Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer

Margherita Gavioli, Gabriele Luppi, Lorena Losi, Federica Bertolini, Mario Santantonio, Anna Maria Falchi, Roberto D'Amico, Pier Franco Conte, Gianni Natalini

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

PURPOSE: In advanced rectal cancer, chemoradiation can induce downstaging until complete disappearance of the tumor or its persistence in minimal form. The complete sterilized and the minimal residual disease often are considered similar. We evaluated the specific incidence of these two conditions and analyzed their impact in terms of local recurrence, distant metastasis, and survival. METHODS: We studied 139 uT3/T4 N0/N+ rectal cancers, treated with preoperative chemoradiation and curative surgery after six to eight weeks. We evaluated ypTNM stage and tumoral regression, according to the five degrees proposed by Dworak, with special attention to 4 and 3 (sterilized and minimal residual disease). RESULTS: Tumor downstaging occurred in 65 patients (46.7 percent), including 25 sterilized lesions (17.9 percent) and 24 minimal residual disease (17.2 percent). In median follow-up of 30 months, none of the patients with sterilized disease developed local or distant recurrence. Among patients with minimal residual disease, none developed local recurrence, whereas two (8.3 percent) developed distant metastasis, and one died from disease. In patients with gross residual disease (Grade 2, 1, 0) the percentage of local recurrence was 8.8 percent, distant recurrence 26.6 percent, and 13.3 percent died from disease. The difference between three groups is statisti-cally significant as regards local and distant recurrence. CONCLUSIONS: After preoperative therapy, the sterilized disease shows an excellent prognosis. The minimal residual disease has an important numeric incidence. Its outcome is different, with a not-negligible risk of distant recurrence. The minimal residual disease has a much better prognosis in comparison with the gross residual disease.

Original languageEnglish
Pages (from-to)1851-1857
Number of pages7
JournalDiseases of the Colon and Rectum
Volume48
Issue number10
DOIs
Publication statusPublished - Oct 2005

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Residual Neoplasm
Chemoradiotherapy
Rectal Neoplasms
Recurrence
Incidence
Neoplasm Metastasis
Neoplasms
Survival

Keywords

  • Complete pathologic response
  • Downstaging
  • Minimal residual disease
  • Preoperative radiochemotherapy
  • Rectal cancer
  • Tumor regression grade

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. / Gavioli, Margherita; Luppi, Gabriele; Losi, Lorena; Bertolini, Federica; Santantonio, Mario; Falchi, Anna Maria; D'Amico, Roberto; Conte, Pier Franco; Natalini, Gianni.

In: Diseases of the Colon and Rectum, Vol. 48, No. 10, 10.2005, p. 1851-1857.

Research output: Contribution to journalArticle

Gavioli, Margherita ; Luppi, Gabriele ; Losi, Lorena ; Bertolini, Federica ; Santantonio, Mario ; Falchi, Anna Maria ; D'Amico, Roberto ; Conte, Pier Franco ; Natalini, Gianni. / Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. In: Diseases of the Colon and Rectum. 2005 ; Vol. 48, No. 10. pp. 1851-1857.
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T1 - Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer

AU - Gavioli, Margherita

AU - Luppi, Gabriele

AU - Losi, Lorena

AU - Bertolini, Federica

AU - Santantonio, Mario

AU - Falchi, Anna Maria

AU - D'Amico, Roberto

AU - Conte, Pier Franco

AU - Natalini, Gianni

PY - 2005/10

Y1 - 2005/10

N2 - PURPOSE: In advanced rectal cancer, chemoradiation can induce downstaging until complete disappearance of the tumor or its persistence in minimal form. The complete sterilized and the minimal residual disease often are considered similar. We evaluated the specific incidence of these two conditions and analyzed their impact in terms of local recurrence, distant metastasis, and survival. METHODS: We studied 139 uT3/T4 N0/N+ rectal cancers, treated with preoperative chemoradiation and curative surgery after six to eight weeks. We evaluated ypTNM stage and tumoral regression, according to the five degrees proposed by Dworak, with special attention to 4 and 3 (sterilized and minimal residual disease). RESULTS: Tumor downstaging occurred in 65 patients (46.7 percent), including 25 sterilized lesions (17.9 percent) and 24 minimal residual disease (17.2 percent). In median follow-up of 30 months, none of the patients with sterilized disease developed local or distant recurrence. Among patients with minimal residual disease, none developed local recurrence, whereas two (8.3 percent) developed distant metastasis, and one died from disease. In patients with gross residual disease (Grade 2, 1, 0) the percentage of local recurrence was 8.8 percent, distant recurrence 26.6 percent, and 13.3 percent died from disease. The difference between three groups is statisti-cally significant as regards local and distant recurrence. CONCLUSIONS: After preoperative therapy, the sterilized disease shows an excellent prognosis. The minimal residual disease has an important numeric incidence. Its outcome is different, with a not-negligible risk of distant recurrence. The minimal residual disease has a much better prognosis in comparison with the gross residual disease.

AB - PURPOSE: In advanced rectal cancer, chemoradiation can induce downstaging until complete disappearance of the tumor or its persistence in minimal form. The complete sterilized and the minimal residual disease often are considered similar. We evaluated the specific incidence of these two conditions and analyzed their impact in terms of local recurrence, distant metastasis, and survival. METHODS: We studied 139 uT3/T4 N0/N+ rectal cancers, treated with preoperative chemoradiation and curative surgery after six to eight weeks. We evaluated ypTNM stage and tumoral regression, according to the five degrees proposed by Dworak, with special attention to 4 and 3 (sterilized and minimal residual disease). RESULTS: Tumor downstaging occurred in 65 patients (46.7 percent), including 25 sterilized lesions (17.9 percent) and 24 minimal residual disease (17.2 percent). In median follow-up of 30 months, none of the patients with sterilized disease developed local or distant recurrence. Among patients with minimal residual disease, none developed local recurrence, whereas two (8.3 percent) developed distant metastasis, and one died from disease. In patients with gross residual disease (Grade 2, 1, 0) the percentage of local recurrence was 8.8 percent, distant recurrence 26.6 percent, and 13.3 percent died from disease. The difference between three groups is statisti-cally significant as regards local and distant recurrence. CONCLUSIONS: After preoperative therapy, the sterilized disease shows an excellent prognosis. The minimal residual disease has an important numeric incidence. Its outcome is different, with a not-negligible risk of distant recurrence. The minimal residual disease has a much better prognosis in comparison with the gross residual disease.

KW - Complete pathologic response

KW - Downstaging

KW - Minimal residual disease

KW - Preoperative radiochemotherapy

KW - Rectal cancer

KW - Tumor regression grade

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