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Medscape
23-05-2025
- Health
- Medscape
Neoadjuvant RT for Rectal Cancer: A Clinical Trade-Off?
Neoadjuvant radiotherapy followed by surgery can improve overall survival compared with surgery alone in certain patients with locally advanced rectal cancers, most notably in those with lower rectal cancers, new research found. However, patients can experience a trade-off: An increased risk for permanent diverting stomas. This risk may become especially concerning in patients with upper rectal cancers. The study revealed that patients with upper rectal cancers did not experience a survival benefit from neoadjuvant radiotherapy and had the highest risk for permanent diverting stomas. 'The trade-off between [neoadjuvant radiotherapy] use and diverting stoma nonreversal may not be justified for upper rectal cancer, emphasizing the importance of considering tumor height when treating resectable [locally advanced rectal cancer],' wrote senior author Chao-Han Lai, MD, PhD, from National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan, and colleagues. The Trade-Off The standard of care for resectable locally advanced rectal cancer has been neoadjuvant radiation and chemotherapy followed by surgery for resectable locally advanced rectal cancers. However, some recent studies have called that standard into question. For instance, the recent PROSPECT trial indicated that many patients without high-risk features could forgo radiation before surgery and just receive neoadjuvant chemotherapy. To better understand the optimal approach for these patients, Lai and colleagues analyzed data from 3792 individuals undergoing curative resection for locally advanced rectal cancer between January 1, 2014, and December 31, 2017, with follow-up until December 31, 2020. Patients were registered on the Taiwan Cancer Registry Database and the Taiwan National Health Insurance Database. A target trial emulation framework was applied to simulate randomization of 1308 who underwent neoadjuvant radiotherapy followed by surgery (median age, 62 years) and 2484 who underwent upfront surgery (median age, 65 years). Among patients in the neoadjuvant radiotherapy group, 82.3% received long-course radiotherapy, and 78.6% received concurrent 5-fluorouracil–based chemotherapy. Patients were followed from the date of treatment until death or December 31, 2020, whichever came first. Primary outcomes were overall survival and local recurrence, and a secondary outcome was intraoperative diverting stoma that remained permanent 3 years after surgery. The researchers found that 3-year overall rates were significantly higher in the radiotherapy group than in the upfront surgery group (88.5% vs 85.2%; hazard ratio [HR], 0.74; 95% CI, 0.59-0.92), though local recurrence rates were not significantly different (5.7% vs 6.6%; HR, 0.78; 95% CI, 0.55-1.11). However, the trade-off in the neoadjuvant radiotherapy group was a higher rate of both intraoperative stoma creation and nonreversal of those stomas. Overall, 49.4% of patients underwent intraoperative diverting stoma creation — 65.5% in the neoadjuvant radiotherapy group and 41.0% in the upfront surgery group (relative risk [RR], 1.6). While 71.6% of all stomas were closed within 1 year of treatment, patients in the radiotherapy group had a nearly twofold higher rate of permanent diverting stoma at 3 years in the radiotherapy group (20.6% vs 11.1% in the surgery group; RR, 1.91). Tumor Height Matters A subgroup analysis revealed that the 3-year overall survival benefit of neoadjuvant radiotherapy was greatest in patients with lower rectal cancers (HR, 0.66). While 3-year overall survival was better among those with middle rectal cancers (90.3% vs 84.5%), the difference was not statistically significant (HR, 0.70; 95% CI, 0.48-1.02). And for those with upper rectal disease, neoadjuvant radiotherapy offered no survival benefit (HR, 1.54; 95% CI, 0.82-2.90). Similarly, for 3-year local recurrence, neoadjuvant radiotherapy led to a statistically significant benefit for lower rectal cancers (HR, 0.53), but not middle (HR, 1.13; 95% CI, 0.60-2.14) or upper (HR, 1.08; 95% CI, 0.23-5.00). Likewise, while the risk of diverting stoma creation and permanent diverting stomas was higher with the neoadjuvant radiotherapy group than in the upfront surgery group overall, the risks were highest for upper rectal cancer (RR, 3.61 and RR, 3.54, respectively) and lowest for lower rectal cancer (RR, 1.31 and RR, 1.62, respectively). 'Thus, for upper rectal cancer, the trade-off between using [neoadjuvant radiotherapy] to pursue better oncological outcomes and creating diverting stomas to lower the risk of symptomatic leak may not be justified,' the authors concluded. 'These findings raise concerns about the potential overtreatment and harm of neoadjuvant radiotherapy.' The Findings in Context George Chang, MD, who wasn't involved in the research, noted that no prior randomized studies have demonstrated an overall survival benefit with radiation. 'The primary reason we give radiation is to decrease local recurrence risk,' explained Chang, chair of Colon and Rectal Surgery at The University of Texas MD Anderson Cancer Center in Houston. But, Chang noted, in North America and other parts of the world, the use of neoadjuvant radiotherapy is already based on factors such as tumor location, microsatellite instability status, and patient preferences. Still, 'we are likely overtreating some rectal cancer patients with radiotherapy in the US if we broadly apply a recommendation for radiotherapy for all patients without risk stratification,' he said. 'Indeed, the greatest benefit of radiotherapy is for those patients with low rectal cancers or those with locally advanced cancers with high-risk features such as at-risk circumferential margins. Those with proximal rectal cancers, especially above the pelvic reflection, are least likely to benefit.' Deborah Schrag, MD, chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York City, agreed. 'When proximal tumors are in the upper rectum and lymph nodes appear to be uninvolved, US practice guidelines continue to endorse surgical resection as a treatment option,' she said. 'The risk is that if surgical pathology identifies more extensive involvement, postoperative radiation could be indicated — and we know that postoperative radiation is less well tolerated than preoperative treatment,' Schrag added. The bottom line, according to Schrag, is 'when it comes to rectal cancer, one size does not fit all.' No disclosures were reported. This study was supported by grants from the Taiwan Ministry of Science and Technology and the National Cheng Kung University Hospital.
TECHx
13-05-2025
- Business
- TECHx
ECS to Unveil Full Range of Smart Solutions at COMPUTEX 2025
Home » COMPUTEX » COMPUTEX 2025 » ECS to Unveil Full Range of Smart Solutions at COMPUTEX 2025 Elitegroup Computer Systems (ECS) confirms its participation in COMPUTEX 2025, taking place from May 20 to 23 at Nangang Exhibition Center Hall 1, Booth I0118. The company will showcase its complete portfolio of intelligent, AI-powered solutions across multiple categories. These include ultra-portable laptops, commercial notebooks, Chromebooks, commercial motherboards, the LIVA Mini PC range, server solutions, and the new EliteSpace OBC. Live demos will highlight how ECS solutions enhance performance across various industries. ECS will launch a new range of AI-powered laptops tailored for mobile professionals and business users. The lineup features the 14-inch UP42 series (UP42AR, UP42KP, UP42PW) and the 15.3-inch UP52PW. These models offer advanced on-device AI using NPU technology for seamless multitasking and smart workflows. The laptops support multiple processors, including Intel® Core™ Ultra Series 2, AMD Krackan Point, and Snapdragon X Plus. They also feature: Dual-slot DDR5 memory and up to 1TB PCIe 4.0 NVMe M.2 SSD Ultra-slim metal chassis, Full HD IPS display, 88% narrow bezel Tri-band WLAN and USB4 support for up to 40Gbps Security and portability are key, while battery life is optimized for all-day productivity. These models are compatible with Copilot+ and built to adapt to future AI needs. In addition, ECS will debut the Q870H8-M and B860H8-M8 motherboards. These support Intel® Core™ Ultra processors (LGA 1851) and are ideal for digital workloads and AI applications. Key features include: Q870H8-M: 192GB DDR5, PCIe Gen5/Gen4, dual M.2 SSDs, quad display outputs B860H8-M8: 96GB DDR5, USB4 (40Gbps), PCIe Gen5, M.2 WLAN, 2.5G LAN ECS will also highlight its LIVA Mini PCs, featuring Intel® Core™ Ultra and AMD Ryzen™ AI chips. Models such as LIVA Z11 PLUS, Z10 PLUS, Z8 PLUS, and Z6 PLUS support up to four 4K displays, dual SSDs, DDR5/DDR4 memory, USB4, and dual LAN. These are ideal for smart retail, education, and edge computing. The LIVA One series (SF110-Q870, SF110-B860, One PRO600) includes support for Intel® LGA1851 and AMD AM5 sockets, up to 96GB DDR5 RAM, and enterprise tools like Intel® vPro, DASH, and TPM 2.0. ECS will also launch new GPU servers to meet growing demand in AI and HPC. These range from desktop models for edge AI to high-density 4U and 6U systems with support for up to 8 GPU cards. They are built for flexibility, connectivity, and high-speed processing in labs, data centers, and enterprise AI environments. Finally, ECS will present the EliteSpace OBC platform for low-earth orbit satellite missions. Built on a patented COTS design, it uses an ARM Cortex M7 processor and includes integrated flight software. The OBC kit includes development boards, simulation tools, and flight-ready models. The first orbital launch is planned with National Cheng Kung University's Lilium3 CubeSat in Q4 2025. These systems offer strong I/O, compact design, and shielding against interference—ideal for academic, research, and industrial satellite programs. ECS invites visitors to explore all innovations firsthand at Booth I0118 during COMPUTEX 2025.
