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Mucinous Rectal Adenocarcinoma Can Be Associated to Tumor Downstaging after Preoperative Chemoradiotherapy

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Diseases of the Colon & Rectum

Abstract

Purpose

The aim of this study was to evaluate downstaging as primary end point, and progression-free survival and overall survival as secondary end points, in rectal adenocarcinoma patients treated with preoperative chemoradiation.

Methods

One hundred and thirty-six extraperitoneal adenocarcinoma patients (33 low rectum T2, 74 T3, 29 T4 [without sacral invasion], 25 with mucinous subtype) were treated with posterior pelvis preoperative radiotherapy (5040 cGy total dose, 180 cGy/fr, 5 fr/w, 10–15 MV linac X-rays) and concomitant 5-fluorouracil-based chemotherapy. After 6 to 8 weeks patients underwent surgery and prechemoradiation clinical stage was compared with pathologic stage to evaluate downstaging in each patient. Seventy-four patients received adjuvant chemotherapy. Median follow-up was 39 months (4–84).

Results

Forty-four patients had macroscopic complete response, 52 patients had partial response, 37 patients showed no change and 3 patients had progression. At multivariate analysis only histotype showed correlation with downstaging (hazard ratio = 0.350 and 0.138 – 0.885 95 percent confidence interval) because of the evidence for poor downstaging in mucinous subtype. There were no significant differences in overall survival and progression-free survival between adenocarcinoma and mucinous subtype.

Conclusions

The main finding is that mucinous histology is associated with poor downstaging after preoperative chemoradiation but this poor response was not associated with worse outcome in this small study. The good outcome for mucinous histology is at odds with other reports in the literature and requires further study.

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Authors and Affiliations

  1. Dipartimento di Oncologia e Radioterapia Generale, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy

    Filippo Grillo-Ruggieri M.D., Giovanna Mantello M.D., Rossana Berardi M.D., Massimo Cardinali M.D., Francesco Fenu M.D., Giuseppina Iovini M.D., Maria Montisci M.D., Letizia Fabbietti M.D., Maurizio Bonsignori M.D. & Stefano Cascinu M.D.

  2. Dipartimento delle Malattie Digestive e Chirurgia Generale, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy

    Cristina Marmorale M.D. & Mario Guerrieri M.D.

  3. Patologia Chirurgica, Istituto Nazionale Ricerca e Cura Anziani, Ancona, Italy

    Vittorio Saba M.D.

  4. Dipartimento di Patologia, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy

    Italo Bearzi M.D.

  5. Oncologia, Ospedale Santa Croce, Fano, Italy

    Rodolfo Mattioli M.D.

Authors
  1. Filippo Grillo-Ruggieri M.D.
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  2. Giovanna Mantello M.D.
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  3. Rossana Berardi M.D.
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  4. Massimo Cardinali M.D.
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  5. Francesco Fenu M.D.
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  6. Giuseppina Iovini M.D.
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  7. Maria Montisci M.D.
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  8. Letizia Fabbietti M.D.
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  9. Cristina Marmorale M.D.
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  10. Mario Guerrieri M.D.
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  11. Vittorio Saba M.D.
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  12. Italo Bearzi M.D.
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  13. Rodolfo Mattioli M.D.
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  14. Maurizio Bonsignori M.D.
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  15. Stefano Cascinu M.D.
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Corresponding author

Correspondence to Filippo Grillo-Ruggieri M.D..

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Grillo-Ruggieri, F., Mantello, G., Berardi, R. et al. Mucinous Rectal Adenocarcinoma Can Be Associated to Tumor Downstaging after Preoperative Chemoradiotherapy. Dis Colon Rectum 50, 1594–1603 (2007). https://doi.org/10.1007/s10350-007-9026-1

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  • DOI: https://doi.org/10.1007/s10350-007-9026-1

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