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A Pathologic Complete Response to Preoperative Chemoradiation Is Associated With Lower Local Recurrence and Improved Survival in Rectal Cancer Patients Treated by Mesorectal Excision

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Preoperative chemoradiation reduces tumor size and nodal metastasis in patients with rectal cancer. Tumor downstaging has been associated with an increased probability of a sphincter-saving procedure and with improved local control. However, pathologic complete response to chemoradiation has not been correlated with local control and patient survival. We studied the prognostic value of pathologic complete response to preoperative chemoradiation in rectal cancer patients. METHODS: We have prospectively followed up 168 consecutive patients with ultrasound Stages II (46) and III (122) rectal cancer treated by preoperative chemoradiation followed by radical resection with mesorectal excision; 161 had a curative resection. Recurrence and survival were compared with tumor characteristics and pathologic complete response. Average follow-up was 37 months. RESULTS: Tumor downstaging occurred in 97 (58 percent) patients, including 21 (13 percent) patients who had a pathologic complete response. None of the clinical or pathologic variables was associated with pathologic complete response. The estimated 5-year rate of local recurrence was 5 percent; of distant metastasis, 14 percent. None of the patients with pathologic complete response has developed disease recurrence. We found no difference in survival among patients with pathologic Stages I, II, or III tumors. CONCLUSIONS: A pathologic complete response to preoperative chemoradiation is associated with improved local control and patient survival. For patients without pathologic complete response, the pathology stage does not have prognostic significance.

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References

  1. ET Chen M Mohiuddin H Brodovsky G Fishbein G Marks (1994) ArticleTitleDownstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation Int J Radiat Oncol Biol Phys 30 169–175

    Google Scholar 

  2. BD Minsky AM Cohen N Kemeny et al. (1992) ArticleTitleEnhancement of radiation-induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy J Clin Oncol 10 79–84

    Google Scholar 

  3. P Rouanet JM Fabre JB Dubois et al. (1995) ArticleTitleConservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic results Ann Surg 221 67–73

    Google Scholar 

  4. BD Minsky AM Cohen WE Enker P Paty (1995) ArticleTitleSphincter preservation with preoperative radiation therapy and coloanal anastomosis Int J Radiat Oncol Biol Phys 31 553–559

    Google Scholar 

  5. NA Janjan VS Khoo J Abbruzzese et al. (1999) ArticleTitleTumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer Int J Radiat Oncol Biol Phys 44 1027–1038

    Google Scholar 

  6. BD Minsky AM Cohen WE Enker et al. (1997) ArticleTitlePreoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer Int J Radiat Oncol Biol Phys 37 289–295

    Google Scholar 

  7. MC Kaminsky-Forrett T Conroy E Luporsi et al. (1998) ArticleTitlePrognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer Int J Radiat Oncol Biolo Phys 42 935–941

    Google Scholar 

  8. AK Chan AO Wong J Langevin et al. (2000) ArticleTitlePreoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer Int J Radiat Oncol Biol Phys 48 843–856

    Google Scholar 

  9. G Theodoropoulos WE Wise A Padmanabhan et al. (2002) ArticleTitleT-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival Dis Colon Rectum 45 895–903

    Google Scholar 

  10. WJ Orrom WD Wong DA Rothenberger LL Jensen SM Goldberg (1990) ArticleTitleEndorectal ultrasound in the preoperative staging of rectal tumors. A learning experience Dis Colon Rectum 33 654–659

    Google Scholar 

  11. U Hildebrandt G Feifel (1985) ArticleTitlePreoperative staging of rectal cancer by intrarectal ultrasound Dis Colon Rectum 28 42–46

    Google Scholar 

  13. J Garcia-Aguilar J Pollack SH Lee et al. (2002) ArticleTitleAccuracy of endorectal ultrasonography in preoperative staging of rectal tumors Dis Colon Rectum 45 10–15

    Google Scholar 

  14. PJ Holdsworth D Johnston AG Chalmers et al. (1988) ArticleTitleEndoluminal ultrasound and computed tomography in the staging of rectal cancer Br J Surg 75 1019–1022

    Google Scholar 

  15. Y Katsura K Yamada T Ishizawa H Yoshinaka H Shimazu (1992) ArticleTitleEndorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer Dis Colon Rectum 35 362–368

    Google Scholar 

  16. DR Adams GJ Blatchford KM Lin CA Ternent AG Thorson MA Christensen (1999) ArticleTitleUse of preoperative ultrasound staging for treatment of rectal cancer Dis Colon Rectum 42 159–166

    Google Scholar 

  17. RS Chari DS Tyler MS Anscher et al. (1995) ArticleTitlePreoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum Ann Surgery 221 778–777

    Google Scholar 

  18. C Berger A De Muret P Garaud et al. (1997) ArticleTitlePreoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications Int J Radiation Oncology Biol Phys 37 619–617

    Google Scholar 

  19. SJ Burke BA Percarpio DC Knight EM Kwasnik (1998) ArticleTitleCombined preoperative radiation and mitomycin/5-fluorouracil treatment for locally advanced rectal adenocarcinoma J Am Coll Surg 187 164–170

    Google Scholar 

  20. JF Bosset V Magnin P Maingon et al. (2000) ArticleTitlePreoperative radiochemotherapy in rectal cancer Int J Radiat Oncol Biol Phys 46 323–327

    Google Scholar 

  21. NR Ahmad D Nagle (1997) ArticleTitleLong-term results of preoperative radiation therapy alone for stage T3 and T4 rectal cancer Br J Surg 84 1445–1448

    Google Scholar 

  22. IJ Kodner EI Shemesh RD Fry et al. (1989) ArticleTitlePreoperative irradiation for rectal cancer Ann Surg 209 194–199

    Google Scholar 

  23. NA Janjan J Abbruzzese R Pazdur et al. (1999) ArticleTitlePrognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer Radiother Oncol 51 153–160

    Google Scholar 

  24. TA Rich JM Skibber JA Ajani et al. (1995) ArticleTitlePreoperative infusional chemoradiation therapy for stage T3 rectal cancer Int J Radiat Oncol Biol Phys 32 1025–1029

    Google Scholar 

  25. CG Fu O Tominaga H Nagawa et al. (1998) ArticleTitleRole of p53 and p21/WAF1 detection in patient selection for preoperative radiotherapy in rectal cancer patients Dis Colon Rectum 41 68–74

    Google Scholar 

  26. JP Palazzo NJ Kafka L Grasso et al. (1997) ArticleTitleThe role of p53, p21 WAF1/CIP1, and bcl-2 in radioresistant colorectal carcinoma Hum Pathol 28 1189–1195

    Google Scholar 

  27. H Qiu P Sirivongs M Rothenberger DA Rothenberger J Garcia-Aguilar (2000) ArticleTitleMolecular prognostic factors in rectal cancer treated by radiation and surgery Dis Colon Rectum 43 451–459

    Google Scholar 

  28. C Gordon-Watson (1935) ArticleTitleDiscussion on the radium treatment of malignant disease of the rectum and anus Proc R Soc Med 28 1251–1263

    Google Scholar 

  29. J Papillon P Berard (1992) ArticleTitleEndocavitary irradiation in the conservative treatment of adenocarcinoma of the low rectum World J Surg 16 451–457

    Google Scholar 

  30. JD Brierley BJ Cummings CS Wong et al. (1995) ArticleTitleAdenocarcinoma of the rectum treated by radical external radiation therapy Int J Radiat Oncol Biol Phys 31 255–259

    Google Scholar 

  31. IJ Kodner MT Gilley EI Shemesh JW Fleshman RD Fry RJ Myerson (1993) ArticleTitleRadiation therapy as definitive treatment for selected invasive rectal cancer Surgery 114 850–857

    Google Scholar 

  32. A Habr-Gama PM de Souza U Ribeiro SuffixJr et al. (1998) ArticleTitleLow rectal cancer Dis Colon Rectum 41 1087–1096

    Google Scholar 

  33. SP Hiotis SM Weber AM Cohen et al. (2002) ArticleTitleAssessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer J Am Coll Surg 194 131–136

    Google Scholar 

  34. PR Williamson MD Hellinger SW Larach A Ferrara (1996) ArticleTitleEndorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation Dis Colon Rectum 39 45–49

    Google Scholar 

  35. A Bernini KI Deen RD Madoff WD Wong (1996) ArticleTitlePreoperative adjuvant radiation with chemotherapy for rectal cancer Ann Surg Oncol 3 131–135

    Google Scholar 

  36. H Kahn A Alexander J Rakinic D Nagle R Fry (1997) ArticleTitlePreoperative staging of irradiated rectal cancers using digital rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does not accurately predict T0, N0 pathology Dis Colon Rectum 40 140–144

    Google Scholar 

  37. B Rau M Hunerbein C Barth et al. (1999) ArticleTitleAccuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer Surg Endosc 13 980–984

    Google Scholar 

  38. B Barbaro A Schulsinger V Valentini P Marano M Rotman (1999) ArticleTitleThe accuracy of transrectal ultrasound in predicting the pathological stage of low-lying rectal cancer after preoperative chemoradiation therapy Int J Radiat Oncol Biol Phys 43 1043–1047

    Google Scholar 

  39. M Gavioli A Bagni I Piccagli S Fundaro G Natalini (2000) ArticleTitleUsefulness of endorectal ultrasound after preoperative radiotherapy in rectal cancer Dis Colon Rectum 43 1075–1083

    Google Scholar 

  40. JG Guillem J Puig-La Calle SuffixJr T Akhurst et al. (2000) ArticleTitleProspective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography Dis Colon Rectum 43 18–24

    Google Scholar 

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    Authors
    1. Julio García-Aguilar M.D., Ph.D.
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    2. Enrique Hernandez de Anda M.D.
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    3. Prayuth Sirivongs M.D.
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    4. Suk-Hwan Lee M.D.
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    5. Robert D. Madoff M.D.
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    6. David A. Rothenberger M.D.
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    García-Aguilar, J., Hernandez de Anda, E., Sirivongs, P. et al. A Pathologic Complete Response to Preoperative Chemoradiation Is Associated With Lower Local Recurrence and Improved Survival in Rectal Cancer Patients Treated by Mesorectal Excision. Dis Colon Rectum 46, 298–304 (2003). https://doi.org/10.1007/s10350-004-6545-x

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    • DOI: https://doi.org/10.1007/s10350-004-6545-x

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