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Incidence and Clinical Impact of Sterilized Disease and Minimal Residual Disease After Preoperative Radiochemotherapy for Rectal Cancer

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Diseases of the Colon & Rectum

PURPOSE

In advanced rectal cancer, chemoradiation can induce downstaging until complete disappearance of the tumor or its persistence in minimal form. The complete sterilized and the minimal residual disease often are considered similar. We evaluated the specific incidence of these two conditions and analyzed their impact in terms of local recurrence, distant metastasis, and survival.

METHODS

We studied 139 uT3/T4 N0/N+ rectal cancers, treated with preoperative chemoradiation and curative surgery after six to eight weeks. We evaluated ypTNM stage and tumoral regression, according to the five degrees proposed by Dworak, with special attention to 4 and 3 (sterilized and minimal residual disease).

RESULTS

Tumor downstaging occurred in 65 patients (46.7 percent), including 25 sterilized lesions (17.9 percent) and 24 minimal residual disease (17.2 percent). In median follow-up of 30 months, none of the patients with sterilized disease developed local or distant recurrence. Among patients with minimal residual disease, none developed local recurrence, whereas two (8.3 percent) developed distant metastasis, and one died from disease. In patients with gross residual disease (Grade 2, 1, 0) the percentage of local recurrence was 8.8 percent, distant recurrence 26.6 percent, and 13.3 percent died from disease. The difference between three groups is statisti-cally significant as regards local and distant recurrence.

CONCLUSIONS

After preoperative therapy, the sterilized disease shows an excellent prognosis. The minimal residual disease has an important numeric incidence. Its outcome is different, with a not-negligible risk of distant recurrence. The minimal residual disease has a much better prognosis in comparison with the gross residual disease.

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Authors and Affiliations

  1. III Division of Surgery, Policlinico Hospital, Modena, Italy

    Margherita Gavioli M.D. & Gianni Natalini M.D.

  2. Department of Oncology, University of Modena and Reggio Emilia, Modena, Italy

    Gabriele Luppi M.D., Federica Bertolini M.D. & Pier Franco Conte M.D.

  3. Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy

    Lorena Losi M.D.

  4. Department of Radiotherapy, University of Modena and Reggio Emilia, Modena, Italy

    Mario Santantonio M.D. & Anna Maria Falchi M.D.

  5. Unity of Biostatistics, Department of Oncology, University of Modena and Reggio Emilia, Modena, Italy

    Roberto D’Amico Stat. Sci

Authors
  1. Margherita Gavioli M.D.
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Correspondence to Margherita Gavioli M.D..

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Gavioli, M., Luppi, G., Losi, L. et al. Incidence and Clinical Impact of Sterilized Disease and Minimal Residual Disease After Preoperative Radiochemotherapy for Rectal Cancer. Dis Colon Rectum 48, 1851–1857 (2005). https://doi.org/10.1007/s10350-005-0133-6

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