09-20-2024 Neoadjuvant Therapy
Scenario:
- Patient presented with Rectal Primary cT2 cN2a cM0 Stage 3B Grade 3 Adenocarcinoma
- Treatment Plan: Total neo-adjuvant therapy followed by consolidative proctocolectomy with perhaps formation of a permanent colostomy pending response to treatment
- Patient treated with Neoadjuvant Chemo/XRT
- After neoadjuvant therapy complete Flexible Sigmoidoscopy shows no visible cancer, biopsies negative. Scans show no evidence of viable disease, no adenopathy, no mets
- Med Onc-Because of the findings on flexible sigmoidoscopy and the biopsy results, patient appears to have a complete clinical response. This provides patient with 2 options. Option 1 is surveillance. This would mean performing a flexible sigmoidoscopy every 3 months with biopsy. Option 2 involves surgical resection. After careful consideration, the patient has elected to undergo serial examinations.
Question: How would you code the SSDI Neoadjuvant Therapy Clinical Response?
- 1 Complete clinical response (CR) (per managing/treating physician statement)
- 2 Partial clinical response (PR) (per managing/treating physician statement)
- 3 Progressive disease (PD) (per managing/treating physician statement)
- 4 Stable disease (SD) (per managing/treating physician statement)
- 5 No response (NR) (per managing/treating physician statement) Not stated as progressive disease (PD) or stable disease (SD)
- 6 Neoadjuvant therapy done, managing/treating physician interpretation not available, treatment response inferred from imaging, biomarkers, or yc stage
- 7 Complete clinical response based on biopsy results from a pathology report (per pathologist assessment)
- 8 Neoadjuvant therapy done, response not documented or unknown
- 9 Unknown if neoadjuvant therapy performed
Answer: 1 Complete clinical response (CR) (per managing/treating physician statement)
Some Other Fields Below to consider:
| Neoadjuvant Therapy | 1 | Neoadjuvant therapy completed according to treatment plan and guidelines |
| Neoadjuvant Therapy-Clinical Response | 1 | Complete clinical response (CR) (per managing/treating physician statement)-Med Onc States patient appears to have a complete clinical response |
| Neoadjuvant Therapy-Treatment Effect | 7 | Neoadjuvant therapy completed and planned surgical resection not performed |
| AJCC Clin Stage | cT2 cN2a cM0 Stage 3B
|
|
| AJCC Path Stage | Blank
|
Not eligible for Path Stage-patient treated with neoadjuvant therapy |
| AJCC Post therapy (yc) Stage | ycT0 ycN0 cM0 Stage 99
|
ycT0 (no evidence of rectal tumor on sigmoidoscopy or scans after neoadjvuant rx)
ycN0 cM0 (no evidence of lymph node or metastatic disease on scans after neoadjvuant therapy) |
| AJCC Post therapy (yp) Stage | BLANK | Not eligible for yp Stage-surgery not done |
| Grade Clinical | 3 | |
| Grade Pathological | 9 | |
| Grade Post therapy Clin yc | 9 | Grade Manual Note 4: Code 9 (unknown) Grade Post Therapy Clin *(yc) when
x Microscopic exam is done after neoadjuvant therapy and there is no residual cancer |
| Grade Posttherapy Path yp | BLANK | Grade Manual Note 1: Leave Grade Post Therapy Path (yp) blank when
x Neoadjuvant therapy completed; surgical resection not done |
Training Resources:
- AJCC Cancer Registrar Education
- SEER*Educate {Create a Free Account]
Click Training Tab, then SEER Educational Workshop-Complete