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Distal intramural spread of rectal cancer after preoperative radiotherapy: The results of a multicenter randomized clinical study

Journal Article · · International Journal of Radiation Oncology, Biology and Physics
 [1];  [2];  [3];  [4];  [2];  [4];  [5];  [6];  [7];  [8];  [9];  [10]
  1. Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice (Poland)
  2. Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw (Poland)
  3. Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw (Poland)
  4. Department of Colorectal Cancer, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw (Poland)
  5. Department of Pathology, Silesian Oncological Center, Wroclaw (Poland)
  6. Department of Pathology, Medical Academy, Poznan (Poland)
  7. Department of Pathology, Holy Cross Oncological Center, Kielce (Poland)
  8. Department of Pathology, Medical Academy, Gdansk (Poland)
  9. Department of Pathology, Medical Academy, Szczecin (Poland)
  10. Department of Pathology, Oncological Center, Bielsko-Biala (Poland)
Purpose: To evaluate the extent of distal intramural spread (DIS) after preoperative radiotherapy for rectal cancer. Methods and Materials: A total of 316 patients with T{sub 3-4} primary resectable rectal cancer were randomized to receive either preoperative 5x5 Gy radiation with immediate surgery or chemoradiation (50.4 Gy, 1.8 Gy per fraction plus boluses of 5-fluorouracil and leucovorin) with delayed surgery. The slides of the 106 patients who received short-course radiation and of the 86 who received chemoradiation were available for central microscopic evaluation of DIS. Results: The length of DIS did not differ significantly (p = 0.64) between the short-course group and the chemoradiation group and was 0 in 47% vs. 49%; 1 to 5 mm in 41% vs. 42%; 6 to 10 mm in 8% vs. 9%, and greater than 10 mm in 4% vs. 0, respectively. Among the 11 clinically complete responders, DIS was found 1 to 5 mm from the microscopically detected ulceration of the mucosa in 5 patients. The discontinuous DIS was more frequent in the chemoradiation group as compared with the short-course group (i.e., 57% vs. 16% of cases, p < 0.001). Conclusions: Approximately 1 out of 10 advanced rectal cancers after preoperative radiotherapy or radiochemotherapy was characterized by DIS of over 5 mm. No significant difference was seen in the length of DIS between the 2 groups.
OSTI ID:
20793473
Journal Information:
International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 65; ISSN IOBPD3; ISSN 0360-3016
Country of Publication:
United States
Language:
English

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