Pathologic Complete Response of Primary Tumor Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Yeo, Seung‐Gu; Kim, Dae Yong; Kim, Tae Hyun; Chang, Hee Jin; Oh, Jae Hwan; Park, Won; Choi, Doo Ho; Nam, Heerim; Kim, Jun Sang; Cho, Moon June; Kim, Jong Hoon; Park, Jin‐Hong; Kang, Min Kyu; Koom, Woong Sub; Kim, Jae Sung; Nam, Taek Keun; Chie, Eui Kyu; Kim, Jung Soo; Lee, Kyung Ja

doi:10.1097/sla.0b013e3181f3f1b1

Cited by 171 publications

(102 citation statements)

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“…En este estudio sobre pacientes sometidos a XRTQ preoperatoria por CR avanzado, se observó un 15% de RPC, lo que es concordante con lo comunicado en otras series, con cifras variables entre 10% y 30% 5 . Publicaciones recientes que incluyen un número significativo de pacientes muestran que aquellos con RPC tienen una mejor sobrevida a 5 años y menores tasas de recidiva local.…”

Section: Discussionunclassified

“…De manera que la respuesta en la pared intestinal a la radioterapia, no garantiza la ausencia de metástasis linfáticas. De acuerdo a experiencias recientemente publicadas, este subgrupo de pacientes tendría una sobrevida a 5 años menor que la comunicada cuando se comprueba RPC 5 . Este hallazgo sería una indicación para completar el tratamiento quirúrgico con quimioterapia adyuvante.…”

Section: Discussionunclassified

“…Un 10-30% de los pacientes sometidos a XRTQ preoperatoria logran una RPC 5,6. Hay un subgrupo de pacientes en los que en el estudio de la pieza operatoria se demuestra que no hay tumor en la pared rectal: respuesta mural completa (RMC), pero hay presencia de metástasis ganglionares.…”

Section: Respuesta Patológica Completa En Pacientes Sometidos a Neoadunclassified

“…Hay un subgrupo de pacientes en los que en el estudio de la pieza operatoria se demuestra que no hay tumor en la pared rectal: respuesta mural completa (RMC), pero hay presencia de metástasis ganglionares. Este hallazgo se observa en el 2 a 17% de aquellos con RMC 7,8. Varios estudios sugieren fuertemente que la RPC se relaciona con un mejor control local de la enfermedad, sobrevida libre de enfermedad y sobrevida global 5,9,10 . Desafortunadamente la RPC y RMC son conocidos cuando se obtiene el estudio histopatológico de la pieza operatoria y el único elemento que pudiera anticipar una RPC o una RMC es el examen endoscópico de la lesión, 6 a 8 semanas después de terminada la XRTQ.…”

Section: Respuesta Patológica Completa En Pacientes Sometidos a Neoadunclassified

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Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto

et al. 2013

Rev Chil Cir

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Pathologic complete response in patients with neoadjuvant chemoradiotherapy for rectal cancer Background: The standard treatment of locally advanced rectal cancer (RC) of the middle and lower third of the rectum is neoadjuvant chemoradiotherapy (XRQT) follow by oncologic resection. After this treatment in 15-25% of the cases, the pathologist reports complete pathological response (pCR). Aim: To describe demographic, clinical and survival data of patients with pCR undergoing chemoradiotherapy and radical resection for RC. Material and Methods: Historic cohort study. In a prospectively maintained database between 2000 and 2010, we identified patients with RC, who underwent neoadjuvant chemoradiotherapy according to protocol, followed by radical resection. The preoperative staging was obtained by clinical examination, endoscopy, rectal ultrasound, CT scan of chest, abdomen and pelvis and pelvic MRI. Demographic data, tumor location, time between the end of XRTQ and surgery, postoperative staging (according AJCC) and survival, were collected. Results: 119 patients received preoperative XRTQ, 65% male, with a mean age of 58 years. The most frequent tumor site was the lower third (63%). Surgery was performed 8 weeks after the end of XRTQ. Of 119 patients with XRTQ, 15.1% had a pCR. Overall survival was 75%, and cancerspecific survival was 80.4% at 5 years in patients without pCR. For patients with pCR, the 5 year survival estimates for overall and cancer specific survival was 100%. We did not identify factors associated with pCR. Conclusions: In this study, pCR was comparable to other larger series reported elsewhere. No factors associated with pCR were identified.Key words: Pathological complete response, rectal cancer, neoadjuvant chemoradiotherapy. ResumenIntroducción: El cáncer de recto (CR) de tercio medio e inferior localmente avanzado se trata con radio-quimioterapia (XRTQ) preoperatoria. Luego XRQT y resección quirúrgica, 15-25% presentan respuesta patológica completa (RPC) de la lesión. Objetivo: Comparar características demográficas, clínicas y sobrevi-

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Section: Discussionunclassified

Section: Respuesta Patológica Completa En Pacientes Sometidos a Neoadunclassified

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Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto

et al. 2013

Rev Chil Cir

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“…En nuestra serie no hemos tenido recidiva local en pacientes con una RPC o casi completa, lo que en series más numerosas no supera el 2,6% 4,7 . En el seguimiento a largo plazo en este escenario los pacientes muestran una sobrevida libre de enfermedad entre 88 y 100% 2,4,7,8 . Desgraciadamente, la RP es pobre en dos tercios de los pacientes, con una tasa relativamente alta de recidiva local (10%) y de mortalidad por cáncer en este subgrupo de pacientes (25%), similar a otras series de mayor envergadura 4 .…”

Section: Discussionunclassified

Valor pronóstico de la respuesta patológica a la radioquimioterapia preoperatoria en el cáncer de recto bajo localmente avanzado

et al. 2013

Rev Chil Cir

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Prognostic value of pathological response to chemo radiotherapy of locally advanced low rectal cancer Background: Preoperative chemo radiotherapy improves the prognosis of locally advanced low rectal cancer and induces a pathological response in the tumor, which may have prognostic value. Aim: To assess the results of rectal cancer treatment according to the degree of pathological response of the tumor after chemo radiotherapy. Patients and Methods: All patients with a locally advanced rectal cancer located within 11 cm of the rectal margin, subjected to preoperative chemo radiotherapy followed by surgical treatment in a period of 13 years, were included. Pathological response was classified as complete, intermediate and poor. The tumor was staged according to TNM 2002 classification. Survival was analyzed with Kaplan Meier curves and Cox regression. Results: Patients were followed for a mean of 50 months (range 18-156). Exclusive and global local relapse was observed in 3 and 9.6% of patients, respectively. Pathological response was complete in 13 patients (none died), intermediate in 23 (three died) and poor in 68 (22 died). Global five years survival was 74%. There was a concordance of 0.64 between survival and pathological response. The concordance between survival and TNM classification was 0.69. Conclusions: The pathological response of the tumor to chemo radiotherapy has a good concordance with prognosis, although it is not superior to the final pathological status.

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Modern Multidisciplinary Perioperative Management of Rectal Cancer

et al. 2015

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Pathologic Complete Response of Primary Tumor Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Abstract: LARC patients achieving ypT0N0 after preoperative CRT had favorable long-term outcomes, whereas positive ypN status had a poor prognosis even after total regression of primary tumor.

Cited by 171 publications

References 21 publications

Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto

Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto

Valor pronóstico de la respuesta patológica a la radioquimioterapia preoperatoria en el cáncer de recto bajo localmente avanzado

Modern Multidisciplinary Perioperative Management of Rectal Cancer

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