Assessing The Predictive Value of Clinical Complete Response To Neoadjuvant Therapy for Rectal Cancer: An Analysis of 488 Patients

Hiotis, Spiros P.; Weber, Sharon M.; Cohen, Alfred M.; Minsky, Bruce D.; Paty, Phillip; Guillem, José G.; Wagman, Raquel; Saltz, Leonard B.; Wong, W. Douglas

doi:10.1016/s1072-7515(01)01159-0

Cited by 345 publications

(192 citation statements)

References 14 publications

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“…Continuing evaluation of MRI, positron emission tomography and endoscopic ultrasound after neoadjuvant treatment as a guide to surgical management may allow more conservative approach for responding patients. However as noted in our study and other studies (Hiotis et al, 2002), many patients with clinical CR had persistent foci of tumours that were not detectable on preoperative imaging, therefore treatment decisions should not be based solely on the absence of clinically palpable or visible tumour after chemoradiation. Indeed, one patient with clinical CR in our study was found to have residual tumour and CRM involvement following resection highlighting the risk of no excision after obtaining a clinical CR.…”

Section: Discussionsupporting

confidence: 45%

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n ¼ 30, CT alone n ¼ 6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m À2 day À1 for 12 weeks) with mitomycin C (MMC) (7 mg m À2 i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m À2 day À1 and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4 -9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range ¼ 40 -85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI ¼ 64 -91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in one patient. Neoadjuvant systemic chemotherapy as a prelude to synchronous chemoradiation can be administered with negligible risk of disease progression and produces considerable symptomatic response with associated tumour regression.

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Section: Discussionsupporting

confidence: 45%

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

et al. 2003

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“…However, the question remains of how important this is, as there are only two circumstances is which the presence of lymph node metastases is relevant in clinical decision making: first, the choice of local excision in the absence of lymphadenopathy and second the present of lymph node metastases outside the end pelvic envelope makes the primary tumor locally advanced [31][32][33]. In this first situation the histological characteristics of the primary tumor are now relevant than lymph node imaging [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Rectal Cancer and Invasion of Veins: Importance in TNM Staging 2

Lorant¹,

Kiss²

2016

J Blood Lymph

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Summary: Accurate information about infiltration of the tumor to the various layers of the rectal wall is important. Material and methods:A histopathological study of surgical specimens from 351 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52%. Results:Follow-up studies showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present.Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick-walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick-walled extramural veins, had greatest adverse influence of all.Venous spread of tumor takes place in parallel with local spread as measured by the Dukes' stage but exerts an influence on prognosis independent of the Dukes' stage.Similarly, veins invasion parallels the number of lymph nodes metastases but appears to exert an independent influence on prognosis. Conclusion:The venous spread provides a precise assessment of the likely behavior of rectal cancer, but does not replace indices such as the Dukes' stage, or the number of lymph nodes metastases in use.

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“…Hiotis [16] reported that a cCR had a sensitivity of 77% and specificity of 16% for pCR. when comparing preoperative clinical exam with surgical specimen.…”

Section: Complete Clinical Responsementioning

confidence: 99%

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

Scully¹,

C²,

Lee-Kong³

2017

J Clin Gastroenterol Hepatol

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The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiation followed by radical proctectomy with total mesorectal excision. A significant percentage of patients exhibit a pathological complete response with associated survival benefit. The management of patients who exhibit a complete clinical response after neoadjuvant chemoradiation, and could potentially avoid major resection, is a topic of great interest in colorectal surgery today. This paper reviews treatment options for this population.

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Assessing The Predictive Value of Clinical Complete Response To Neoadjuvant Therapy for Rectal Cancer: An Analysis of 488 Patients

Cited by 345 publications

References 14 publications

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

Rectal Cancer and Invasion of Veins: Importance in TNM Staging 2

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

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