The concept of "diagnosis priority using the normalized methods" is the foundation for individualized treatment. A multidisciplinary team, including colorectal surgeons, radiologists and pathologists, should be established for the patients of mid-low rectal cancer. In order to ensure the scientific treatment strategies, reasonable methods of clinical imaging should be arranged to obtain precise clinical TNM staging of pre-therapy. Preoperative neoadjuvant chemoradiotherapy should be performed for the patients of middle-low rectal cancer, whose cancer staging is cT3-4 or cN1-2. The emphasis of the seventh edition of AJCC TNM staging in rectal cancer is to determine what T3 carcinoma is. The basic principle of normalization of mid-low rectal cancer is to achieve R0 resection according to preoperative staging, and to administer comprehensive adjuvant therapy with the evaluation of pathological staging.
Humans ; Neoplasm Staging ; Rectal Neoplasms ; pathology

Humans ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery

Anal Canal ; pathology ; surgery ; Humans ; Rectal Neoplasms ; pathology ; surgery

Even in patients undergoing an optimal surgical technique (e.g., total mesorectal excision), radiotherapy provides a significant benefit in the local control of rectal cancer. Compared with postoperative treatment, chemoradiotherapy given preoperatively has been shown to decrease local recurrence rates and toxicity. Additionally, preoperative chemoradiotherapy permits the early identification of tumor responses to this cytotoxic treatment by surgical pathology. Pathological parameters reflecting the tumor response to chemoradiotherapy have been shown to be surrogate markers for long-term clinical outcomes. Post-chemoradiotherapy downstaging from cStage II-III to ypStage 0-I indicates a favorable prognosis, with no difference between ypStage 0 and ypStage I. Research is ongoing to develop useful tools (clinical, molecular, and radiological) for clinical determination of the pathologic chemoradiotherapeutic response before surgery, and possibly even before preoperative treatment. In the future, risk-adapted strategies, including intensification of preoperative therapy, conservative surgery, or the selective administration of postoperative chemotherapy, will be realized for locally-advanced rectal cancer patients based on their response to preoperative chemoradiotherapy.
Biomarkers ; Chemoradiotherapy ; Humans ; Pathology, Surgical ; Prognosis ; Rectal Neoplasms ; Recurrence

The combination of preoperative chemoradi-otherapy and surgery has become the standard treatment for locally advanced rectal cancer. Up to 30% of patients received pathologic complete response(pCR) after neoadjuvant therapy, for whom low rates of local recurrence and improved outcome after surgery were achieved. Given that, some authors have recommended local resection for clinical extensive response or non operative "wait and see" policy for clinical complete response(cCR) respectively, in which radical surgery-associated complication and dysfunction can be avoided. Current imaging can provide excellent accuracy in primary staging of rectal cancer, however, when used for restaging, the ability is less satisfactory, especially for pCR prediction, as a result of modification on tumor and surrounding tissue induced by neoadjuvant therapy. The question on how to identify patients with pCR before surgery has received more attention recently. On the basis of pathological findings after surgery, in this article, we review the reliability and predictive ability of current imaging for restaging and pCR after preoperative chemoradiotherapy in rectal cancer.
Chemoradiotherapy ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; pathology ; therapy ; Treatment Outcome

OBJECTIVETo demonstrate the association of tumor budding with clinicopathological features and prognosis in T2 rectal cancer.

METHODSClinicopathological data of 123 patients who underwent potentially curative resection for T2 rectal carcinoma between 2001 and 2005 at the Changhai Hospital were collected. All pathology slides were stained with hematoxylin and eosin for microscopic examinations. The maximum value of tumor buds(MV) and average value of tumor buds(AV) were calculated, which were classified as low value (≤5), median value (5 < bud value < 10), and high value (≥10).

RESULTSUnivariate analysis and multivariate analysis revealed that MV(P=0.000), AV(P=0.001), and lymphatic invasion (P=0.006) were independent predictors for lymph node metastasis in T2 rectal cancer. Neural invasion and poorly differentiation were significantly associated with MV(P<0.05). Neural invasion, vascular invasion and poorly differentiation were were significantly associated to AV (P<0.01). Disease-free survival (DFS) of patients with low AV, median AV and high AV was 110.5 months, 95.8 months, and 60.0 months respectively. There were significance differences in DFS of low AV with median and high AV(P<0.05). DFS of patients with low MV, median MV and high MV was 115.1 months, 98.5 months, and 86.0 months respectively. There were significance differences in DFS between low and high AV, and median and high MV(P<0.01 and P<0.05), while no significant difference existed between low and median MV.

CONCLUSIONTumor budding is a useful marker to indicate high invasiveness of rectal cancer and a valuable prognostic predictor.

Humans ; Neoplasm Recurrence, Local ; prevention & control ; Rectal Neoplasms ; pathology

For locally advanced rectal cancer, multiple disciplinary team (MDT) has been the standard care. As a part of MDT, radiotherapy (RT) plays an important role in clinical practice. With mounting clinical evidence, RT is swifted from postoperative administration to preoperative. Compared to post-operative RT, pre-operative RT increased local control rate significantly, but not in DFS and OS. Two different preoperative RT models, short-course RT and long-course chemoradiotherapy demonstrated similar local control and long-term survival. However, a better tumor regression was observed in long-course CRT. In recent year, some small sample size studies, optimized the current pre-operative RT model, such as prolonging the interval between RT and surgery and adding consolidation chemotherapy (CT) in the interval, or adding induction CT before pre-operative RT. These optimizations decreased toxicities and increased treatment compliance, then improved the prognosis to a certain extent.
Chemoradiotherapy ; Humans ; Preoperative Care ; Prognosis ; Rectal Neoplasms ; pathology ; therapy

Humans ; Magnetic Resonance Imaging ; Neoplasm Staging ; Rectal Neoplasms ; diagnosis ; pathology

Humans ; Lymph Node Excision ; Neoplasm Staging ; Rectal Neoplasms ; pathology ; surgery