Document Detail

Tumor scatter after neoadjuvant therapy for rectal cancer: are we dealing with an invisible margin?
MedLine Citation:
PMID:  23135577     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: After the impressive response of rectal cancers to neoadjuvant therapy, it seems reasonable to ask: can we can excise the small ulcer locally or avoid a radical resection if there is no gross residual tumor? Does gross response reflect what happens to tumor cells microscopically after radiation?
OBJECTIVE: The aim of this study was to identify microscopic tumor cell response to radiation.
DESIGN: This study is a retrospective review of a prospectively collected database.
SETTING: This investigation was conducted at a single tertiary medical center.
PATIENTS: Patients were selected who had elective radical resection for rectal cancer after preoperative chemotherapy and radiation performed by 2 colorectal surgeons between 2006 and 2011.
MAIN OUTCOME MEASURES: The primary outcome measured was tumor presence after radiation therapy
RESULTS: Of the 75 patients, 20 patients were complete responders and 55 had residual cancer. Of these patients, 28 had no tumor cells seen outside the gross ulcer, and 27 (49.1%) had tumor outside the visible ulcer or microscopic tumor present with no overlying ulcer. Of these tumors, 81.5% were skewed away from the ulcer center. The mean distance of distal scatter was 1.0 cm from the visible ulcer edge to a maximum of 3 cm; 3 patients had tumor cells more than 2 cm distal to the visible ulcer edge. Tumor scatter outside the ulcer was not associated with poor prognostic factors, such as nodal and distant disease, perineural invasion, or mucin; however, it was associated with lymphovascular invasion (χ2 = 4.12, p = 0.038)
LIMITATIONS: There was limited access to clinical information gathered outside our institution.
CONCLUSIONS: Our study suggests that 1) after radiation, the gross ulcer cannot be used to determine the sole area of potential residual tumor, 2) cancer cells may be found up to 3 cm distally from the gross ulcer, so the traditional 2-cm margin may not be adequate, and 3) local excision of the ulcer or no excision after apparent complete response appears to be insufficient treatment for rectal cancer.
Dana M Hayden; Shriram Jakate; Maria C Mora Pinzon; Deborah Giusto; Amanda B Francescatti; Marc I Brand; Theodore J Saclarides
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  2013-02-11     Revised Date:  2013-07-24    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1206-12     Citation Subset:  IM    
Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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MeSH Terms
Aged, 80 and over
Chi-Square Distribution
Combined Modality Therapy
Middle Aged
Neoadjuvant Therapy*
Neoplasm Invasiveness*
Neoplasm Metastasis*
Neoplasm Staging
Neoplasm, Residual
Proportional Hazards Models
Rectal Neoplasms / pathology*,  therapy*
Retrospective Studies
Treatment Outcome
Comment In:
Dis Colon Rectum. 2013 Jul;56(7):e345   [PMID:  23739205 ]
Dis Colon Rectum. 2013 Jul;56(7):e346   [PMID:  23739206 ]
Dis Colon Rectum. 2012 Dec;55(12):1203-5   [PMID:  23135576 ]

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