• Int. J. Radiat. Oncol. Biol. Phys. · Nov 2005

    Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival?

    • Suzannah Mawdsley, Rob Glynne-Jones, Juliet Grainger, Paul Richman, Andreas Makris, Mark Harrison, Richard Ashford, Richard A Harrison, Melanie Osborne, Jeremy I Livingstone, Peter MacDonald, Ian C Mitchell, John Meyrick-Thomas, John M A Northover, Alastair Windsor, Richard Novell, and Marina Wallace.
    • Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom. mawdsley@gci.ac.uk
    • Int. J. Radiat. Oncol. Biol. Phys. 2005 Nov 1; 63 (3): 745-52.

    PurposeThis study set out to determine the impact of a positive circumferential resection margin (CRM) (R1-R2) and pathologic downstaging on local recurrence and survival in patients with borderline resectable or unresectable rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy (CRT).Methods And MaterialsA total of 150 patients with locally advanced rectal cancer were treated with long-course neoadjuvant CRT using low-dose folinic acid and 5-fluorouracil. CRT was followed 6-12 weeks later by surgical excision. The CRM rate and incidence, site, and pattern of local and systemic recurrences were recorded. The median follow-up was 25 months.ResultsThe overall median survival was 37 months, with a 5-year overall survival rate of 34%. Of the 150 patients, 122 underwent curative resection; 12% had a complete pathologic response, and downstaging to pT1-T2 occurred in an additional 16%. A negative CRM (R0) was achieved in 65% overall (98 of 150). Local recurrence occurred in 10% of those with R0 resection and 62% of those with R1-R2 resections. Distant metastases occurred in 29% of those with R0 resections and 75% of those with R1-R2 resections. The 3-year disease-free and 3-year overall survival rate was 9% and 25% and 52% and 64%, respectively, for patients with and without a histologically positive CRM.ConclusionAfter 5-fluorouracil-based CRT, a positive CRM predicted for a high risk of subsequent local recurrence and a 3-year disease-free survival rate of only 9%. For this reason, the CRM should be considered a major prognostic factor and should be validated in future trials as an early alternative clinical endpoint.

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