Complete Pathological Response Following Radiochemotherapy for Locally Advanced Rectal Cancer: Short and Long-term Outcome

Abstract

Background/Aim: Preoperative radiochemotherapy (RCT) followed by total mesorectum excision has become the gold standard for locally advanced carcinoma of the low and middle rectum. The aim of the study is to evaluate the short and long-term outcomes of patients in complete pathological response (PR) following this treatment sequence. Patients and Methods: One hundred and thirty patients were retrospectively included between 2005 and 2017 in an expert centre, with 3 groups formed, according to the PR: i) complete PR (absence of tumour cells on the surgical specimen ypT0N0), ii) partial PR (T or N downsizing) and iii) without PR. Results: The complete PR rate was 13.1%. The complete PR group tended to develop less symptomatic fistulas compared to partial PR and without PR groups (5.8% versus 13.5% versus 18.7, respectively; p=0.607). The 5-year disease-free survival was increased for complete-PR patients (93% versus 79% versus 47%, respectively; p=0.0003) without an improvement in overall survival. Conclusion: Complete PR is associated with an improvement in survival without recurrence and without an improvement in the overall survival at 5 years.

Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer

“…As a result, the identification of biologic markers associated with pCR and tumor downstaging have become an increasing focus of research. [8][9][10] The Kirsten rat sarcoma (KRAS) gene is one of the most common mutations found in colorectal cancer, which is seen in approximately 30%-50% of cases.…”

“…Although several disease‐ and treatment‐related factors including histopathologic stage, tumor size, radiation therapy dosing, and timing of surgery 3 have been associated with pCR and low NAR scores, tumor biology appears to be the most important factor in determining response to treatment. As a result, the identification of biologic markers associated with pCR and tumor downstaging have become an increasing focus of research 8–10 . The Kirsten rat sarcoma ( KRAS ) gene is one of the most common mutations found in colorectal cancer, which is seen in approximately 30%–50% of cases.…”

The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

“…Interestingly, data from literature show a wide variety of response to neoadjuvant treatments, with complete clinical responses ranging from 8 to 30% [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

The efficacy and dosimetry analysis of CT-guided 125I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer

“…Locally recurrent rectal cancer (LRRC) is defined as an intrapelvic recurrence following a primary rectal cancer resection, with or without distal metastasis. Concurrent preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery plus systemic chemotherapy is the first recommended standard treatment for patients with resectable rectal cancer (stage II-III) [ 1 – 3 ]. This treatment strategy has significantly decreased local recurrence rate and increased disease free survival (DFS) rate.…”