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. 2013 Feb;56(2):142-9.
doi: 10.1097/DCR.0b013e31827541e2.

Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer

Marjun P Duldulao  1 , Wendy Lee, Leanne Streja, Peiguo Chu, Wenyan Li, Zhenbin Chen, Joseph Kim, Julio Garcia-Aguilar
Affiliations

Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer

Marjun P Duldulao et al. Dis Colon Rectum. 2013 Feb.

Abstract

Background: The standard treatment for locally advanced rectal cancer is preoperative chemoradiation and total mesorectal excision. After surgery, tumors are classified according to the depth of tumor invasion, nodal involvement, and tumor regression grade. However, these staging systems do not provide information about the distribution of residual cancer cells within the bowel wall.

Objective: This study aimed to determine the distribution of residual cancer cells in each layer of the bowel wall in rectal cancer specimens.

Design: This was a secondary analysis of data from a prospective phase II study.

Setting: This study was performed in a multi-institutional setting.

Patients: Included were 153 patients with stage II or stage III rectal cancer.

Interventions: Patients were treated with chemoradiation and surgery. The surgical specimen tumor tissue was analyzed, and the distribution of residual cancer cells in each layer of the bowel wall was determined.

Main outcome measures: Statistical analysis was used to examine the correlation of residual cancer cells in each layer of the bowel wall with the clinical/pathologic stage and tumor regression grade.

Results: Forty-two of 153 (27%) patients had complete response in the bowel wall (ypT0). Of the remaining 111 patients who had residual cancer cells, 5 (3%) were ypTis, 12 (8%) were ypT1, 41 (27%) were ypT2, 50 (33%) were ypT3, and 3 (2%) were ypT4. Of the 94 patients with ypT2-4 tumors, 12 (13%) had cancer cells in the mucosa, and 53 (56%) had cancer cells in the submucosa; 92 (98%) had cancer cells in the muscularis propria. Pretreatment cT correlated with the distribution of residual cancer cells. Tumor regression grade was not associated with the distribution of residual cancer cells after chemoradiation.

Limitations: : Patients received different chemotherapy regimens.

Conclusions: Residual cancer cells in rectal cancer specimens after chemoradiation are preferentially located close to the invasive front. This should be considered when designing strategies to diagnose complete pathologic response and when investigating the mechanisms of tumor resistance to chemoradiation.

Trial registration: ClinicalTrials.gov NCT00335816.

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Conflict of interest statement

Disclosures: The authors declare no conflicts of interest associated with this manuscript.

Figures

Figure 1
Figure 1
Distribution of residual cancel cells (RCCs) in the different layers of the bowel wall according to the pathologic (ypT) stage; p<0.001.
Figure 2
Figure 2
Distribution of residual cancer cells (RCCs) in the different layers of the bowel wall according to the clinical T (cT) stage; p<0.001.
Figure 3
Figure 3
Distribution of residual cancer cells (RCCs) in the different layers of the bowel wall according to tumor regression grade (TRG); p=0.1.
See this image and copyright information in PMC

References

    1. Medich D, McGinty J, Parda D, et al. Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: Pathologic findings and clinical implications. Dis Colon Rectum. 2001;44:1123–1128. - PubMed
    1. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740. - PubMed
    1. García-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46:298–304. - PubMed
    1. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data. Lancet Oncol. 2010;11:835–844. - PubMed
    1. Habr-Gama A, Perez RO. Non-operative management of rectal cancer after neoadjuvant chemoradiation. Br J Surg. 2009;96:125–127. - PubMed

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