Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease‐free survival after preoperative radiochemotherapy for advanced rectal cancer

Objective  The reduction in tumour stage induced by full course radiotherapy plus chemotherapy is apparent from histological changes. The purpose of this study was to determine the rate of complete pathological response and to evaluate the prognostic value for disease free survival (DFS) and disease specific survival (DSS) of the response. The relation between pretreatment variables (age, gender, stage, tumour height and [carcinoembryogenic antigen (CEA)] and postsurgical variables was compared to the pathological response.

[1]  Laurence Collette,et al.  Chemotherapy with preoperative radiotherapy in rectal cancer. , 2006, The New England journal of medicine.

[2]  J. Jass,et al.  Recommendations for the reporting of surgically resected specimens of colorectal carcinoma , 2006, Virchows Archiv.

[3]  Rainer Fietkau,et al.  Preoperative versus postoperative chemoradiotherapy for rectal cancer. , 2004, The New England journal of medicine.

[4]  S. Andreola,et al.  Pathological features of rectal cancer after preoperative radiochemotherapy , 1998, International Journal of Colorectal Disease.

[5]  H. Ueno,et al.  Preoperative Parameters Expanding the Indication of Sphincter Preserving Surgery in Patients With Advanced Low Rectal Cancer , 2004, Annals of surgery.

[6]  C. L. Brown,et al.  Response to Preoperative Chemoradiation in Stage II and III Rectal Cancer , 2003, Diseases of the colon and rectum.

[7]  V. Mehta,et al.  Radiotherapy, concomitant protracted-venous-infusion 5-fluorouracil, and surgery for ultrasound-staged T3 to T4 rectal cancer , 2001, Diseases of the colon and rectum.

[8]  O Søreide,et al.  Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer , 2002, The British journal of surgery.

[9]  M. Ychou,et al.  Conservative Surgery for Low Rectal Carcinoma After High‐Dose Radiation Functional and Oncologic Results , 1995, Annals of surgery.

[10]  Rieken,et al.  [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer]. , 2001, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[11]  W. Hohenberger,et al.  Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  C. Rödel,et al.  Apoptosis as a cellular predictor for histopathologic response to neoadjuvant radiochemotherapy in patients with rectal cancer. , 2002, International journal of radiation oncology, biology, physics.

[13]  J. Petiot,et al.  Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations , 1994, Cancer.

[14]  G. Williams,et al.  A histopathological assessment of the response of rectal adenocarcinoma to combination chemo-radiotherapy: relationship to apoptotic activity, p53 and bcl-2 expression. , 1998, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[15]  Rainer Fietkau,et al.  Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  A. Koong,et al.  Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer. , 2003, International journal of radiation oncology, biology, physics.

[17]  C. Compton,et al.  Rectal cancer: the influence of tumor proliferation on response to preoperative irradiation. , 1995, International journal of radiation oncology, biology, physics.

[18]  D. Rothenberger,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 , 2003, Diseases of the colon and rectum.

[19]  M. Mazumdar,et al.  Long-term Oncologic Outcome Following Preoperative Combined Modality Therapy and Total Mesorectal Excision of Locally Advanced Rectal Cancer , 2005, Annals of surgery.

[20]  D. Treanor,et al.  Pathological response following long‐course neoadjuvant chemoradiotherapy for locally advanced rectal cancer , 2005, Histopathology.

[21]  R. Pazdur,et al.  Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. , 1999, International journal of radiation oncology, biology, physics.

[22]  R. Zucali,et al.  Preoperative radiotherapy for resectable cancer of the middle-distal rectum: its effect on the primary lesion as determined by endorectal ultrasound using flexible echo colonoscope , 1996, International Journal of Colorectal Disease.

[23]  J. Jass,et al.  Recommendations for the reporting of surgically resected specimens of colorectal carcinoma: Association of Directors of Anatomic and Surgical Pathology. , 2008, American journal of clinical pathology.

[24]  P. Bioulac-Sage,et al.  Impact of Colloid Response on Survival After Preoperative Radiotherapy in Locally Advanced Rectal Carcinoma , 2005, The American journal of surgical pathology.

[25]  P. Finan.  The Association of Coloproctology of Great Britain and Ireland , 2007 .

[26]  B. Dörken,et al.  Dynamic expression profile of p21WAF1/CIP1 and Ki-67 predicts survival in rectal carcinoma treated with preoperative radiochemotherapy. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  L Påhlman,et al.  Improved survival with preoperative radiotherapy in resectable rectal cancer. , 1997, The New England journal of medicine.

[28]  C. Taylor,et al.  T-Level Downstaging and Complete Pathologic Response After Preoperative Chemoradiation for Advanced Rectal Cancer Result in Decreased Recurrence and Improved Disease-Free Survival , 2002, Diseases of the colon and rectum.

[29]  I. Nagtegaal,et al.  Circumferential Margin Involvement Is Still an Important Predictor of Local Recurrence in Rectal Carcinoma: Not One Millimeter but Two Millimeters Is the Limit , 2002, The American journal of surgical pathology.

[30]  C. del Rio,et al.  Response to neoadjuvant therapy for rectal cancer: influence on long‐term results , 2005, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[31]  J. Jass,et al.  Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. , 2007, Human pathology.

[32]  T. Conroy,et al.  Preoperative (preop) radiotherapy (RT) + 5FU/folinic acid (FA) in T3,4 rectal cancers: Preliminary results of the FFCD 9203 randomized trial , 2004 .

[33]  P. Quirke,et al.  Rates of Circumferential Resection Margin Involvement Vary Between Surgeons and Predict Outcomes in Rectal Cancer Surgery , 2002, Annals of surgery.