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Pathologic response to neoadjuvant treatment in locally advanced rectal cancer and impact on outcome

Jalilian, Mahshid, Davis, Sidney, Mohebbi, Mohammadreza, Sugamaran, Bhuvana, Porter, Ian W., Bell, Stephen, Warrier, Satish K. and Wale, Roger 2016, Pathologic response to neoadjuvant treatment in locally advanced rectal cancer and impact on outcome, Journal of gastrointestinal oncology, vol. 7, no. 4, pp. 603-608, doi: 10.21037/jgo.2016.05.03.

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Title Pathologic response to neoadjuvant treatment in locally advanced rectal cancer and impact on outcome
Author(s) Jalilian, Mahshid
Davis, Sidney
Mohebbi, Mohammadreza
Sugamaran, Bhuvana
Porter, Ian W.
Bell, Stephen
Warrier, Satish K.
Wale, Roger
Journal name Journal of gastrointestinal oncology
Volume number 7
Issue number 4
Start page 603
End page 608
Total pages 6
Publisher Pioneer Bioscience Publishing Company
Place of publication Hong Kong, China
Publication date 2016-08
ISSN 2078-6891
Keyword(s) rectal cancer
chemoradiotherapy (CRT)
histopathology response
Summary BACKGROUND: Downstaging and pathologic complete response (pCR) after chemoradiotherapy (CRT) may improve progression-free survival and overall survival (OS) after curative therapy of locally advanced adenocarcinoma of rectum. The purpose of this study is to evaluate the pathologic response subsequent to neoadjuvant chemoradiation in locally advanced rectal adenocarcinoma and any impact of response on oncological outcome [disease-free survival (DFS), OS]. METHODS: A total of 127 patients with histologically-proven rectal adenocarcinoma, locally advanced, were treated with preoperative radiotherapy and concurrent 5-fluorouracil (5 FU), and followed by curative surgery. Pathologic response to neoadjuvant treatment was evaluated by comparing pathologic TN (tumour and nodal) staging (yp) with pre-treatment clinical staging. DFS and OS were compared in patients with: pCR, partial pathologic response and no response to neoadjuvant therapy. RESULTS: 14.96% (19 patients) had a pCR, 58.27% [74] showed downstaging and 26.77% [34] had no change in staging. At follow-up (range, 4-9 years, median 6 years 2 months or 74 months), 17.32% [22] showed recurrence: 15.74% [20] distant metastasis, 1.57% [2] pelvic failure. 10.5% [2] of the patients with pCR showed distant metastasis, none showed local recurrence. In the downstaged group, nine developed distant failure and two had local recurrence (14.86%). Distant failure was seen in 26.47% [9] of those with no response to neoadjuvant treatment. DFS and OS rates for all groups were 82.67% and 88.97% respectively. Patients with pCR showed 89.47% DFS and 94.7% OS. In partial responders, DFS was 85.1% and OS was 90.5%. In non-responders, DFS and OS were 73.5% and 82.3% respectively. Patients with pCR had a significantly greater probability of DFS and OS than non-responders. Rectal cancer-related death was 11.02% [14]: one patient (5.26%) with pCR, 9.47% [7] in the downstaged group and 17.64% [6] of non-responders. CONCLUSIONS: The majority of patients showed some response to neoadjuvant treatment. Findings of this study indicate tumour response to neoadjuvant CRT improves the long-term outcome, with a better result in patients with pCR.
Language eng
DOI 10.21037/jgo.2016.05.03
Field of Research 111299 Oncology and Carcinogenesis not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Journal of Gastrointestinal Oncology
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Document type: Journal Article
Collections: Faculty of Health
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Created: Mon, 05 Dec 2016, 13:45:59 EST

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