Abstract
Background: Rectal carcinoma tends to recur locally, with invasion of adjacent organs and significant pelvic pain. Both radiation therapy alone and combined chemoradiation have been used in an attempt to decrease the local recurrence rate and thereby improve survival. Although preoperative chemoradiation can clinically downstage rectal tumors, the pathologic extent of the residual disease has not been studied.
Methods: Thirty-seven patients with T3 rectal cancer diagnosed by transrectal ultrasonography (uT3) received 45 Gy with continuous infusion 5-fluorouracil (300 mg/m2/day). Proctoscopy with mucosal/submucosal biopsy was performed in patients (16 of 37) posttreatment and before definitive surgery.
Results: Microscopic evaluation of the 37 resected specimens showed a 30% (11 patients) pathologic complete remission rate. The pattern of residual disease in the remaining 26 patients showed that nine (25%) had microscopic residual tumor without evidence of mucosal involvement. Of the 14 patients with a negative proctoscopic evaluation and biopsy only, five (36%) had no residual tumor on final pathology.
Conclusions: After chemoradiation, the pathologic presentation of rectal cancer may be altered, making endoscopic procedures and mucosal/submucosal biopsies unreliable in detection of residual disease. Despite the relatively good pathologic complete remission rate noted in this study, all patients undergoing chemoradiation for uT3 rectal carcinomas need definitive surgical resection to confirm a complete clinical remission.
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References
American Cancer Society Cancer Statistics. 1989;39:1–32.
Kodner IJ, Shemesh EI, Fry RD, et al. Preoperative irradiation for rectal cancer: improved local control and long-term survival.Ann Surg 1989;209:194–9.
Higgins GA Jr, Conn JH, Jordan PH, et al. Preoperative radiotherapy for colorectal cancer.Ann Surg 1975;181:624–31.
Gastrointestinal Study Group. Prolongation of the diseasefree interval in surgically treated rectal carcinoma.New Engl J Med 1985;312:1465–72.
Fisher B, Wolmark N, Rockette C, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01.J Natl Cancer Inst 1980;80:21–9.
Byfield JE, Frankel SS, Hoenback CL, et al. Phase I and pharmacological study of 72 hr infused and hypofractionated cyclical radiation.Int J Radiat Oncol Biol Phys 1985;11:791–800.
Rotman M, Aziz H. Concomitant continuous infusion chemotherapy and radiation.Cancer 1990;65:823–35.
Minsky BD, Cohen AM, Kemeny N, et al. Enhancement of radiation-induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy.J Natl Can Inst 1992;10:79–84.
Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound.Dis Colon Rectum 1985;28:24–6.
Miles WE, A method for performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon.Lancet 1908;2:1812–3.
Mendenhall WM, Bland K, Rout R, et al. Clinically resectable adenocarcinoma of the rectum treated with preoperative irradiation and surgery.Dis Colon Rectum 1988;31:287–90.
Stockholm Rectal Cancer Study Group. Preoperative shortterm radiation therapy in operable rectal carcinoma: a prospective randomized trial.Cancer 1990;66:49–55.
Gerard A, Buyse M, Nordberger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer.Ann Surg 1988;208:606–14.
Dahl O, Horn A, Morld I, et al. Low dose preoperative radiation postpones recurrences in operable rectal cancer: results of a randomized multicenter trial in Western Norway.Cancer 1990;66:2286–94.
Napoleon B, Pujol B, Berger F, et al. Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy.Br J Surg 1991;78:785–8.
Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high risk rectal carcinoma.New Engl J Med 1991;324:709–15.
Luna-Perez P, Barrentos H, Delgado S. Usefulness of frozen-section examination in resected mid-rectal cancer after preoperative radiation.Am J Surg 1990;159:582–4.
Winchester DP, Cox JD. Standards for breast-conservation treatment.CA 1992;42:135–63.
Mohuiddin M, Marks G. High dose preoperative irradiation for cancer of the rectum.Int J Radiat Oncol Biol Phys 1991;20:37–43.
Stevens KP, Allen CV, Fletcher WS. Preoperative radiotherapy for adenocarcinoma of the rectosigmoid.Cancer 1976;37:2866–74.
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Meterissian, S., Skibber, J., Rich, T. et al. Patterns of residual disease after preoperative chemoradiation in ultrasound T3 rectal carcinoma. Annals of Surgical Oncology 1, 111–116 (1994). https://doi.org/10.1007/BF02303553
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DOI: https://doi.org/10.1007/BF02303553