Pathologic Complete Response in Rectal Cancer

Nahas, Sérgio Carlos; Nahas, Caio Sérgio Rizkallah; Marques, Carlos Frederico Sparapan; Ribeiro, Ulysses; Cotti, Guilherme Cutait de Castro; Imperiale, Antônio Rocco; Capareli, Fernanda; Chen, André Tsin Chih; Hoff, Paulo M.; Cecconello, Ivan

doi:10.1097/dcr.0000000000000558

Cited by 99 publications

(45 citation statements)

References 19 publications

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“…13–27 Eight studies reported data for an adequate control proctectomy group, but there was significant variation. Four used a post-surgical pathological complete response (pCR) group for comparison 14,16,25,26 , 2 used cCR tumors undergoing surgery, 19,20 1 used both, 22 and 1 used a surgical group matched for clinical stage (regardless of tumor response). 23 Outcome data for incomplete response, non-response, and local excision were excluded from comparisons as these were not regarded as adequate control group data.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, the use of consolidation or adjuvant chemotherapy was highly variable, ranging from frequent use, 18,25,26 to use only if staged as node positive prior to neoadjuvant treatment, 15,21 infrequent use, 14,20,23 and complete omission. 13,16,17,19,22 Consolidation or adjuvant chemotherapy, when used, was most commonly 5-FU based with the addition of Oxaliplatin in two studies. 21,25 …”

Section: Resultsmentioning

confidence: 99%

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Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

et al. 2017

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Purpose There is increasing interest in non-operative management (NOM) for rectal cancer with complete clinical (cCR) response after neoadjuvant chemoradiation (nCRT). The aim of this review is to summarize the available data on NOM, with the intention of formulating standardised protocols on which to base future investigation. Methods Systematic review following PRISMA guidelines was conducted. A highly sensitive literature search identified all relevant studies published between Jan 2004 and Dec 2016. Data extraction and quality assessment was performed independently by two authors, and resolved by consensus with a third. Results In total, 15 studies met inclusion criteria including 920 patients, 575 (62.5%) who underwent NOM after cCR, and the rest forming a surgical control group. The weighted mean followup was 39.4 (12.7) months in the NOM group and 39.8 (5.1) months in the surgery group. The pooled re-growth rate in the NOM group was 21.3% at a mean of 15.6 (7.0) months. Surgical salvage was possible and undertaken in 93.2% of these patients. Overall survival in the NOM group was 91.7%, and disease free survival was 82.7%. For the comparison proctectomy group, pooled rates of local recurrence, overall survival and disease free survival were 8.4%, 92.4%, and 87.5%, respectively. Conclusion NOM may be a feasible option for surgically eligible rectal cancer patients with cCR after nCRT. Before such a strategy can be widely implemented, further prospective data is required with standardised definitions, diagnostic criteria, and management protocols, with an emphasis on shared patient-provider decision making and patient centered outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

et al. 2017

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“…In addition, the colostomy-free survival was significantly better in the observational group (47% vs 74%, P 0.001). Evaluation of clinic complete response according to current adopted criteria has low sensitivity [39], so how to identify the patients with a cCR who may potentially benefit from the nonoperative management is still a problem.…”

Section: Discussionmentioning

confidence: 99%

Total neoadjuvant chemoradiotherapy (consolidation chemotherapy during the interval after chemoradiotherapy) for distal rectal cancer increases the rates of complete response

Zhai¹,

Zhang²,

Wang³

et al. 2020

Preprint

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Objective To compare the safety and efficacy between neoadjuvant concurrent chemoradiotherapy (CRT) and total neoadjuvant chemoradiotherapy (TNT) in patients with locally advanced rectal cancer. Methods Patients with cT3/T4 or TxN+M0 rectal cancer were randomized to receive CRT/TNT. In CRT group, we planned pelvic radiotherapy (50.0Gy in 25 fractions) with two cycles of concurrent CAPOX followed by total mesorectal excision (TME). In TNT group, 3 cycles of CAPOX were administered 2 weeks after the completion of CRT before TME. The primary endpoints of my study were pathological complete response (pCR) rates in the two cohorts. Results A total of 197 patients were included in our study. Eighty-one patients received CRT while one hundred and sixteen patients received TNT (consolidation chemotherapy). Nine patients did not undergo surgery because of the distant metastases (1 patient (1.2%) in CRT group, 2 patients (1.7%) in TNT group) or clinical complete response (cCR) (2 patients in CRT group, 4 patients in TNT group). The rate of pathological complete response in TNT was significantly higher than the rate in CRT (32.7% vs12.8%, P =0.002). No grade 4 or serious adverse events were observed. There was no statistically significant difference in the grade 3 acute toxicities of neoadjuvant treatment and surgical complications between the two groups (all P >0.05). Conclusions Our data suggests that total neoadjuvant chemoradiotherapy (consolidation chemotherapy) is effective and safe for patients with locally advanced rectal cancer and is associated with high rates of pathological complete response. The long-term follow-up and survival outcomes for patients are necessary to be evaluated in future prospective randomized trial.

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“…This method has been adopted globally in the selection of patients for organ preservation (43). Despite the good results, up to 15% of complete responders are still missed, due to the fact that many complete responding patients may show some findings that are often associated with residual tumor (e.g., ulcers at endoscopy, focal diffusion signal on DWI, irregular nodes on T2W-MRI among others) (44)(45)(46). Unfortunately, biopsies are of limited clinical value in this setting, because of the risk for sampling error and a risk for false positive findings (e.g., dysplasia in biopsy, but complete response in the TME specimen) (44,(46)(47)(48).…”

Section: Response Evaluationmentioning

confidence: 99%

Modern MR Imaging Technology in Rectal Cancer; There Is More Than Meets the Eye

Haak

Maas

2020

Front. Oncol.

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MR imaging (MRI) is now part of the standard work up of patients with rectal cancer. Restaging MRI has been traditionally used to plan the surgical approach. Its role has recently increased and been adopted as a valuable tool to assist the clinical selection of clinical (near) complete responders for organ preserving treatment. Recently several studies have addressed new imaging biomarkers that combined with morphological provides a comprehensive picture of the tumor. Diffusion-weighted MRI (DWI) has entered the clinics and proven useful for response assessment after chemoradiotherapy. Other functional (quantitative) MRI technologies are on the horizon including artificial intelligence modeling. This narrative review provides an overview of recent advances in rectal cancer (re)staging by imaging with a specific focus on response prediction and evaluation of neoadjuvant treatment response. Furthermore, directions are given for future research.

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Pathologic Complete Response in Rectal Cancer

Abstract: Evaluation of clinic complete response according to current adopted criteria has low sensitivity because pathologic complete response more frequently presented as clinic incomplete response (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A221).

Cited by 99 publications

References 19 publications

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

Nonoperative Management or ‘Watch and Wait’ for Rectal Cancer with Complete Clinical Response After Neoadjuvant Chemoradiotherapy: A Critical Appraisal

Total neoadjuvant chemoradiotherapy (consolidation chemotherapy during the interval after chemoradiotherapy) for distal rectal cancer increases the rates of complete response

Modern MR Imaging Technology in Rectal Cancer; There Is More Than Meets the Eye

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