000132826 001__ 132826
000132826 005__ 20240315113108.0
000132826 0247_ $$2doi$$a10.1111/codi.14361
000132826 0248_ $$2sideral$$a137553
000132826 037__ $$aART-2018-137553
000132826 041__ $$aeng
000132826 100__ $$aThe 2017 European Society of Coloproctology (ESCP) collaborating group
000132826 245__ $$aEvaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
000132826 260__ $$c2018
000132826 5203_ $$aIntroduction
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.
000132826 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/
000132826 590__ $$a2.997$$b2018
000132826 591__ $$aSURGERY$$b49 / 203 = 0.241$$c2018$$dQ1$$eT1
000132826 591__ $$aGASTROENTEROLOGY & HEPATOLOGY$$b45 / 84 = 0.536$$c2018$$dQ3$$eT2
000132826 592__ $$a1.208$$b2018
000132826 593__ $$aGastroenterology$$c2018$$dQ1
000132826 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000132826 700__ $$aEchazarreta-Gallego, E.
000132826 773__ $$g20, S6 (2018), 58-68$$pColorectal Disease$$tColorectal Disease$$x1462-8910
000132826 8564_ $$s180411$$uhttps://zaguan.unizar.es/record/132826/files/texto_completo.pdf$$yVersión publicada
000132826 8564_ $$s2412707$$uhttps://zaguan.unizar.es/record/132826/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000132826 909CO $$ooai:zaguan.unizar.es:132826$$particulos$$pdriver
000132826 951__ $$a2024-03-15-08:50:42
000132826 980__ $$aARTICLE