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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2018

01-06-2018 | Original Article

Do clinical criteria reflect pathologic complete response in rectal cancer following neoadjuvant therapy?

Authors: Aurelie Garant, Livia Florianova, Adrian Gologan, Alan Spatz, Julio Faria, Nancy Morin, Carol-Ann Vasilevsky, Te Vuong

Published in: International Journal of Colorectal Disease | Issue 6/2018

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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.
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Metadata
Title
Do clinical criteria reflect pathologic complete response in rectal cancer following neoadjuvant therapy?
Authors
Aurelie Garant
Livia Florianova
Adrian Gologan
Alan Spatz
Julio Faria
Nancy Morin
Carol-Ann Vasilevsky
Te Vuong
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 6/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-018-3033-7

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