Clinicopathologic Comparison of High-Dose-Rate Endorectal Brachytherapy versus Conventional Chemoradiotherapy in the Neoadjuvant Setting for Resectable Stages II and III Low Rectal Cancer

Figure 3

Representative H&E stained histopathologic sections at 4x magnification from patients who exhibited a complete pathologic response to EBT (a)–(e) and conventional external beam radiation (f)–(j). All images are taken from the region of the rectal wall where the tumor was located prior to neoadjuvant therapy. All insets are shown at 20x magnification. First row: at the mucosa, extensive ulceration (solid arrows) is apparent after EBT (a), while the mucosa remains intact (solid arrows) after conventional CRT (f). Hyalinization of the lamina propria (asterisks) is also evident after EBT (a). Second row: in the submucosa, marked hypertrophy and sclerosis of vessel walls can be seen following EBT (b), while only slight hypertrophy of vessel walls is seen after conventional CRT (g). Third row: within the muscularis propria, the more superficial interna layer can be seen to exhibit degeneration and atrophy after EBT while the externa layer remains largely intact (c); in a contrary fashion, following conventional CRT, it is the externa layer that exhibits more prominent degeneration compared to the interna (h). fourth row: at the level of the subserosa, vessel walls appear normal in patients treated with EBT (d), but distinctly hypertrophied in patients treated with conventional CRT (i). Fifth row: the serosa demonstrates few adhesions (asterisk) after treatment with EBT (e), in contrast to the extensive adhesions (asterisks) present after treatment with conventional CRT (j).