Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer Journal Article
| Authors: | Minsky, B. D.; Rich, T.; Recht, A.; Harvey, W.; Mies, C. |
| Article Title: | Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer |
| Abstract: | As an alternative to radical surgery, local excision with or without adjuvant pelvic radiation therapy has been used in selected patients with rectal cancer. To determine which clinical and pathologic features can predict the presence of positive lymph nodes (LN+), a retrospective review of 168 patients who underwent potentially curative surgery for rectosigmoid and rectal cancer was performed. By univariate analysis, tumor penetration, grade, and histology were significant predictive features. This was confirmed by logistic regression analysis. The incidence of LN+ increased with increasing tumor penetration (T1, 0%; T2, 28%; T3, 36%; T4, 53%; P = 0.04), grade of adenocarcinoma (well‐differentiated, 0%; moderately differentiated, 30%; poorly differentiated, 50%; P = 0.07, [borderline significance]), and the presence of any colloid histology (pure adenocarcinoma, 30%; total colloid, 52%; P = 0.04). Using 2 × 2 contingency tables, the presence of blood vessel invasion (BVI), lymphatic vessel invasion (LVI), vascular invasion (VI), total colloid histology, and high grade further increased the incidence of LN+ with increasing tumor penetration. Regardless of tumor size, grade, histology, BVI, LVI, or VI, none of the nine patients with Stage T1 tumors or the seven with well‐differentiated adenocarcinomas had LN+. For this group, local excision alone is recommended. The incidence of LN+ was ≥19% in all other categories. For this group of patients, if there is no evidence of gross tumor in the pelvis, then a local excision plus adjuvant pelvic radiation may be an alternative to radical surgery. Copyright © 1989 American Cancer Society |
| Keywords: | adult; aged; aged, 80 and over; retrospective studies; major clinical study; patient selection; cancer adjuvant therapy; combined modality therapy; lymphatic metastasis; neoplasm staging; adenocarcinoma; registries; neoplasm invasiveness; regression analysis; rectal neoplasms; rectum cancer; middle age; sigmoid neoplasms; human; male; female; priority journal; support, non-u.s. gov't |
| Journal Title: | Cancer |
| Volume: | 63 |
| Issue: | 7 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 1989-04-01 |
| Start Page: | 1421 |
| End Page: | 1429 |
| Language: | English |
| DOI: | 10.1002/1097-0142(19890401)63:7<1421::Aid-cncr2820630732>3.0.Co;2-h |
| PUBMED: | 2920368 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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