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Impact of Pathologic Complete Response to Neoadjuvant Treatment on Rectal Cancer Recurrence Rates
*Anne M Dinaux, *Ramzi Amri, Liliana G Bordeianou, *Theodore S Hong, *Jennifer Y Wo, *Lawrence S Blaszkowsky, *Jill N Allen, *Janet E Murphy, *Eunice L Kwak, *Hiroko Kunitake, David L Berger
Massachusetts General Hospital/Harvard Medical School, Boston, MA
Objective
Currently, the gold standard in the US when treating locally advanced rectal cancer is neo-adjuvant chemoradiation followed by surgical resection regardless of whether the patient has complete regression of the primary tumor. There is growing evidence that it is possible to closely observe patients who have a complete response (CR) after neo-adjuvant treatment. This abstract retrospectively reviews the outcomes of patients who were found to have a pathologic CR after surgical resection.
Design
Retrospective review of our prospectively maintained IRB approved data repository
Setting
Tertiary Care Center
Patients
All rectal cancer patients without baseline metastasis treated with neoadjuvant chemoradiation followed by surgical resection at our center between January 2004 and February 2011 (n= 173) were included such that adequate follow-up was achieved.
Main Outcome Measures
Rates of distant metastatic and local recurrence were compared between patients with a pathologic CR and patients with residual disease in the postoperative pathologic specimen.
Results
Out of 36 patients with a pathologic CR, one patient (2.8%) developed distant metastatic disease during follow up (median duration: 61 months, no significant difference between groups; P=0.14), compared to 25 patients in the residual carcinoma group (n=137, 18.2%; Relative Risk [RR]:0.15; P=0.06).
No local recurrence occurred in the complete remission group in contrast to 11 (8%) in the residual carcinoma group, corresponding to a Relative Risk of 0.16 (P=0.20)
Conclusions
A pathologic complete response is associated with better disease-free survival, with clinically significant differences in local recurrence and distant metastatic disease rates. Although not statistically significant due to sample size limitations, the differences are sufficient to lend credence to the idea of observing patients who have a complete response after neoadjuvant therapy.
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