Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients

Akoglu, Musa; cayci, haci murat; Dalgic, Tahsin; zengin, neslihan inci; yuksel, adem; Bostanci, Erdal Birol; Ozer, ilter; Ulas, Murat

doi:10.3906/sag-2007-102

Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients

İlter ÖZER, (Osmangazi Üniversitesi, Gastroenterolojik Cerrahi Anabilim Dalı, Eskişehir, Türkiye)

Neslihan İnci ZENGİN, (Ankara Şehir Hastanesi, Patoloji Anabilim Dalı, Ankara, Türkiye)

Haci Murat ÇAYCI, (Şevket Yılmaz Eğitim ve Araştırma Hastanesi, Gastroenterolojik Cerrahi Anabilim Dalı, Bursa, Türkiye)

Adem YÜKSEL, (Derince Eğitim ve Araştırma Hastanesi, Gastroenterolojik Cerrahi Anabilim Dalı, Kocaeli, Türkiye)

Tahsin DALGİC, (Ankara Şehir Hastanesi, Gastroenterolojik Cerrahi Anabilim Dalı, Ankara, Türkiye)

Murat ULAŞ, (Osmangazi Üniversitesi, Gastroenterolojik Cerrahi Anabilim Dalı, Eskişehir, Türkiye)

Erdal BOSTANCI, (Ankara Şehir Hastanesi, Gastroenterolojik Cerrahi Anabilim Dalı, Ankara, Türkiye)

Musa AKOĞLU (Ankara Şehir Hastanesi, Gastroenterolojik Cerrahi Anabilim Dalı, Ankara, Türkiye)

Turkish Journal of Medical Sciences

2 0

Yıl: 2021 Cilt: 51 Sayı: 6 Sayfa Aralığı: 2978 - 2985 Metin Dili: İngilizce DOI: 10.3906/sag-2007-102 İndeks Tarihi: 05-01-2022

Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients

Öz:

Background/aim: This study aimed to evaluate the regression pattern with the distal intramural spread (DIS) of rectum cancer after preoperative chemoradiation. Materials and methods: Specimens from 56 patients who underwent radical resection after preoperative chemoradiation for rectal cancer were examined. The regression pattern (total, fragmented) of the tumor was recorded. DIS status was evaluated by creating sections 0.2 to 0.3 cm thick. Results: A single macroscopic residual area was detected in all specimens. In 10 patients (17.8 %), pathologically complete responses were identified, and DIS was detected in 33 patients (58.9%). The average DIS distance was 0.56 ± 0.3 cm (range 0.2 – 1.8 cm); the spread was < 1 cm in 87.9% of the patients (29/33). The overall survival rates for 5 and 7 years were 76.8% and 73.2%, respectively. The survival rates between patients with and without DIS were not statistically different (94.6 ± 5.5 vs. 75.1 ± 10.2 months, respectively). In all of the patients, tumor regression pattern was total shrinkage of the tumor. Conclusion: A sufficient distal resection margin for rectal cancer after preoperative chemoradiation is 1 cm in the vast majority of cases. However, DIS may exceed 1 cm in a small proportion of patients.Key words: Rectum cancer, neoadjuvant therapy, resection margin

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Mezhir JJ, Smith KD, Fichera A, Hart J, Posner MC et al. Presence of distal intramural spread after preoperative combined-modality therapy for adenocarcinoma of the rectum: what is now the appropriate distal resection margin? Surgery 2005; 138 (4): 658-664. doi: 10.1016/j.surg.2005.06.048
2. Bozzetti F, Andreola S, Baratti D, Mariani L, Stani SC et al. Preoperative chemoradiation in patients with resectable rectal cancer: results on tumor response. Annals of Surgical Oncology 2002; 9 (5): 444-449. doi: 10.1007/BF02557266
3. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. New England Journal of Medicine 2004; 351 (17): 1731-1740. doi: 10.1056/NEJMoa040694
4. Williams N, Dixon M, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. British Journal of Surgery 1983; 70 (3): 150-154. doi: 10.1002/ bjs.1800700305
5. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid. British Journal of Surgery 1984; 71 (1): 17-20. doi: 10.1002/bjs.1800710105
6. Bujko K, Rutkowski A, Chang GJ, Michalski W, Chmielik E et al. Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review. Annals of Surgical Oncology 2012; 19 (3): 801-808. doi: 10.1007/ s13193-012-0158-y
7. Fitzgerald TL, Brinkley J, Zervos EE. Pushing the envelope beyond a centimeter in rectal cancer: oncologic implications of close, but negative margins. Journal of the American College of Surgeons 2011; 213 (5): 589-595. doi: 10.1016/j. jamcollsurg.2011.07.020
8. Perez RO, Habr-Gama A, Smith FM, Kosinski L, São Julião GP et al. Fragmented pattern of tumor regression and lateral intramural spread may influence margin appropriateness after TEM for rectal cancer following neoadjuvant CRT. Journal of Surgical Oncology 2014; 109 (8): 853-858. doi: 10.1002/ jso.23571
9. Edge SB, Byrd DR, Carducci MA, Compton CC, Fritz A et al. AJCC cancer staging manual: Springer New York; 2010.
10. Ryan R, Gibbons D, Hyland JM, Treanor D, White A et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 2005; 47 (2): 141-146. doi: 10.1111/j.1365- 2559.2005.02176.x
11. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 1995; 76 (3): 388- 392. doi: 10.1002/1097-0142(19950801)76:3<388::aidcncr2820760307>3.0.co;2-y
12. Andreola S, Leo E, Belli F, Lavarino C, Bufalino R et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Disease of the Colon Rectum 1997; 40 (1): 25-29. doi: 10.1007/BF02055677
13. Hayden DM, Jakate S, Pinzon MC, Giusto D, Francescatti AB et al. Tumor scatter after neoadjuvant therapy for rectal cancer: are we dealing with an invisible margin? Disease of the Colon Rectum 2012; 55 (12): 1206-1212. doi: 10.1097/ DCR.0b013e318269fdb3
14. Chmielik E, Bujko K, Nasierowska-Guttmejer A, Nowacki MP, Kepka L et al. Distal intramural spread of rectal cancer after preoperative radiotherapy: the results of a multicenter randomized clinical study. International Journal of Radiation Oncology, Biology, Physics 2006; 65 (1): 182-188. doi: 10.1016/j.ijrobp.2005.11.039
15. Mezhir JJ, Shia J, Riedel E, Temple LK, Nash GM et al. Whole-mount pathologic analysis of rectal cancer following neoadjuvant therapy: implications of margin status on longterm oncologic outcome. Annals of Surgery 2012; 256 (2): 274- 279. doi: 10.1097/SLA.0b013e31825c13d5
16. Pahlman L, Bujko K, Rutkowski A, Michalski W. Altering the therapeutic paradigm towards a distal bowel margin of < 1 cm in patients with low-lying rectal cancer: a systematic review and commentary. Colorectal Disease 2013; 15 (4): e166-e174. doi: 10.1111/codi.12120
17. Nakagoe T, Yamaguchi E-i, Tanaka K, Sawai T, Tsuji T et al. Distal Intramural Spread Is an Independent Prognostic Factor for Distant Metastasis and Poor Outcome in Patients With Rectal Cancer: A Multivariate Analysis. Annals of Surgical Oncology 2003; 10 (2): 163-170. doi: 10.1245/aso.2003.05.027

APA	Ozer i, zengin n, cayci h, yuksel a, Dalgic T, Ulas M, Bostanci E, Akoglu M (2021). Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. , 2978 - 2985. 10.3906/sag-2007-102
Chicago	Ozer ilter,zengin neslihan inci,cayci haci murat,yuksel adem,Dalgic Tahsin,Ulas Murat,Bostanci Erdal Birol,Akoglu Musa Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. (2021): 2978 - 2985. 10.3906/sag-2007-102
MLA	Ozer ilter,zengin neslihan inci,cayci haci murat,yuksel adem,Dalgic Tahsin,Ulas Murat,Bostanci Erdal Birol,Akoglu Musa Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. , 2021, ss.2978 - 2985. 10.3906/sag-2007-102
AMA	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. . 2021; 2978 - 2985. 10.3906/sag-2007-102
Vancouver	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. . 2021; 2978 - 2985. 10.3906/sag-2007-102
IEEE	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M "Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients." , ss.2978 - 2985, 2021. 10.3906/sag-2007-102
ISNAD	Ozer, ilter vd. "Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients". (2021), 2978-2985. https://doi.org/10.3906/sag-2007-102

APA	Ozer i, zengin n, cayci h, yuksel a, Dalgic T, Ulas M, Bostanci E, Akoglu M (2021). Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. Turkish Journal of Medical Sciences, 51(6), 2978 - 2985. 10.3906/sag-2007-102
Chicago	Ozer ilter,zengin neslihan inci,cayci haci murat,yuksel adem,Dalgic Tahsin,Ulas Murat,Bostanci Erdal Birol,Akoglu Musa Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. Turkish Journal of Medical Sciences 51, no.6 (2021): 2978 - 2985. 10.3906/sag-2007-102
MLA	Ozer ilter,zengin neslihan inci,cayci haci murat,yuksel adem,Dalgic Tahsin,Ulas Murat,Bostanci Erdal Birol,Akoglu Musa Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. Turkish Journal of Medical Sciences, vol.51, no.6, 2021, ss.2978 - 2985. 10.3906/sag-2007-102
AMA	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. Turkish Journal of Medical Sciences. 2021; 51(6): 2978 - 2985. 10.3906/sag-2007-102
Vancouver	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients. Turkish Journal of Medical Sciences. 2021; 51(6): 2978 - 2985. 10.3906/sag-2007-102
IEEE	Ozer i,zengin n,cayci h,yuksel a,Dalgic T,Ulas M,Bostanci E,Akoglu M "Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients." Turkish Journal of Medical Sciences, 51, ss.2978 - 2985, 2021. 10.3906/sag-2007-102
ISNAD	Ozer, ilter vd. "Distal spread and tumor regression patterns following preoperative chemoradiotherapy in rectal cancer patients". Turkish Journal of Medical Sciences 51/6 (2021), 2978-2985. https://doi.org/10.3906/sag-2007-102