title: Pathological response of locally advanced rectal cancer to preoperative chemotherapy without pelvic irradiation.
abstract: OBJECTIVE
  Pathological response to chemotherapy without pelvic irradiation is not well defined in rectal cancer. This study aimed to evaluate the objective pathological response to preoperative chemotherapy without pelvic irradiation in middle or low locally advanced rectal cancer (LARC).
  
  
  METHODS
  Between 2008 and 2013, 22 patients with middle or low LARC (T3/4 and/or N+ and circumferential resection margin < 2 mm) and synchronous metastatic disease or a contraindication to pelvic irradiation underwent rectal resection after preoperative chemotherapy. The pathological response of rectal tumour was analysed according to the Rödel tumour regression grading (TRG) system. Predictive factors of objective pathological response (TRG 2-4) were analysed.
  
  
  RESULTS
  All patients underwent rectal surgery after a median of six cycles of preoperative chemotherapy. Of these, 20 (91%) had sphincter saving surgery and an R0 resection. Twelve (55%) patients had an objective pathological response (TRG 2-4), including one complete response. Poor response (TRG 0-1) to chemotherapy was noted in 10 (45%) patients. In univariate analyses, none of the factors examined was found to be predictive of an objective pathological response to chemotherapy. At a median follow-up of 37.2 months, none of the 22 patients experienced local recurrence. Of the 19 patients with Stage IV rectal cancer, 15 (79%) had liver surgery with curative intent.
  
  
  CONCLUSIONS
  Preoperative chemotherapy without pelvic irradiation is associated with objective pathological response and adequate local control in selected patients with LARC. Further prospective controlled studies will address the question of whether it can be used as a valuable alternative to radiochemotherapy in LARC.
authors.affiliation: Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Bensignor
authors.affiliation: Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Brouquet
authors.affiliation: Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Dariane
authors.affiliation: Department of Digestive Oncology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Thirot-Bidault
authors.affiliation: Department of Pathology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Lazure
authors.affiliation: Department of Pathology, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Julié
authors.affiliation: Department of Surgical Oncology, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Nordlinger
authors.affiliation: Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Penna
authors.affiliation: Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Benoist
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010388:Pelvis; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Rectal cancer; liver metastases; pathologic response; preoperative chemotherapy