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Can we predict pathologic complete response before surgery for locally advanced rectal cancer treated with preoperative chemoradiation therapy?

  • Li-Jen Kuo
  • Jeng-Fong Chiou
  • Cheng-Jeng Tai
  • Chun-Chao Chang
  • Ching-Huei Kung
  • Sey-En Lin
  • Chin-Sheng Hung
  • Weu Wang
  • Ka-Wai Tam
  • Hung-Chia Lee
  • Hung-Hua Liang
  • Yu-Jia ChangEmail author
  • Po-Li WeiEmail author
Original Article

Abstract

Background

Pathologic complete response has been proven to have oncological benefits for locally advanced rectal cancer treated with chemoradiation therapy. The aims of this study are to analyze and determine the factors to predict pathologic complete response for patients treated with preoperative neoadjuvant therapy.

Methods

Patients with biopsy-proven, locally advanced rectal cancer were treated neoadjuvantly followed by radical surgical resection. Tumors were re-assessed after completing chemoradiation, including pelvic magnetic resonance images, colonoscopic examination, and re-biopsy. The results of examination were compared with the final pathologic status.

Results

A retrospective chart review of 166 patients was conducted. Twenty-five patients (15.1%) had pathologic complete response after chemoradiation. The 5-year overall survival rates were better in the complete response group than the residual tumor group (91.1% vs. 70.8%; P = 0.047), and there were also significant differences in the 5-year disease-free survival rates between these two groups (91.1% vs. 70.2%; P = 0.027). The prediction rates for pathologic complete response by re-biopsy, magnetic resonance images, and colonoscopy were 21.4%, 33.3%, and 53.8%, respectively. In addition, when we further combine the results of colonoscopic findings and re-biopsy, the prediction rate for pathologic complete response reached 77.8% (P = 0.009).

Conclusions

Combining the results of the re-biopsy and post-treatment colonoscopic findings, we can achieve a good prediction rate for pathologic complete response. Post-treatment magnetic resonance images are not useful tools in predicting tumor clearance following chemoradiation.

Keywords

Chemoradiation Colonoscopy Complete pathologic response Magnetic resonance images Neoadjuvant therapy Rectal cancer 

Notes

Acknowledgments

This work was supported by Taipei Medical University and Hospital Grant (100TMU-TMUH-02).

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Li-Jen Kuo
    • 1
    • 2
    • 3
  • Jeng-Fong Chiou
    • 4
  • Cheng-Jeng Tai
    • 5
  • Chun-Chao Chang
    • 6
  • Ching-Huei Kung
    • 7
  • Sey-En Lin
    • 8
  • Chin-Sheng Hung
    • 1
    • 2
    • 3
  • Weu Wang
    • 2
    • 3
  • Ka-Wai Tam
    • 1
    • 2
    • 3
  • Hung-Chia Lee
    • 2
  • Hung-Hua Liang
    • 2
    • 3
  • Yu-Jia Chang
    • 1
    • 3
    Email author
  • Po-Li Wei
    • 1
    • 2
    • 3
    Email author
  1. 1.Graduate Institute of Clinical Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  2. 2.Division of General Surgery, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan
  3. 3.Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  4. 4.Department of Radiation OncologyTaipei Medical University HospitalTaipeiTaiwan
  5. 5.Division of Hematology and Oncology, Department of Internal MedicineTaipei Medical University HospitalTaipeiTaiwan
  6. 6.Division of Gastroenterology and Hepatology, Department of Internal MedicineTaipei Medical University HospitalTaipeiTaiwan
  7. 7.Department of Diagnostic RadiologyTaipei Medical University HospitalTaipeiTaiwan
  8. 8.Department of PathologyTaipei Medical University HospitalTaipeiTaiwan

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