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Rectal cancer – current treatment strategy and the tumor regression grade evaluation after neoadjuvant therapy in patients who underwent surgery at the I. Department of Surgery, General University Hospital in Prague between 2012 and 2016

Czech version

Authors: P. Koželský 1;  V. Frýba 1;  M. Bártů 2;  V. Černý 3;  J. Ulrych 1;  Z. Krška 1
Authors‘ workplace: I. chirurgická klinika − hrudní, břišní a úrazové chirurgie 1. lékařské fakulty Univerzity Karlovy a Všeobecná fakultní, nemocnice v Praze 1;  Ústav patologie 1. lékařské fakulty Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze 2;  Radiodiagnostická klinika 1. lékařské fakulty Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze 3
Published in: Rozhl. Chir., 2021, roč. 100, č. 2, s. 74-82.
Category: Original articles

Overview

Introduction: The article contains a summary of the issues of staging and therapy with an emphasis on the neoadjuvant treatment and associated tumor regression grade with the analysis of our own group of patients.

Methods: Retrospective analysis of patients with rectal cancer who underwent a surgery at the 1st Department of Surgery – Thoratic, Abdominal and Injury Surgery; First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic, focusing on those who underwent neoadjuvant chemoradiotherapy and their pathologists evaluated tumor regression grade after the resection.

Results: The group consists of 161 patients operated on between 2012 and 2016. 47 patients underwent neoadjuvant oncological treatment with further evaluation of the tumor regression grade by a pathologist, a scoring system according to Ryan was used. A complete pathological response was elicited in 10.4% of patients, no response in 35.4% of patients, and partial tumor regression in 54.2%.

Conclusion: Although there is a difference in our results compared to foreign publications, the proportion of patients remains comparable. Studies evaluating the advantages versus disadvantages of neoadjuvant therapy will certainly follow, and the question of the suitability of surgical treatment as the only curative solution is partially raised.

Keywords:

rectal cancer – neoadjuvant chemoradiotherapy – tumor regression grade – Ryan

Sources
  1. Hoch J, Dytrych P, Prausová J. Nádory konečníku. In: Krška Z, Hoskovec D, et al. Chirurgická onkologie. Praha, Grada publishing 2014:553−562.
  2. WWW.SVOD.CZ, 2017.
  3. Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer. Int Semin Surg Oncol. 2006;3:36. doi:10.1186/1477-7800-3-36.
  4. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;(01)28(suppl 4):iv22–40. doi:10.1093/annonc/mdx224.
  5. Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radio­logy 1999;211(1):215–22. doi: 10.1148/radiology.211.1.r99ap35215.
  6. Brouwer NPM, Stijns RCH, Lemmens VEPP, et al. Clinical lymph node staging in colorectal cancer; J Surg Oncol. 2018;44(8):1241–6. doi:10.1016/j.ejso.2018.04.008.
  7. Feeney G, Sehgal R, Sheehan M, et al. Neoadjuvant radiotherapy for rectal cancer management. World J Gastroenterol. 2019;25:4850–69 doi:  10.3748/wjg.v25.i33.4850.
  8. Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22: 277–281.
  9. Sauer R, Becker H, Hohenberger W, et al. German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740. doi: 10.1056/NEJMoa040694.
  10. Ansari N, Solomon MJ, Fisher RJ, et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group trial (TROG 01.04). Ann Surg. 2017;265:882–888. doi: 10.1097/SLA.0000000000001987.
  11. Croese AD, Lonie JM, Trollope, et al. A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors. Int J Surg. 2018;56:234–241. doi: 10.1016/j.ijsu.2018.06.031.
  12. Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev. 2008:CD006040 doi: 10.1002/14651858.CD006040.pub2.
  13. Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a po­pulation-based cross-sectional study. Colorectal Dis. 2013;15:1130–1139. doi: 10.1111/codi.12244.
  14. Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer 2015;14:106–114. doi: 10.1016/j.clcc.2014.12.007.
  15. Hendren SK, O‘Connor BI, Liu M, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005;242:212–223. doi: 10.1097/01.sla.0000171299.43954.ce.
  16. Ledebo A, Bock D, Prytz M, et al. Urogenital function 3 years after abdominoperineal excision for rectal cancer. Colorectal Dis. 2018;20:O123–O134 doi: 10.1111/codi.14229.
  17. Hopewell JW. Radiation-therapy effects on bone density. Med Pediatr Oncol. 2003;41:208–211. doi: 10.1002/mpo.10338.
  18. Jørgensen JB, Bondeven P, Iversen LH, et al. Pelvic insufficiency fractures frequently occur following preoperative chemo-radiotherapy for rectal cancer − a nationwide MRI study. Colorectal Dis. 2018;20:873–880. doi: 10.1111/codi.14224.
  19. Parfitt JR, Driman DK. The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol. 2007;60(8):849−855. doi: 10.1136/jcp.2006.043802.
  20. Campa-Thompson M, Weir R, Calcetera N, et al. Pathologic processing of the total mesorectal excision. Clin Colon Rectal Surg. 2015;28(1):43−52. doi: 10.1055/s-0035-1545069.
  21. Ghadimi M, Liersch T, Grabenbauer GG, et al. Tumor regression grading after preoperative chemoradiotherapy as a prognostic factor and individual-level surrogate for disease-free survival in rectal cancer. J Natl Cancer Inst. 2017;109(12). doi: 10.1093/jnci/djx095.
  22. Langer R, Becker K. Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy. Virchows Arch. 2018;472(2):175−186. doi: 10.1007/s00428-017-2232-x.
  23. Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73(11):2680−2686. doi: 10.1002/1097-0142(19940601)73:11 <2680::aid-cncr2820731105>3.0.co;2-c.
  24. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12(1):19−23. doi: 10.1007/s003840050072.
  25. Ryan R, Gibbons D, Hyland JM, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 2005;47(2):141−146. doi: 10.1111/j.1365-2559.2005.02176.x.
  26. Edge SB, Byrd DR, Compton CC, et al. A 3rd. AJCC cancer staging manual. 7th ed. New York, Springer-Verlag 2010. doi: 10.3322/caac.21388.
  27. Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Ocol. 2005;23(34):8688−8696. doi: 10.1200/JCO.2005.02.1329.
  28. Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 2003;98(7):1521−1530. doi: 10.1002/cncr.11660.
  29. Bateman AC, Jaynes E, Bateman AR. Rectal cancer staging post neoadjuvant therapy − how should the changes be assessed? Histopathology 2009;54(6):713−721. doi: 10.1111/j.1365-2559.2009.03292.x.
  30. Kim SH, Chang HJ, Kim DY, et al. What is the ideal tumor regression grading system in rectal cancer patients after pre­operative chemoradiotherapy? Cancer Res Treat. 2016;48(3):998−1009. doi: 10.4143/crt.2015.254.
  31. Cotte E, Passot G, Decullier E, et al. Pathologic response, when increased by longer interval, is a marker but not the cause of good prognosis in rectal cancer: 17-year follow-up of the Lyon R90-01 randomized trial. Int J Radiat Oncol Biol Phys. 2016;94(3):544−553. doi: 10.1016/j.ijrobp.2015.10.061.
  32. Sauer R, Becker H, Hohenberger Wet, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–1740. doi: 10.1056/NEJMoa040694.
  33. Francois Y, Nemoz CJ, Baulieux J, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: The Lyon R90-01 randomized trial. J Clin Oncol. 1999;17:2396. doi: 10.1200/JCO.1999.17.8.2396.
  34. Erlandsson J, Holm T, Pettersson D, et al. Optimal fractionation of preope­rative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. 2017;18:336–346. doi: 10.1016/S1470-2045(17)30086-4.
  35. Petrelli F, Sgroi G, Sarti E, et al. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: a meta-analysis of published studies. Ann Surg. 2013;00:1–8. doi: 10.1097/SLA.0000000000000368.
  36. Laurence B, Balyasnikova S, Tait D, et al. Watch-and wait as a therapeutic strategy in rectal cancer. Current Colorectal Cancer Reports 2018;14:37–55. doi: 10.1007/s11888-018-0398-5.
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Article was published in

Perspectives in Surgery

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2021 Issue 2
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