| Tumor scatter after neoadjuvant therapy for rectal cancer: are we dealing with an invisible margin? | |
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MedLine Citation:
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PMID: 23135577 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 55 ISSN: 1530-0358 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-08 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
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Languages: eng Pagination: 1206-12 Citation Subset: IM |
Affiliation:
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1 Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois 2 Department of Pathology, Rush University Medical Center, Chicago, Illinois 3 Path Pathology Services, Justice, Illinois 4 Department of General Surgery, Division of Colon and Rectal Surgery, Loyola University Medical Center, Maywood, Illinois. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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