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Pathological response after chemoradiation for T3 rectal cancer
Author(s) -
Chennupati S. K.,
Kamaya A.,
Fisher G. A.,
Ford J. M.,
Kunz P.,
Itakura H.,
Welton M. L.,
Shelton A.,
Van Dam J.,
Koong A. C.,
Chang D. T.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.02013.x
Subject(s) - medicine , capecitabine , adenocarcinoma , chemoradiotherapy , colorectal cancer , pathological , radiation therapy , gastroenterology , cancer
Objective The aim of this study was to investigate the effect of preoperative chemoradiotherapy (CRT) on nodal disease in locally advanced rectal adenocarcinoma. Method Thirty‐two patients staged uT3N0 and 27 patients staged uT3N1 rectal adenocarcinoma who underwent pre‐CRT staging using endoscopic ultrasound or rectal protocol CT were included. The median radiation dose was 50.4 Gy (range: 45–50.4 Gy) at 1.8 Gy per fraction and all patients received concurrent 5‐FU or capecitabine‐based chemotherapy. Low anterior resection or abdomino‐perineal resection occurred at a median of 46 days (range: 27–112 days) after CRT. Results Eleven of 32 uT3N0 patients (34.4%) and 13 of 26 uT3N1 patients (50.0%) had ypN+ ( P = 0.29). For patients with uT3N0, 10 of 20 (50.0%) with ypT2‐3 and 1 of 12 (8.3%) with ypT0‐1 were ypN+ ( P = 0.02). For patients with uT3N1, 12 of 20 (60.0%) with ypT2‐3 and 1 of 6 (16.7%) with ypT0‐1 were ypN+ ( P = 0.16). Overall, the ypN+ rate was 11.1% in the ypT0‐yT1 group compared with 55.0% in the ypT2‐yT3 group ( P = 003). Among patients with uT3N0 disease, the ypN+ rate in patients who had surgery > 46 days vs ≤ 46 days was 7.1% vs 55.6% ( P = 0.01) respectively. Among patients with uT3N1 disease, the ypN+ rate in patients who had surgery > 46 days vs ≤ 46 days was 54.5% vs 46.7%, ( P = 0.99) respectively. Overall, the ypN+ rate in patients who had surgery > 46 days vs ≤ 46 days was 28.0% vs 51.5% ( P = 0.11). Conclusions The risk of residual nodal disease after CRT is significant. Primary tumour response is associated with nodal response.