Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: results of a randomised trial. Implication for subsequent local excision

Bujko, Krzysztof; Nowacki, Marek P.; Nasierowska‐Guttmejer, Anna; Kępka, Lucyna; Winkler-Spytkowska, B.; Suwiński, Rafał; Olędzki, Janusz; Stryczyńska, G.; Wieczorek, Andrzej; Serkies, Krystyna; Rogowska, Danuta; Tokar, Piotr

doi:10.1016/j.radonc.2005.04.004

Cited by 88 publications

(50 citation statements)

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“…Sin embargo, 3 de ellos (14%) tenían metástasis linfáticas en ganglios del mesorrecto (RMC). Este hecho también se ha observado en otros estudios, entre el 2 y 17% de los pacientes logran una RMC 7,8 . De manera que la respuesta en la pared intestinal a la radioterapia, no garantiza la ausencia de metástasis linfáticas.…”

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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

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

et al. 2013

Rev Chil Cir

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“…Demonstrating a complete remission is important not only because of its prognostic value but also because of the need of assessment of indications for the postoperative chemotherapy or radiotherapy, for the decision about the appropriate method of surgery [20,37,45,46,49,57,58,63,64] or to compare the effects of different treatment methods [45] . Zmora et al [58] showed that metastases to regional lymph nodes and cancer cells in the mesorectal tissue may be present in patients with complete tumor regression within the rectal wall (TRG 1, ypT0) [58] .…”

Section: Discussionmentioning

confidence: 99%

“…Zmora et al [58] showed that metastases to regional lymph nodes and cancer cells in the mesorectal tissue may be present in patients with complete tumor regression within the rectal wall (TRG 1, ypT0) [58] . However, neo-adjuvant therapy makes it possible to reduce the percentage of patients submitted to abdominoperineal resection and, in some cases, to perform local tumor excision [15,25,41,49,[64][65][66][67] . Randomized study conducted by Polish researchers on a group of 316 patients treated with long-ter m radiochemotherapy or shor t-ter m preoperative radiotherapy did not show differences in terms of sphincter preservation rate (58% vs 61%, P = 0.57) [67] .…”

Section: Discussionmentioning

confidence: 99%

“…Randomized study conducted by Polish researchers on a group of 316 patients treated with long-ter m radiochemotherapy or shor t-ter m preoperative radiotherapy did not show differences in terms of sphincter preservation rate (58% vs 61%, P = 0.57) [67] . Appropriate selection of the study patients treated with local excision is a very important issue [41,[64][65][66]68] . The local tumor stage seems to be a reliable predictor of lymph node regression in these patients [41,64] .…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate selection of the study patients treated with local excision is a very important issue [41,[64][65][66]68] . The local tumor stage seems to be a reliable predictor of lymph node regression in these patients [41,64] . The assessment of eventual residual cancer, local stage (ypT), surgical clearance in the resection margins in patients submitted to local resection may reveal the necessity of immediate radical resection (performed within 30 d after the primary surgery) [65,66,68] .…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Liszka

Zielińska-Pająk²,

Pajak³

et al. 2007

WJG

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INTRODUCTIONColorectal cancer is the third most common malignancy diagnosed in the USA [1] . The estimated colorectal cancer mortality in the USA in 2006 is 55 170 [2] . The primary treatment method for rectal cancer is surgery, namely anterior rectal resection, abdomino-perineal resection or local excision [3][4][5][6] . Preoperative radiotherapy and radiochemotherapy play an increasing role in the treatment of rectal cancer [7][8][9][10][11][12][13] . The effectiveness of neo-adjuvant therapy may be assessed and monitored by means of longterm survival follow up, incidence of local recurrence, estimation of the percentage of patients with primary high stage tumor suitable for radical surgery, estimation of the percentage of patients suitable for sphincter-saving surgery or by monitoring the tumor stage using visualizing diagnostic methods [14,15] . Transrectal ultrasound (TRUS) is a useful method for the assessment of the local tumor stage and the regional lymph node status prior to neo-adjuvant therapy [3,4,6,16] . Basing on TRUS and histopathological examination one can define the tumor reg ression parameter "T-downstaging". Lower ypT parameter value (local tumor stage assessed by the pathologist in surgical specimen following neo-adjuvant therapy) than uT (local Abstract AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS:Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS:Complete regression (ypT0, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging" and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5.No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION:Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients

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Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer

et al. 2019

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for the CARTS Study Group IMPORTANCE Treatment of rectal cancer is shifting toward organ preservation aiming to reduce surgery-related morbidity. Short-term outcomes of organ-preserving strategies are promising, but long-term outcomes are scarce in the literature.OBJECTIVE To explore long-term oncological outcomes and health-related quality of life (HRQL) in patients with cT1-3N0M0 rectal cancer who underwent neoadjuvant chemoradiotherapy (CRT) followed by transanal endoscopic microsurgery (TEM). DESIGN, SETTING, AND PARTICIPANTSIn this multicenter phase II feasibility study, patients with cT1-3N0M0 rectal cancer admitted to referral centers for rectal cancer throughout the Netherlands between February 2011 and September 2012 were prospectively included. These patients were to be treated with neoadjuvant CRT followed by TEM in case of good response. An intensive follow-up scheme was used to detect local recurrences and/or distant metastases. Data from validated HRQL questionnaires and low anterior resection syndrome questionnaires were collected. Data were analyzed from February 2011 to April 2017. MAIN OUTCOMES AND MEASURESThe primary study outcome of the study was the number of ypT0-1 specimens by performing TEM. Secondary outcome parameters were locoregional recurrences and HRQL. RESULTSOf the 55 included patients, 30 (55%) were male, and the mean (SD) age was 64 (39-82) years. Patients were followed up for a median (interquartile range) period of 53 (39-57) months. Two patients (4%) died during CRT, 1 (2%) stopped CRT, and 1 (2%) was lost to follow-up. Following CRT, 47 patients (85%) underwent TEM, of whom 35 (74%) were successfully treated with local excision alone. Total mesorectal excision was performed in 16 patients (4 with inadequate responses, 8 with completion after TEM, and 4 with salvage for local recurrence). The actuarial 5-year local recurrence rate was 7.7%, with 5-year disease-free and overall survival rates of 81.6% and 82.8%, respectively. Health-related quality of life during follow-up was equal to baseline, with improved emotional well-being in patients treated with local excision (mean score at baseline, 72.0; 95% CI, 67.1-80.1; mean score at follow-up, 86.9; 95% CI, 79.2-94.7; P = .001). Major, minor, and no low anterior resection syndrome was experienced in 50%, 28%, and 22%, respectively, of patients with successful organ preservation. CONCLUSIONS AND RELEVANCEIn early-stage rectal cancer (cT1-3N0M0), CRT enables organ preservation with additional TEM surgery in approximately two-thirds of patients with good long-term oncological outcome and HRQL. This multimodality treatment triggers a certain degree of bowel dysfunction, and one-third of patients still undergo radical surgery and are overtreated by CRT.

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Prediction of mesorectal nodal metastases after chemoradiation for rectal cancer: results of a randomised trial. Implication for subsequent local excision

Cited by 88 publications

References 35 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

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer

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