Do clinical criteria reflect pathologic complete response in rectal cancer following neoadjuvant therapy?

  • Aurelie Garant
  • Livia Florianova
  • Adrian Gologan
  • Alan Spatz
  • Julio Faria
  • Nancy Morin
  • Carol-Ann Vasilevsky
  • Te Vuong
Original Article
  • 58 Downloads

Abstract

Background

Clinical complete response (cCR) in rectal cancer is being evaluated as a tool to identify patients who would not require surgery in the curative management of rectal cancer. Our study reviews mucosal changes after neoadjuvant therapy for rectal cancer in patients treated at our center.

Methods

Pathology reports were retrieved for patients treated with neoadjuvant chemoradiation therapy (CRT) or high-dose rate brachytherapy (HDRBT). The macroscopic appearance of the specimen was compared with pathologic staging.

Results

This study included 282 patients: 88 patients underwent neoadjuvant CRT and 194 patients underwent HDRBT; all patients underwent total mesorectal excision (TME). There were 160 male and 122 female patients with a median age of 65 years (range 29–87). The median time between neoadjuvant therapy and surgery was 50 and 58 days. Sixty patients (21.2%) were staged as ypT0N0, 21.2% had a pathologic complete response (pCR), and only 3.2% had a cCR. Of the 67 patients with initial involvement of the circumferential radial margin (CRM), 44 converted to pathologic CRM−. Two hundred seventy-three patients (96.8%) had mucosal abnormalities. Of the 222 patients with residual tumor, 70 patients had no macroscopic tumor visualized but an ulcer in its place.

Conclusion

Most patients undergoing neoadjuvant therapy for rectal cancer have residual mucosal abnormalities which preclude to a cCR as per published criteria from Brazil. Further studies are required to optimize clinical evaluation and MRI imaging in selected patients.

Keywords

Pathologic response High-dose rate brachytherapy Clinical complete response 

Notes

Author contribution

Aurelie Garant M.D., Livia Florianova M.D. M.Sc., Adrian Gologan M.D., Alan Spatz M.D. Ph.D., Julio Faria M.D., Nancy Morin M.D., Carol-Ann Vasilevsky M.D., and Te Vuong M.D. have all provided substantial contributions to the conception work, assisted in writing the work and approving the final version, and agreed to be accountable for the accuracy and integrity of all aspects of the work.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sir Mortimer B. Davis Jewish General Hospital, Department of Radiation OncologyMcGill UniversityMontrealCanada
  2. 2.Sir Mortimer B. Davis Jewish General Hospital, Department of PathologyMcGill UniversityMontrealCanada
  3. 3.Sir Mortimer B. Davis Jewish General Hospital, Department of SurgeryMcGill UniversityMontrealCanada

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