Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival

Mark W. Onaitis, Robert B. Noone, Ryan Fields, Herbert Hurwitz, Michael Morse, Paul Jowell, Kevin McGrath, Catherine Lee, Mitchell S. Anscher, Bryan Clary, Christopher Mantyh, Theodore N. Pappas, Kirk Ludwig, Hilliard F. Seigler, Douglas Tyler

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background: Up to 30% of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patients treated with neoadjuvant chemoradiation. Methods: From 1987 to 2000, 141 consecutive patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative 5-fluorouracil -based chemotherapy and radiation. Clinical restaging after treatment consisted of proctoscopic examination and often computed tomography scan. One hundred forty patients then underwent operative resection, with results tracked in a database. Standard statistical methods were used to examine the outcomes of those patients with complete clinical or pathologic responses. Results: No demographic differences were detected between either clinical complete and clinical partial responders or pathologic complete and pathologic partial responders. The positive predictive value of clinical restaging was 60%, and accuracy was 82%. By use of the Kaplan-Meier life table analysis, clinical complete responders had no advantage in local recurrence, disease-free survival, or overall survival rates when compared with clinical partial responders. Pathologic complete responders also had no recurrence or survival advantage when compared with pathologic partial responders. Of the 34 pathologic TO tumors, 4 (13%) had lymph node metastases. Conclusions: Clinical assessment of complete response to neoadjuvant chemoradiation is unreliable. Micrometastatic disease persists in a proportion of patients despite pathologic complete response. Observation or local excision for patients thought to be complete responders should be undertaken with caution.

Original languageEnglish (US)
Pages (from-to)801-806
Number of pages6
JournalAnnals of Surgical Oncology
Volume8
Issue number10
DOIs
StatePublished - 2001
Externally publishedYes

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Rectal Neoplasms
Survival
Recurrence
Life Tables
Fluorouracil
Disease-Free Survival
Survival Rate
Lymph Nodes
Tomography
Observation
Demography
Databases
Radiation
Neoplasm Metastasis
Biopsy
Drug Therapy
Neoplasms

Keywords

  • Complete response
  • Neoadjuvant chemoradiation
  • Rectal cancer
  • Total mesorectal excision

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. / Onaitis, Mark W.; Noone, Robert B.; Fields, Ryan; Hurwitz, Herbert; Morse, Michael; Jowell, Paul; McGrath, Kevin; Lee, Catherine; Anscher, Mitchell S.; Clary, Bryan; Mantyh, Christopher; Pappas, Theodore N.; Ludwig, Kirk; Seigler, Hilliard F.; Tyler, Douglas.

In: Annals of Surgical Oncology, Vol. 8, No. 10, 2001, p. 801-806.

Research output: Contribution to journalArticle

Onaitis, MW, Noone, RB, Fields, R, Hurwitz, H, Morse, M, Jowell, P, McGrath, K, Lee, C, Anscher, MS, Clary, B, Mantyh, C, Pappas, TN, Ludwig, K, Seigler, HF & Tyler, D 2001, 'Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival', Annals of Surgical Oncology, vol. 8, no. 10, pp. 801-806. https://doi.org/10.1245/aso.2001.8.10.801
Onaitis, Mark W. ; Noone, Robert B. ; Fields, Ryan ; Hurwitz, Herbert ; Morse, Michael ; Jowell, Paul ; McGrath, Kevin ; Lee, Catherine ; Anscher, Mitchell S. ; Clary, Bryan ; Mantyh, Christopher ; Pappas, Theodore N. ; Ludwig, Kirk ; Seigler, Hilliard F. ; Tyler, Douglas. / Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. In: Annals of Surgical Oncology. 2001 ; Vol. 8, No. 10. pp. 801-806.
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abstract = "Background: Up to 30{\%} of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patients treated with neoadjuvant chemoradiation. Methods: From 1987 to 2000, 141 consecutive patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative 5-fluorouracil -based chemotherapy and radiation. Clinical restaging after treatment consisted of proctoscopic examination and often computed tomography scan. One hundred forty patients then underwent operative resection, with results tracked in a database. Standard statistical methods were used to examine the outcomes of those patients with complete clinical or pathologic responses. Results: No demographic differences were detected between either clinical complete and clinical partial responders or pathologic complete and pathologic partial responders. The positive predictive value of clinical restaging was 60{\%}, and accuracy was 82{\%}. By use of the Kaplan-Meier life table analysis, clinical complete responders had no advantage in local recurrence, disease-free survival, or overall survival rates when compared with clinical partial responders. Pathologic complete responders also had no recurrence or survival advantage when compared with pathologic partial responders. Of the 34 pathologic TO tumors, 4 (13{\%}) had lymph node metastases. Conclusions: Clinical assessment of complete response to neoadjuvant chemoradiation is unreliable. Micrometastatic disease persists in a proportion of patients despite pathologic complete response. Observation or local excision for patients thought to be complete responders should be undertaken with caution.",
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AU - Onaitis, Mark W.

AU - Noone, Robert B.

AU - Fields, Ryan

AU - Hurwitz, Herbert

AU - Morse, Michael

AU - Jowell, Paul

AU - McGrath, Kevin

AU - Lee, Catherine

AU - Anscher, Mitchell S.

AU - Clary, Bryan

AU - Mantyh, Christopher

AU - Pappas, Theodore N.

AU - Ludwig, Kirk

AU - Seigler, Hilliard F.

AU - Tyler, Douglas

PY - 2001

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N2 - Background: Up to 30% of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patients treated with neoadjuvant chemoradiation. Methods: From 1987 to 2000, 141 consecutive patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative 5-fluorouracil -based chemotherapy and radiation. Clinical restaging after treatment consisted of proctoscopic examination and often computed tomography scan. One hundred forty patients then underwent operative resection, with results tracked in a database. Standard statistical methods were used to examine the outcomes of those patients with complete clinical or pathologic responses. Results: No demographic differences were detected between either clinical complete and clinical partial responders or pathologic complete and pathologic partial responders. The positive predictive value of clinical restaging was 60%, and accuracy was 82%. By use of the Kaplan-Meier life table analysis, clinical complete responders had no advantage in local recurrence, disease-free survival, or overall survival rates when compared with clinical partial responders. Pathologic complete responders also had no recurrence or survival advantage when compared with pathologic partial responders. Of the 34 pathologic TO tumors, 4 (13%) had lymph node metastases. Conclusions: Clinical assessment of complete response to neoadjuvant chemoradiation is unreliable. Micrometastatic disease persists in a proportion of patients despite pathologic complete response. Observation or local excision for patients thought to be complete responders should be undertaken with caution.

AB - Background: Up to 30% of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patients treated with neoadjuvant chemoradiation. Methods: From 1987 to 2000, 141 consecutive patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative 5-fluorouracil -based chemotherapy and radiation. Clinical restaging after treatment consisted of proctoscopic examination and often computed tomography scan. One hundred forty patients then underwent operative resection, with results tracked in a database. Standard statistical methods were used to examine the outcomes of those patients with complete clinical or pathologic responses. Results: No demographic differences were detected between either clinical complete and clinical partial responders or pathologic complete and pathologic partial responders. The positive predictive value of clinical restaging was 60%, and accuracy was 82%. By use of the Kaplan-Meier life table analysis, clinical complete responders had no advantage in local recurrence, disease-free survival, or overall survival rates when compared with clinical partial responders. Pathologic complete responders also had no recurrence or survival advantage when compared with pathologic partial responders. Of the 34 pathologic TO tumors, 4 (13%) had lymph node metastases. Conclusions: Clinical assessment of complete response to neoadjuvant chemoradiation is unreliable. Micrometastatic disease persists in a proportion of patients despite pathologic complete response. Observation or local excision for patients thought to be complete responders should be undertaken with caution.

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