Garant Aurelie, Florianova Livia, Gologan Adrian, Spatz Alan, Faria Julio, Morin Nancy, Vasilevsky Carol-Ann, Vuong Te
Sir Mortimer B. Davis Jewish General Hospital, Department of Radiation Oncology, McGill University, 3755 Cote-Ste-Catherine, Montreal, QC, H3T 1E2, Canada.
Sir Mortimer B. Davis Jewish General Hospital, Department of Pathology, McGill University, Montreal, Canada.
Int J Colorectal Dis. 2018 Jun;33(6):727-733. doi: 10.1007/s00384-018-3033-7. Epub 2018 Mar 30.
Clinical complete response (cCR) in rectal cancer is being evaluated as a tool to identify patients who would not require surgery in the curative management of rectal cancer. Our study reviews mucosal changes after neoadjuvant therapy for rectal cancer in patients treated at our center.
Pathology reports were retrieved for patients treated with neoadjuvant chemoradiation therapy (CRT) or high-dose rate brachytherapy (HDRBT). The macroscopic appearance of the specimen was compared with pathologic staging.
This study included 282 patients: 88 patients underwent neoadjuvant CRT and 194 patients underwent HDRBT; all patients underwent total mesorectal excision (TME). There were 160 male and 122 female patients with a median age of 65 years (range 29-87). The median time between neoadjuvant therapy and surgery was 50 and 58 days. Sixty patients (21.2%) were staged as ypT0N0, 21.2% had a pathologic complete response (pCR), and only 3.2% had a cCR. Of the 67 patients with initial involvement of the circumferential radial margin (CRM), 44 converted to pathologic CRM-. Two hundred seventy-three patients (96.8%) had mucosal abnormalities. Of the 222 patients with residual tumor, 70 patients had no macroscopic tumor visualized but an ulcer in its place.
Most patients undergoing neoadjuvant therapy for rectal cancer have residual mucosal abnormalities which preclude to a cCR as per published criteria from Brazil. Further studies are required to optimize clinical evaluation and MRI imaging in selected patients.
直肠癌的临床完全缓解（cCR）正被评估为一种用于识别在直肠癌根治性治疗中无需手术的患者的工具。我们的研究回顾了在我们中心接受治疗的直肠癌患者新辅助治疗后的黏膜变化。
检索接受新辅助放化疗（CRT）或高剂量率近距离放疗（HDRBT）患者的病理报告。将标本的宏观外观与病理分期进行比较。
本研究纳入282例患者：88例接受新辅助CRT，194例接受HDRBT；所有患者均接受了全直肠系膜切除术（TME）。有160例男性和122例女性患者，中位年龄为65岁（范围29 - 87岁）。新辅助治疗与手术之间的中位时间分别为50天和58天。60例患者（21.2%）分期为ypT0N0，21.2%达到病理完全缓解（pCR），仅有3.2%达到cCR。在最初累及环周切缘（CRM）的67例患者中，44例转变为病理CRM阴性。273例患者（96.8%）存在黏膜异常。在222例有残留肿瘤的患者中，70例未见宏观肿瘤，但在其位置有溃疡。
大多数接受直肠癌新辅助治疗的患者存在残留黏膜异常，根据巴西公布的标准，这排除了cCR的可能。需要进一步研究以优化对特定患者的临床评估和MRI成像。
