International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 4 , Pages 1158-1165 , 15 July 2010

Pathologic Nodal Classification Is the Most Discriminating Prognostic Factor for Disease-Free Survival in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy and Curative Resection

  • Tae Hyun Kim, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Hee Jin Chang, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Dae Yong Kim, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
    • Corresponding Author InformationReprint requests to: Dae Yong Kim, M.D. Center for Colorectal Cancer, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea. Tel: +82-31-920-1721; Fax: +82-31-920-0149
  • ,
  • Kyung Hae Jung, M.D.

      Affiliations

    • Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • ,
  • Yong Sang Hong, M.D.

      Affiliations

    • Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • ,
  • Sun Young Kim, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Ji Won Park, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Jae Hwan Oh, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Seok-Byung Lim, M.D.

      Affiliations

    • Department of Colon & Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • ,
  • Hyo Seong Choi, M.D.

      Affiliations

    • Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • ,
  • Seung-Yong Jeong, M.D.

      Affiliations

    • Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea

Received 21 April 2009 ,Revised 1 June 2009 ,Accepted 9 June 2009.

References 

  1. Adjuvant radiotherapy for rectal cancer. A systematic overview of 8,507 patients from 22 randomised trials. Lancet. 2001;358:1291–1304
  2. Benson AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22:3408–3419
  3. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740
  4. Guillem JG, Chessin DB, Cohen AM, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005;241:829–836discussion 836–828
  5. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–1123
  6. Berger C, de Muret A, Garaud P, et al. Preoperative radiotherapy (RT) for rectal cancer: Predictive factors of tumor downstaging and residual tumor cell density (RTCD): Prognostic implications. Int J Radiat Oncol Biol Phys. 1997;37:619–627
  7. Kim JS, Kim JS, Cho MJ, et al. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2002;54:403–408
  8. Kim DY, Jung KH, Kim TH, et al. Comparison of 5-fluorouracil/leucovorin and capecitabine in preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2007;67:378–384
  9. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, et al. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46:298–304
  10. Mohiuddin M, Hayne M, Regine WF, et al. Prognostic significance of postchemoradiation stage following preoperative chemotherapy and radiation for advanced/recurrent rectal cancers. Int J Radiat Oncol Biol Phys. 2000;48:1075–1080
  11. Rodel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23:8688–8696
  12. Gunderson LL, Sargent DJ, Tepper JE, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: A pooled analysis. J Clin Oncol. 2004;22:1785–1796
  13. Yoon SM, Kim DY, Kim TH, et al. Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2007;69:1167–1172
  14. Kim YH, Kim DY, Kim TH, et al. Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:761–768
  15. Kim JH, Beets GL, Kim MJ, et al. High-resolution MR imaging for nodal staging in rectal cancer: Are there any criteria in addition to the size?. Eur J Radiol. 2004;52:78–83
  16. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344:707–711
  17. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23
  18. Akaike H. A new look at statistical model identification. IEEE Trans Automatic Control. 1974;19:716–722
  19. Theodoropoulos G, Wise WE, Padmanabhan A, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum. 2002;45:895–903
  20. Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73:2680–2686
  21. Bujko K, Michalski W, Kepka L, et al. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: An analysis of outcomes in a randomized trial. Int J Radiat Oncol Biol Phys. 2007;67:369–377
  22. Valentini V, Coco C, Picciocchi A, et al. Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys. 2002;53:664–674
  23. Kuo LJ, Liu MC, Jian JJ, et al. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy?. Ann Surg Oncol. 2007;14:2766–2772
  24. Chan AK, Wong A, Jenken D, et al. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61:665–677
  25. Suarez J, Vera R, Balen E, et al. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer. Colorectal Dis. 2008;10:563–568
  26. Kim NK, Baik SH, Seong JS, et al. Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer: Impact of postirradiated pathologic downstaging on local recurrence and survival. Ann Surg. 2006;244:1024–1030
  27. Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: Results from NSABP protocol R-01. J Natl Cancer Inst. 1988;80:21–29
  28. Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: A population-based analysis. Int J Radiat Oncol Biol Phys. 2005;61:426–431
  29. Cummings BJ. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Tech Coloproctol. 2002;6:199;discussion 199–200
  30. Thorn CC, Woodcock NP, Scott N, et al. What factors affect lymph node yield in surgery for rectal cancer?. Colorectal Dis. 2004;6:356–361

 T.H. Kim and H.J. Chang contributed equally to this study.

 Conflict of interest: none.

PII: S0360-3016(09)00914-6

doi: 10.1016/j.ijrobp.2009.06.019

International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 4 , Pages 1158-1165 , 15 July 2010