or rare

small groups of cancer cells.[2]

[INLINE:1]

5 (c). 25 Gy in 5 fractions.[3]

6 (b). 18 weeks.[4]

7 (a). The modified Glasgow prognostic score (mGPS) considers the CRP and serum albumin levels. It's a score estimating survival in cancer patients. The mGPS value varies from 0 to 2, depending on presence of high CRP and hypoalbuminemia.[5]

8 (c). In this study, it was noted that a normal platelet-lymphocyte ratio was associated with statistically and clinically significant better outcomes in terms of overall survival and disease-free survival. This has been observed in some of the previous studies as well, and this study further strengthens the evidence for it.[1]

9 (a). 10% patients[1]

10(c). good pathologic response[1]

References

1Aktan M, Yavuz BB, Gul K, Oltulu P. Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients. Indian J Cancer 2021;58:561-8.
2John MJ, Richard MG, Elliot AA, Al BB, James DB, George JC, et al. Colon and Rectum. In: Mahul BA, editor. American Joint Committee on Cancer (AJCC). AJCC cancer staging manual. 8th ed. New York, NY: Springer; 2017. pp. 264.
3Manisha P, Brain GC, Christopher GW. Chapter 65: Cancer of the Colon and Rectum. In: Halperin EC, Brady LW, Wazer DE, Perez CA, (editors). Perez and Brady's principles and practice of radiation oncology, 7th ed. Philadelphia: Wolters Kluwer, 2018.
4Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CA, Putter H, Kranenbarg EM, et al. RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol 2021;22:29-42.
5Proctor MJ, Morrison DS, Talwar D, Balmer SM, O'Reilly DS, Foulis AK, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011;104:726.