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Endoscopic evaluation of clinical response after preoperative chemoradiotherapy for lower rectal cancer: the significance of endoscopic complete response

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The management of rectal cancer is a significant oncologic challenge because rectal cancer has a poor prognosis among the various types of colorectal cancer. There have been several recent reports on a nonoperative approach for advanced lower rectal cancer, and this may be best for local disease control. However, objective evaluation of tumor response after preoperative chemoradiotherapy has not been standardized. The purpose of this study is to evaluate our method of endoscopic evaluation of complete response.

Methods

This is a retrospective chart review. All patients received a long course of preoperative chemoradiotherapy (5-fluorouracil-based chemotherapy and 45–50.4 Gy) followed by radical surgical resection from May 2005 to March 2012 in The Cancer Institute Hospital of Japanese Foundation for Cancer Research. One hundred fifty-seven patients were reviewed consecutively. Criteria for endoscopic complete response were defined with a focus on the degree of ulcer healing and pit pattern without magnification.

Results

Endoscopic CR (E-CR) evaluation with our definitions reflected histopathologic response evaluation with an accuracy of 91.7 %, sensitivity of 27.8 %, specificity of 100 %, positive predictive value (PPV) of 100 %, and negative predictive value (NPV) of 91.4 % (p < 0.001). Our criteria of E-CR led all cases of y-clinical CR (ycCR) to pathological CR.

Conclusions

Endoscopic evaluation focused on the degree of ulcer healing, and pit pattern without magnification is useful for judging ycCR.

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References

  1. (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 336:980–987

  2. Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Article  CAS  PubMed  Google Scholar 

  3. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  CAS  PubMed  Google Scholar 

  4. Gerard A, Buyse M, Nordlinger B et al (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 208:606–614

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Moriya Y (1997) Rectal cancer surgery: optimisation, standardisation, and documentation. In: Soreide O, Norstein J (eds) Importance of lymphatic spread. Springer-Verlag Berlin and Heidelberg, New York, pp 153–164

    Google Scholar 

  6. Murata K, Okamura S, Okubo H et al (2013) Neoadjuvant chemoradiotherapy with capecitabine and oxaliplatin for the treatment of locally advanced lower rectal cancer. Gan To Kagaku Ryoho 40:2020–2022

    PubMed  Google Scholar 

  7. Inomata M, Akagi T, Nakajima K et al (2013) Prospective feasibility study to evaluate neoadjuvant-synchronous S-1 + RT for locally advanced rectal cancer: a multicenter phase II trial (UMIN ID: 03396). Jpn J Clin Oncol 43:321–323

    Article  PubMed  Google Scholar 

  8. Kuriu Y, Kokuba Y, Murayama Y et al (2012) Neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Gan To Kagaku Ryoho 39:1951–1953

    PubMed  Google Scholar 

  9. Akiyoshi T, Kuyoyanagi H, Oya M et al (2009) Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy. J Gastrointest Surg 13:521–525

    Article  PubMed  Google Scholar 

  10. Habr-Gama A, Sabbaga J, Gama-Rodrigues J et al (2013) Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 56:1109–1117

    Article  PubMed  Google Scholar 

  11. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (vesion 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  12. Kudo S, Tamura S, Nakajima T et al (1996) Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 44:8–14

    Article  CAS  PubMed  Google Scholar 

  13. Japanese Society for Cancer of the Colon and rectum (2009) Japanese classification of colorectal carcinoma, 2nd edn. Kanehara, Tokyo

    Google Scholar 

  14. Maas M, Beets-Tan RGH et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4634–4640

    Article  Google Scholar 

  15. Smith JD, Rudy JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256:965–972

    Article  PubMed  Google Scholar 

  16. Zomora O, Dasilva GM, Gurland B et al (2004) Does rectal wall tumor eradication with preoperative chemoradiation permit a change in the operative strategy? Dis Colon Rectum 47:1607–1612

    Article  Google Scholar 

  17. Suzuki T, Sadahiro S, Fukasawa M et al (2004) Predictive factors of tumor shrinkage and histological regression in patients who received preoperative radiotherapy for rectal cancer. Jpn J Clin Oncol 34:740–746

    Article  PubMed  Google Scholar 

  18. Yeo SG, Kim DY, Kim TH et al (2010) Tumor volume reduction rate measured by magnetic resonance xolumetry correkated with pathologic tumor response of preoperative chemotherapy fore rectal cancer. Int J Radiat Oncol Biol Phys 78:164–171

    Article  PubMed  Google Scholar 

  19. Kang JH, Kim YC, Kim H et al (2010) Tumor volume changes assessed by three-dimensional magnetic resonance volumetry in rectal cancer patients after preoperative chemoradiation: the impact of the volume reduction ratio on the prediction of pathologic complete response. Int J Radiat Oncol Biol Phys 76:1018–1025

    Article  PubMed  Google Scholar 

  20. Kim NK, Baik SH, Min BS et al (2007) A comparative study of volumetric analysis, histopathologic downstaging, and tumor regression grade in evaluating tumor response in locally advanced rectal cancer following preoperative chemoradiation. Int J Radiat Oncol Biol Phys 67:204–210

    Article  PubMed  Google Scholar 

  21. Tulchinsky H, Shmueli E, Figer A et al (2008) An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 15:2661–2667

    Article  PubMed  Google Scholar 

  22. Wolthuis AM, Penninckx F, Haustermans K et al (2012) Impact pathologic response and oncologic outcome. Ann Surg Oncol 19:2833–2841

    Article  PubMed  Google Scholar 

  23. Kalady MF, de Campos-Lobato LF, Stocchi L et al (2009) Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 250:582–589

    PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Atsushi Ogura, Tsuyoshi Konishi, Takashi Akiyoshi & Masashi Ueno

  2. Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Atsushi Ogura, Akiko Chino, Teruhito Kishihara, Yoshiro Tamegai & Masahiro Igarashi

Authors
  1. Atsushi Ogura
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  2. Akiko Chino
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  3. Tsuyoshi Konishi
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  4. Takashi Akiyoshi
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  5. Teruhito Kishihara
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  6. Yoshiro Tamegai
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  7. Masashi Ueno
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  8. Masahiro Igarashi
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Correspondence to Atsushi Ogura.

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Ogura, A., Chino, A., Konishi, T. et al. Endoscopic evaluation of clinical response after preoperative chemoradiotherapy for lower rectal cancer: the significance of endoscopic complete response. Int J Colorectal Dis 30, 367–373 (2015). https://doi.org/10.1007/s00384-014-2105-6

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  • DOI: https://doi.org/10.1007/s00384-014-2105-6

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