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Colorectal Dis. 2018 Sep;20 Suppl 6:58-68. doi: 10.1111/codi.14361.

Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery.

Collaborators (1370)

Battersby N, Glasbey JC, Neary P, Negoi I, Kamarajah S, Sgro A, Bhangu A, Pinkney T, Frasson M, El-Hussuna A, Battersby NJ, Bhangu A, Buchs NC, Buskens C, Chaudri S, Gallo G, Glasbey J, Minaya-Bravo AM, Morton D, Nepogodiev D, Pata F, Sánchez-Guillén L, Singh B, Zmora O, Perry R, Magill L, Bhangu A, Altomare D, Bemelman W, Brown S, Denost Q, Knowles C, Laurberg S, Lefevre JH, Möeslein G, Pinkney T, Vaizey C, Bilali S, Bilali V, Salomon M, Cillo M, Estefania D, Patron Uriburu J, Ruiz H, Farina P, Carballo F, Guckenheimer S, Proud D, Brouwer R, Bui A, Nguyen B, Smart P, Warwick A, Theodore JE, Herbst F, Birsan T, Dauser B, Ghaffari S, Hartig N, Stift A, Argeny S, Unger L, Strouhal R, Heuberger A, Varabei A, Lahodzich N, Makhmudov A, Selniahina L, Feryn T, Leupe T, Maes L, Reynvoet E, Van Langenhove K, Nachtergaele M, Monami B, Francart D, Jehaes C, Markiewicz S, Weerts J, Van Belle K, Bomans B, Cavenaile V, Nijs Y, Vertruyen M, Pletinckx P, Claeys D, Defoort B, Muysoms F, Van Cleven S, Lange C, Vindevoghel K, Wolthuis A, Todorovic M, Dabic S, Kenjic B, Lovric S, Vidovic J, Delibegovic S, Mehmedovic Z, Christiano A, Lombardi B, Marchiori M Jr, Tercioti V Jr, Dardanov D, Petkov P, Simonova L, Yonkov A, Zhivkov E, Maslyankov S, Pavlov V, Sokolov M, Todorov G, Stoyanov V, Batashki I, Iarumov N, Lozev I, Moshev B, Slavchev M, Atanasov B, Belev N, Krstev P, Penkov R, Šantak G, Ćosić J, Previšić A, Vukušić L, Zukanović G, Zelić M, Kršul D, Lekić Vitlov V, Mendrila D, Orhalmi J, Dusek T, Maly O, Paral J, Sotona O, Skrovina M, Bencurik V, Machackova M, Kala Z, Farkašová M, Grolich T, Procházka V, Hoch J, Kocian P, Martinek L, Antos F, Pruchova V, El-Hussuna A, Ceccotti A, Madsbøll T, Straarup D, Uth Ovesen A, Christensen P, Bondeven P, Edling P, Elfeki H, Alexandrovich Gameza V, Michelsen Bach S, Zheltiakova I, Krarup PM, Krogh A, Rolff HC, Lykke J, Juvik AF, Lóven HHK, Marckmann M, Osterkamp JTF, Madsen AH, Worsøe J, Ugianskis A, Kjaer MD, Youn Cho Lee B, Khalid A, Kristensen MH, El Sorogy M, Elgeidie A, Elhemaly M, El Nakeeb A, Elrefai M, Shalaby M, Emile S, Omar W, Sakr A, Thabet W, Awny S, Metwally I, Refky B, Shams N, Zuhdy M, Lepistö A, Keränen I, Kivelä A, Lehtonen T, Siironen P, Rautio T, Ahonen-Siirtola M, Klintrup K, Paarnio K, Takala H, Hyöty M, Haukijärvi E, Kotaluoto SM, Lehto K, Tomminen T, Huhtinen H, Carpelan A, Karvonen J, Rantala A, Varpe P, Cotte E, Francois Y, Glehen O, Passot G, d'Alessandro A, Chouillard E, Etienne JC, Ghilles E, Vinson-Bonnet B, Germain A, Ayav A, Bresler L, Chevalier R, Denost Q, Didailler R, Rullier E, Tiret E, Chafai N, Lefevre JH, Parc Y, Sielezneff I, Mege D, Lakkis Z, Barussaud M, Krones C, Bock B, Webler R, Baral J, Lang T, Münch S, Pullig F, Schön M, Hinz S, Becker T, Möller T, Richter F, Schafmayer C, Hardt J, Kienle P, Crescenti F, Ahmad M, Soleiman Y, Papaconstantinou I, Gklavas A, Nastos K, Theodosopoulos T, Vezakis A, Stamou K, Saridaki A, Xynos E, Paraskakis S, Zervakis N, Skroubis G, Amanatidis T, Germanos S, Maroulis I, Papadopoulos G, Dimitriou N, Alexandrou A, Felekouras E, Griniatsos J, Karavokyros I, Papadopoulos A, Chouliaras C, Ioannidis P, Katsounis D, Kefalou E, Katsoulis IE, Balalis D, Korkolis DP, Manatakis D, Tzovaras G, Baloyiannis I, Mamaloudis I, Lázár G, Ábraham S, Paszt A, Simonka Z, Tóth I, Zaránd A, Baranyai Z, Ferreira G, Harsányi L, Ónody P, Banky B, Burány Á, Lakatos M, Marton J, Solymosi A, Besznyák I, Bursics A, Papp G, Saftics G, Svastics I, Valsdottir E, Atladottir J, Jonsson T, Moller P, Sigurdsson H, Gupta SK, Gupta S, Kaul N, Mohan S, Sharma G, Wani R, Chowdri N, Khan M, Mehraj A, Parray FQ, Coveney A, Burke J, Deasy J, El-Masry S, McNamara D, Khan MF, Cahill R, Faul E, Mulsow J, Shields C, Kelly ME, Bass G, Martin ST, O'Connell R, Ryan E, Connelly T, Ahmad G, Bukhari W, Cooke F, Zmora O, Gold Deutch R, Haim N, Lavy R, Moscovici A, Shussman N, Gefen R, Marom G, Pikarsky A, Weiss D, Avital S, Hermann N, Raguan B, Slavin M, White I, Wasserberg N, Arieli H, Gurevich N, Freund MR, Dorot S, Edden Y, Halfteck G, Reissman P, Pery R, Tulchinsky H, Weizman A, Agresta F, Curinga R, Finotti E, Savino G, Verza LA, Asteria CR, Boccia L, Pascariello A, Tamini N, Bugatti A, Gianotti L, Totis M, Vincenti L, Andriola V, Giannini I, Travaglio E, Balestri R, Buccianti P, Roffi N, Rossi E, Urbani L, Mellano A, Cinquegrana A, Lauretta A, Belluco C, Mistrangelo M, Allaix ME, Arolfo S, Morino M, Testa V, Delrio P, Pace U, Rega D, Scala D, Gallo G, Clerico G, Cornaglia S, Realis Luc A, Trompetto M, Ugolini G, Antonacci N, Fabbri S, Montroni I, Zattoni D, D'Urbano C, Cornelli A, Viti M, Inama M, Bacchion M, Casaril A, Impellizzeri H, Moretto G, Spinelli A, Carvello M, David G, Di Candido F, Sacchi M, Frontali A, Ceriani V, Molteni M, Rosati R, Aleotti F, Elmore U, Lemma M, Vignali A, Scabini S, Casoni Pattacini G, Luzzi A, Romairone E, Marino F, Lorusso D, Pezzolla F, Colombo F, Baldi C, Foschi D, Sampietro G, Sorrentino L, Di Saverio S, Birindelli A, Segalini E, Spacca D, Romano GM, Belli A, Bianco F, De Franciscis S, Falato A, Muratore A, Marsanic P, Grimaldi S, Castaldo N, Ciolli MG, Picarella P, Porfidia R, Tugnoli G, Bondurri A, Cavallo D, Maffioli A, Pertusati A, Pulighe F, Balestra F, De Nisco C, Podda M, Opocher E, Longhi M, Mariani NM, Maroni N, Pisani Ceretti A, Galleano R, Aonzo P, Curletti G, Reggiani L, Marconi M, Del Prete L, Oldani M, Pappalardo R, Zaccone L S, Scatizzi M, Baraghini M, Cantafio S, Feroci F, Giani I, Tutino R, Cocorullo G, Gulotta G, Licari L, Salamone G, Sileri P, Saraceno F, La Torre F, Chirletti P, Coletta D, De Toma G, Mingoli A, Papandrea M, De Luca E, Sacco R, Sammarco G, Vescio G, Tonini V, Bianchini S, Cervellera M, Vaccari S, Cracco N, Barugola G, Bertocchi E, Rossini R, Ruffo G, Sartori A, Clemente N, De Luca M, De Luca A, Scaffidi G, Lorenzon L, Balducci G, Bocchetti T, Ferri M, Mercantini P, Pata F, Bauce S, Benevento A, Bottini C, Crapa PR, Rubbini M, Anania G, Carcoforo P, Cavallesco G, Feo C, Yamamoto T, Sivins A, Ancans G, Gerkis S, Lunis R, Pcolkins A, Venskutonis D, Bradulskis S, Dainius E, Subocius A, Vencius J, Zeromskas P, Eismontas V, Nutautiene V, Simcikas D, Tamosiunas A, Svagzdys S, Latkauskas T, Lizdenis P, Saladzinskas Z, Tamelis A, Dulskas A, Kuliavas J, Samalavicius NE, Poskus T, Jotautas V, Mikalauskas S, Poskus E, Strupas K, Zakaria AD, Lah NN, Wong M, Zain WZ, Zakaria Z, Mazlan L, Mohd Azman ZA, Sagap I, Psaila J, Andrejevic P, Cini C, Ellul S, Pace K, Ahallat M, Hamid M, Hrora A, Majbar MA, Raiss M, Westerduin E, Bemelman W, Buskens C, Tanis P, van der Sluis PC, Davids PH, Pronk A, Schiphorst AHW, Smakman N, Zimmerman D, Koeter T, Stijns J, van Loon YT, Vermaas M, de Graaf E, Doornebosch P, van Hagen P, van Ruler O, Toorenvliet B, Nonner J, van den Berg I, van Steensel L, Vles W, Melenhorst J, Orsini R, Visschers R, Hoff C, Blom R, Marsman H, Mulder I, Cense H, de Castro S, Demirkiran A, Hunfeld M, van Geloven A, de Groof J, Hendriks E, Leeuwenburg M, van Oorschot N, Wit F, Rupert C, Veldman P, Keijzers M, Konsten J, Den Boer F, Corver M, Boerma EG, Koolen L, Martens M, Van Wijck K, Ignjatovic D, Breuer R, Gurpreet B, Oresland T, Tetens Moe T, Nesbakken A, Flaaten Backe I, Wik TA, Radiya K, Dehli T, Gjessing P, Norderval S, Woll K, Anwer M, Qureshi MS, Qureshi AU, Billah M, Jawad MY, Raza A, Urooj N, Wang X, Li L, Jajtner D, Gasinski B, Kabiesz W, Walega P, Romaniszyn M, Zawadzki M, Czarnecki R, Obuszko Z, Rzaca M, Sitarska M, Silva P, Duarte A, Gonçalves D, Morais M, Rama N, Nobre J, Sales I, Costa Pereira J, Costa S, Costa Pereira C, Insua C, Romero I, Figueiredo N, Cunha J, Domingos H, Vieira P, Cunha M, Americano M, Amorim E, Rachadell J, Carvas JM, Armas I, Fernandes P, Pires C, Reis R, Martins R, Dos Santos M, Henriques P, Oliveira O, Duarte M, Ferreira L, Miranda J, Vilela N, Corte Real J, Carlos S, Frois Borges M, Moniz Pereira P, Simões J, Silva-Vaz P, Bettencourt V, Gouveia A, Perez H, Rainho R, Bintintan V, Ciuce C, Dindelegan G, Scurtu R, Seicean R, Cristian D, Burcos T, Grama F, Mandi DM, Richiteanu G, Miron A, Calu V, Enciu O, Nadragea M, Parvuletu R, Mogoanta SS, Crafciuc A, Paitici S, Negoi I, Beuran M, Ciubotaru C, Prodan A, Vartic M, Tomulescu V, Copaescu C, Yanishev A, Abelevich A, Kokobelyan A, Lebedeva M, Luzan R, Pozdnyakov A, Cherdancev D, Mahotin D, Nesytykh A, Samsonyuk V, Pravosudov I, Ivlev D, Karachun A, Lebedev K, Samsonov D, Aiupov R, Feoktistov D, Garipov M, Suleymanov N, Tarasov N, Rasulov A, Dzhumabaev H, Mamedli Z, Bedzhanyan A, Popov D, Sednev A, Klimenko A, Semenov A, Vasilyev S, Khazov A, Khanevich M, Khrykov G, Katorkin S, Andreev P, Chernov A, Davidova O, Zhuravlev A, Achkasov S, Shakhmatov D, Shelygin Y, Sushkov O, Vardanyan A, Ilkanich A, Barbashinov N, Darvin V, Onishchenko S, Voronin Y, Krivokapić Z, Barišić G, Dimitrijević I, Marković V, Sekulić A, Stanojevic G, Brankovic B, Nestorovic M, Pecic V, Petrovic D, Kostic I, Aleksic A, Dabic D, 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Abstract

INTRODUCTION:

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.

METHODS:

A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.

RESULTS:

Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).

CONCLUSION:

The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.

KEYWORDS:

Rectal surgery; deferral of surgery; neoadjuvant therapy; pathology; radiology; rectal cancer; surgical oncology

PMID:
30255641
DOI:
10.1111/codi.14361

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