Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy

Abstract

Preoperative chemoradiotherapy is considered by many as the preferred treatment strategy for distal rectal cancer. The observation of complete tumour regression has led to the proposition of nonoperative management of selected patients with complete clinical response (cCR) following treatment. We present results for the treatment of distal rectal cancer during 1991-2005. We have outlined the issues concerning adequate tumour assessment, the definition of complete response, and the advantages and disadvantages of conservative or surgical resection in patients with clinical and radiological evidence of cCR.

Complete Clinical Response in Rectal Adenocarcinoma: Review of Treatment Options

“…Clinical assessment of cCR was inaccurate in 29 patients (8%) -Five patients classified as cCR (5%) developed early LR and underwent salvage surgery, while 24 patients (9.1%) determined to have incomplete clinical response had pCR on histological exam [15]. The sensitivity and specificity for cCR predicting pCR in this study is 80% and 98%, respectively.…”

Câncer ano-reto-cólico: aspectos atuais II - câncer colorretal - fatores de riscos e prevenção

“…Melhorou o controle local, mas não interferiu com a sobrevida global 15 . Porém, em outros estudos foi possível observar que, de fato, a radioterapia pré-operatória melhorava significativamente a sobrevida global dependente especificamente do câncer comparado quando o procedimento terapêutico foi apenas a operação cirúrgi-ca [16][17][18][19][20][21] , além de ter ampliado a chance de abordagens cirúrgicas menos radicais 21 Contudo, a pequena magnitude do benefício 14,15 aponta para uma maior preocupação no sentido da necessidade de se estabelecer critérios para identificar os pacientes que poderiam ser mais beneficiados com a radioterapia adjuvante 14 ou, eventualmente, com procedimentos cirúrgicos mais conservadores [22][23][24][25][26] , com todos os riscos inerentes 14,22 . Por outro lado, é possível enfeixar nesse conjunto a tática operatória, não só sob o aspecto da "cura" objetivada como sob a sombra dos danos possíveis.…”

Complete Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: Will DW MRI Hold the Key to Deciding Non Surgical Management?

“…[3,4,5,6,7] The assessment of CPR includes clinical examination, biopsy confirmation and a multipronged imaging evaluation which includes PET CT and MRI. [8,9] Multiparametric MR, in addition to its pre eminent role in staging, also plays an important role in the post treatment setting. This versatility of MRI is enhanced by diffusion weighted imaging (DWI) which reflects the cellularity of the tissue being imaged.…”