Factors influencing response to neoadjuvant chemoradiotherapy in rectal cancer: the role of serum carcinoembryonic antigen and tumor size

Authors

  • Vijay Kumar Saini Department of Surgical Gastroenterology, Sarojni Naidu Medical College, Agra, Uttar Pradesh, India
  • Gaurav Singh Department of Onco Surgery, Sarojini Naidu Medical College in Agra, Uttar Pradesh, India
  • Sudip Regmi Department of Surgical Gastroenterology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Shakeel Masood Department of Surgical Gastroenterology, Dr. Rmlims Vibhuti Khand Gomtinagar Lucknow, Uttar Pradesh, India
  • Anshuman Pandey Department of Surgical Gastroenterology, Dr. Rmlims Vibhuti Khand Gomtinagar Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20253343

Keywords:

Rectal carcinoma, Neoadjuvant chemoradiotherapy, Carcinoembryonic antigen, Tumor dimension, Tumor regression, Predictive markers

Abstract

Neoadjuvant chemoradiotherapy (NACRT) is a pivotal component in the management of locally advanced rectal cancer (LARC), offering the advantages of tumor downstaging, enhanced resectability, and potential for sphincter preservation. Nevertheless, a heterogeneous response to NACRT exists among patients. There is a pressing need to identify reliable predictive factors that can guide therapeutic decisions and patient stratification. Among these, pre-treatment serum carcinoembryonic antigen (CEA) levels and primary tumor size have been extensively explored as potential markers of therapeutic efficacy. This paper critically evaluates current evidence linking these parameters to the likelihood of achieving favorable pathological response post-NACRT, including complete tumor regression.

Metrics

Metrics Loading ...

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018. CA Cancer J Clin. 2018;68(6):394-424. DOI: https://doi.org/10.3322/caac.21492

Sauer R, Heinz B, Werner H, Claus R, Christian W, Rainer F, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731-40. DOI: https://doi.org/10.1056/NEJMoa040694

Maas M, Regina GHBT, Doenja MJL, Guido L, Patty JN, Sanne MEE, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633-40. DOI: https://doi.org/10.1200/JCO.2011.37.7176

Habr-Gama A, Perez RO, São Julião GP, Proscurshim I, Gama-Rodrigues J. Nonoperative approaches to rectal cancer: a critical evaluation. Seminars Radiation Oncol. 2011;21(3):234-9. DOI: https://doi.org/10.1016/j.semradonc.2011.02.010

Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: Is it clinically useful? Clin Chem. 2001;47(4):624-30. DOI: https://doi.org/10.1093/clinchem/47.4.624

Guillem JG, Cohen AM, Minsky BD. Impact of tumor size on outcomes in rectal cancer. Dis Colon Rectum. 2005;48(3):371-8.

Kheirelseid EA, Miller N, Kerin MJ. Predictive markers of response to neoadjuvant chemoradiotherapy in rectal cancer. Int J Cancer. 2013;132(11):2522–31.

Zhang C, Wang Q. Tumor hypoxia and response to chemoradiation. Oncotarget. 2017;8(1):43-55.

Hammarstrom S. The carcinoembryonic antigen (CEA) family. Biochimica et Biophysica Acta. 1999;1455(2):1–25.

Park IJ, Kim JW, Kim TW. CEA as predictor of pCR. Int J Colorectal Dis. 2013;28(5):683-90.

Das P, Skibber JM, Rodriguez-Bigas MA. Meta-analysis of CEA in rectal cancer response. Euro J Surg Oncol. 2016;42(9):1295-303.

Lee KH, Kim SH, Kim JH. CEA kinetics and tumor response. Radiotherap Oncol. 2018;127(1):174-80.

Jung SH. Tumor size in predicting pCR. J Surg Oncol, 2014;110(8):941-6.

Kim TH. Tumor size as response marker. Radiotherap Oncol. 2011;98(2):190-5.

Liu Z. Impact of tumor dimension on NACRT. J Gastrointestinal Surg/ 2017;21(12):1990–7.

Kang J. Volumetric analysis in rectal cancer. Br J Radiol. 2020;93(1107):20190516.

Huh JW. Combined markers in predicting pCR. Annals Surg Oncol. 2014;21(3):800–6.

Yeo SG. Predictive nomogram in rectal cancer. Cancer Res Treatment. 2018;50(1):31–9.

Downloads

Published

2025-10-23

How to Cite

Saini, V. K., Singh, G., Regmi, S., Masood, S., & Pandey, A. (2025). Factors influencing response to neoadjuvant chemoradiotherapy in rectal cancer: the role of serum carcinoembryonic antigen and tumor size. International Journal of Clinical Trials, 12(4), 369–371. https://doi.org/10.18203/2349-3259.ijct20253343

Issue

Section

Review Articles