Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Nov;3(4):277-88.
doi: 10.1093/gastro/gov039. Epub 2015 Aug 19.

Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

Linda Ferrari  1 , Alessandro Fichera  2
Affiliations
Review

Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

Linda Ferrari et al. Gastroenterol Rep (Oxf). 2015 Nov.

Abstract

The management of rectal cancer has evolved significantly in the last few decades. Significant improvements in local disease control were achieved in the 1990s, with the introduction of total mesorectal excision and neoadjuvant radiotherapy. Level 1 evidence has shown that, with neoadjuvant chemoradiation therapy (CRT) the rates of local recurrence can be lower than 6% and, as a result, neoadjuvant CRT currently represents the accepted standard of care. This approach has led to reliable tumor down-staging, with 15-27% patients with a pathological complete response (pCR)-defined as no residual cancer found on histological examination of the specimen. Patients who achieve pCR after CRT have better long-term outcomes, less risk of developing local or distal recurrence and improved survival. For all these reasons, sphincter-preserving procedures or organ-preserving options have been suggested, such as local excision of residual tumor or the omission of surgery altogether. Although local recurrence rate has been stable at 5-6% with this multidisciplinary management method, distal recurrence rates for locally-advanced rectal cancers remain in excess of 25% and represent the main cause of death in these patients. For this reason, more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting (in order to offer early treatment of disseminated micrometastases, thus improving control of systemic disease) and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm.

Keywords: neoadjuvant chemoradiation therapy; pathological complete response; rectal cancer.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Management of rectal cancer in the USA according to NCCN guidelines [26] CRT = chemoradiotherapy; CT = chemotherapy; RT = radiotherapy
Figure 2.
Figure 2.
European management of rectal cancer [27–29] LR = local recurrence; MRF = mesorectal fascia; TME = total mesorectal excision
Figure 3.
Figure 3.
The PROSPECT trial CT = computed tomography; ERUS = endorectal ultrsound; MRI = magnetic resonance imaging
See this image and copyright information in PMC

References

    1. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72. - PubMed
    1. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991;324:709–15. - PubMed
    1. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–50. - PubMed
    1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82. - PubMed
    1. Arbman G, Nilsson E, Hallböök O, et al. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375–9. - PubMed