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Evaluating the incidence of pathological complete response in current international rectal cancer practice : the barriers to widespread safe deferral of surgery

Battersby, Nick and Frasson, Matteo (2018) In Colorectal Disease 20(Suppl 6). p.58-68
Abstract

INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging... (More)

INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.

METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.

RESULTS: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).

CONCLUSION: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.

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author
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LU ; LU and LU
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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Chemoradiotherapy, Adjuvant, Europe, Female, Humans, Incidence, Magnetic Resonance Imaging, Male, Medical Audit, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging/methods, Preoperative Period, Prospective Studies, Rectal Neoplasms/diagnostic imaging, Remission Induction, Reproducibility of Results, Response Evaluation Criteria in Solid Tumors, Treatment Outcome
in
Colorectal Disease
volume
20
issue
Suppl 6
pages
58 - 68
publisher
Wiley-Blackwell
external identifiers
  • scopus:85053820944
  • pmid:30255641
ISSN
1462-8910
DOI
10.1111/codi.14361
language
English
LU publication?
yes
additional info
Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.
id
d747bd01-572d-410b-b7bc-0b4d9d74d7ca
date added to LUP
2021-12-29 12:02:01
date last changed
2024-04-20 18:52:20
@article{d747bd01-572d-410b-b7bc-0b4d9d74d7ca,
  abstract     = {{<p>INTRODUCTION: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.</p><p>METHODS: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.</p><p>RESULTS: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).</p><p>CONCLUSION: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.</p>}},
  author       = {{Battersby, Nick and Frasson, Matteo}},
  issn         = {{1462-8910}},
  keywords     = {{Adult; Aged; Chemoradiotherapy, Adjuvant; Europe; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Medical Audit; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging/methods; Preoperative Period; Prospective Studies; Rectal Neoplasms/diagnostic imaging; Remission Induction; Reproducibility of Results; Response Evaluation Criteria in Solid Tumors; Treatment Outcome}},
  language     = {{eng}},
  number       = {{Suppl 6}},
  pages        = {{58--68}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{Evaluating the incidence of pathological complete response in current international rectal cancer practice : the barriers to widespread safe deferral of surgery}},
  url          = {{http://dx.doi.org/10.1111/codi.14361}},
  doi          = {{10.1111/codi.14361}},
  volume       = {{20}},
  year         = {{2018}},
}