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Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point.

Publication ,  Journal Article
Guillem, JG; Chessin, DB; Shia, J; Moore, HG; Mazumdar, M; Bernard, B; Paty, PB; Saltz, L; Minsky, BD; Weiser, MR; Temple, LKF; Cohen, AM; Wong, WD
Published in: J Clin Oncol
May 20, 2005

PURPOSE: Clinical assessment of rectal cancer response to preoperative combined-modality therapy (CMT) using digital rectal examination (DRE) has been proposed as a means of assessing efficacy of therapy. However, because the accuracy of this approach has not been established, we conducted a prospective analysis to determine the operating surgeon's ability to assess response using DRE. PATIENTS AND METHODS: Ninety-four prospectively accrued patients with locally advanced rectal cancer (T3/4 or N1) were evaluated with DRE and sigmoidoscopy in order to determine the following tumor characteristics: size, location, mobility, morphology, and circumference. Following preoperative CMT (50.40 Gy with fluorouracil-based chemotherapy) and under general anesthesia, the same surgeon estimated tumor response based on changes in these tumor characteristics, assessed via DRE. Percent pathologic tumor response was determined prospectively by a single pathologist using whole mount sections of the resected cancer. RESULTS: Clinical assessment using DRE underestimated pathologic response in 73 cases (78%). In addition, DRE was able to identify only 3 of 14 cases (21%) with a pathologic complete response. There were no clinical overestimates of response. None of the clinicopathologic tumor characteristics examined had a significant impact on DRE estimation of response. CONCLUSION: Clinical examination underestimates the extent of rectal cancer response to preoperative CMT. Given the inaccuracy of DRE following preoperative CMT, it should not be used as a sole means of assessing efficacy of therapy nor for selecting patients following CMT for local surgical therapies.

Duke Scholars

Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

May 20, 2005

Volume

23

Issue

15

Start / End Page

3475 / 3479

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Sensitivity and Specificity
  • Risk Assessment
  • Rectal Neoplasms
  • Radiotherapy, Adjuvant
  • Prospective Studies
  • Prognosis
  • Preoperative Care
  • Physical Examination
 

Citation

APA
Chicago
ICMJE
MLA
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Guillem, J. G., Chessin, D. B., Shia, J., Moore, H. G., Mazumdar, M., Bernard, B., … Wong, W. D. (2005). Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point. J Clin Oncol, 23(15), 3475–3479. https://doi.org/10.1200/JCO.2005.06.114
Guillem, Jose G., David B. Chessin, Jinru Shia, Harvey G. Moore, Madhu Mazumdar, Bianca Bernard, Philip B. Paty, et al. “Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point.J Clin Oncol 23, no. 15 (May 20, 2005): 3475–79. https://doi.org/10.1200/JCO.2005.06.114.
Guillem JG, Chessin DB, Shia J, Moore HG, Mazumdar M, Bernard B, et al. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point. J Clin Oncol. 2005 May 20;23(15):3475–9.
Guillem, Jose G., et al. “Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point.J Clin Oncol, vol. 23, no. 15, May 2005, pp. 3475–79. Pubmed, doi:10.1200/JCO.2005.06.114.
Guillem JG, Chessin DB, Shia J, Moore HG, Mazumdar M, Bernard B, Paty PB, Saltz L, Minsky BD, Weiser MR, Temple LKF, Cohen AM, Wong WD. Clinical examination following preoperative chemoradiation for rectal cancer is not a reliable surrogate end point. J Clin Oncol. 2005 May 20;23(15):3475–3479.

Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

May 20, 2005

Volume

23

Issue

15

Start / End Page

3475 / 3479

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Sensitivity and Specificity
  • Risk Assessment
  • Rectal Neoplasms
  • Radiotherapy, Adjuvant
  • Prospective Studies
  • Prognosis
  • Preoperative Care
  • Physical Examination