Aurelie Garant1, Livia Florianova2, Adrian Gologan2, Alan Spatz2, Julio Faria3, Nancy Morin3, Carol-Ann Vasilevsky3, Te Vuong4. 1. Sir Mortimer B. Davis Jewish General Hospital, Department of Radiation Oncology, McGill University, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada. aurelie.garant@mail.mcgill.ca. 2. Sir Mortimer B. Davis Jewish General Hospital, Department of Pathology, McGill University, Montreal, Canada. 3. Sir Mortimer B. Davis Jewish General Hospital, Department of Surgery, McGill University, Montreal, Canada. 4. Sir Mortimer B. Davis Jewish General Hospital, Department of Radiation Oncology, McGill University, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada.
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.
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.
Authors: Julio Garcia-Aguilar; Oliver S Chow; David D Smith; Jorge E Marcet; Peter A Cataldo; Madhulika G Varma; Anjali S Kumar; Samuel Oommen; Theodore Coutsoftides; Steven R Hunt; Michael J Stamos; Charles A Ternent; Daniel O Herzig; Alessandro Fichera; Blase N Polite; David W Dietz; Sujata Patil; Karin Avila Journal: Lancet Oncol Date: 2015-07-14 Impact factor: 41.316
Authors: J Joshua Smith; Oliver S Chow; Marc J Gollub; Garrett M Nash; Larissa K Temple; Martin R Weiser; José G Guillem; Philip B Paty; Karin Avila; Julio Garcia-Aguilar Journal: BMC Cancer Date: 2015-10-23 Impact factor: 4.430