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MULTIDISCIPLINARY TREATMENT OF RECTAL CANCER: THE ASSESSMENT OF CLINICAL AND PATHOLOGIC RESPONSE FOR LOCALLY ADVANCED RECTAL CANCER TREATED WITH NEOADJUVANT CHEMORADIOTHERAPY

https://doi.org/10.17650/2220-3478-2012-0-1-7-10

Abstract

Preoperative staging by digital examination, endorectal ultrasound and magnetic resonance imaging (MRI) allows an assessment of the risk of local recurrence after surgery alone. The successful management of rectal cancer requires a multidisciplinary approach, with treatment decisions based on precise patient evaluations. Chemoradiotherapy (CRT) is associated with reduction of tumor size and downstaging.
The aim of this study is to assess how often complete clinical response is achieved after eoadjuvant CRT and its concordance with pathologic complete response.
Results. Patients with biopsy-proven, locally advanced rectal cancer (T3, T4) were treated by CRT followed by radical surgery. Tumors were re-assessed after 8 weeks from CRT completion using MRI and endoscopic examination. The results of examination were compared
with the final histopathologic status.
Conclusions. Neoadjuvant CRT leads to significant tumor regression and in some patients there is complete disappearance of neoplasm. MRI combining with colonoscopic findings is a useful tool to evaluate these features.

About the Authors

I. V. Pravosudov
N.N. Petrov Research Institute of Oncology, Ministry of Health and Social Development of Russia, Saint Petersburg
Russian Federation


I. I. Aliyev
N.N. Petrov Research Institute of Oncology, Ministry of Health and Social Development of Russia, Saint Petersburg
Russian Federation


A. V. Shulepov
N.N. Petrov Research Institute of Oncology, Ministry of Health and Social Development of Russia, Saint Petersburg
Russian Federation


P. I. Krzhivitsky
N.N. Petrov Research Institute of Oncology, Ministry of Health and Social Development of Russia, Saint Petersburg
Russian Federation


References

1. Злокачественные новообразования в России в 2004 году (заболеваемость и смертность). Под ред. В.И. Чиссова, В.В. Старинского. М.: Антиф, 2005. 258 с.

2. Sauer R., Becker H., Hohenberger W. et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731–40.

3. Vauthey J.N., Marsh R.W., Zlotecki R.A. et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg 1999;229(5):745–54.

4. Kapiteijn E., Marijnen C.A., Nastegaal I.D. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 200;345:638–46.

5. Perez R.O, Habr-Gama A., Proscurshim I. et al. Local excision for ypT2 rectal cancer — much ado about something. J Gastrointest Surg 2007;11:1431–40.

6. Chan A.K., Wong A., Jenken D. et al. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005;61:665–77.

7. Kim D.W., Kim D.Y., Kim T.H. et al. Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer? Cancer 2006;106:1694–700.

8. Stipa F., Chessin D.B., Shia J. et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieve no downstaging on the basis of preoperative endorectal ultrasonography. Ann Surg Oncol 2006;13:1047–53.

9. Quirke P., Dixon M.F. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 1988;3(2):127–31.

10. Capirci C., Valentini V., Cionini L. et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72(1):99–107.

11. Rödel C., Martus P., Papadoupolos T. et al. Prognostic significance of tumor regression after preoperative radiotherapy for rectal cancer. J Clin Oncol 2005;23(34):8688–96.

12. Chen C.C., Lee R.C., Lin J.K. et al. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 2005;48(4):722–8.

13. MERCURY study group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006;333(7572):779–84.

14. Smith N.J., Barbahano Y., Norman A.R. et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 2007;95(2):229–36.

15. Eisenhauer E.A. et al. New response evalution criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–47.

16. Blomqvist L., Machado M., Rubio C. et al. Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol 2000;10(4):653–60.

17. Fuchsjäger M.H., Maier A.G., Schima W. et al. Comparison of transrectal sonography and double — contrast MR imaging when staging rectal cancer. Am J Roentgenol 2003;181(2):421–7.

18. Theodoropoulos G., Wise W.E., Padmanabhan A. et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer results in decreased recurrence and improved disease-free survival. Dis Colon Rectum 2002;45:895–903.

19. Garcia-Aguilar J., Hernandez de Anda E., Sirivongs P. et al. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003;46:298–304.

20. Crane C.H., Skibber J.M., Birnbaum E.H. et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumour response, leading to increased sphincter preservation in locally advanced low rectal cancer. Int J Radiat Oncol Biol Phys 2003;57:84–9.

21. Guillem J.G., Chessin D.B., Shia J. et al. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate endpoint. J Clin Oncol 2005;23:3475–9.

22. Habr-Gama A., Perez R.O., Nadalin W. et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: longterm results. Ann Surg 2004;240:711–7.

23. Hoffmann K.T., Rau B., Wust P. et al. Restaging of locally advanced carcinoma of the rectum with MR imaging after preoperative radio-chemotherapy plus regional hyperthermia. Strahlenther Oncol 2002;178(7):386–92.

24. Maier A.G., Barton P.P., Neuhold N.R. et al. Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation. Radiology 1997;203(3):785–9.


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