Defining Treatment Outcomes

[Tom Galli]

These definitions were provided by a general medical oncologist who treats most forms of cancer. He cautions that although the terms have distinct meanings, there is overlap.

Cure. Should be reserved for specific diseases where recurrences happen quickly and one can safely say there is a cure. Not useful for diseases like most cancers where recurrences can occur up to 5-10-20 years later.  Mostly applies to non-melanoma skin cancers.  Commonly used by surgeons who don't follow the patient long-term and want the patient to feel good about the surgery. But this pronouncement can be VERY misleading as I have had patients without followup because the surgeon said: "I was cured,” and then suffered a recurrence.  I use it with qualifiers, such as "about 95-percent chance of a cure" if someone is still free of disease at 5 or 10 years in concert with statistical predictions.

5-year survivor. This term is mostly used to describe patients if still free of disease at that time, and often implies a reasonable chance of a cure.  Most commonly used term now and has supplanted the use of term "cure".

No evidence of disease (NED). Describes how things are at a specific time, such as after scan, surgery, re-staging workup, after chemo, or XRT [radiation therapy].  This is a point-specific-term, and is good, but does not guarantee anything long-term.

Remission. Similar to NED, but usually used after someone has had disease treated by XRT or chemotherapy and not just surgery but is a general term. It IMPLIES a complete remission but not always. The disease has disappeared at least for awhile, to exam or testing.

Several sub classes of remission:

• Partial remission (PR) meaning at least 50% reduction in the bulk or evidence of the cancer, usually measured by size in mm or cm.
• Minor remission or minor regression suggesting the same but at least 25% reduction in size/bulk of the cancer and a less useful term.
• Complete remission (CR) meaning all evidence of cancer gone after some treatment. Once again, usually after XRT or chemotherapy, but not surgery (surgeons usually just say, "I got it all”).
• Complete pathologic remission (CPR) (also called complete pathologic response) usually implies that the patient received chemo or XRT PRIOR to surgery (neoadjuvant therapy) to reduce the size of the cancer prior to surgery, and in the final surgical specimen NO cancer was found pathologically. Often used for breast cancer patients. 
• Partial pathologic remission like CPR but with a poorer outcome. Implies the cancer is sensitive to the treatment but not 100-percent, and often implies need for more therapy after the surgery.

Stable. Implies the disease has not grown nor appreciably shrunk (due to variance in measurements, this often suggests a single change +/- 10%), and then the trend in change is the most important determinant.  Used to be considered a reason to change therapy, but in some diseases may imply continued survival benefit, and thus no need to change therapy.

Progression. This is the worst outcome suggesting significant growth or continued trend in growth and implies need to change therapy.  If no therapy, then "Best Supportive Care" (BSC) like Hospice or comfort measures.

There are three other terms used for surgery results: R0, R1, and R2.  These describe visual and pathologic review of the resected cancer specimen.  

• R0 implies all cancer removed. No obvious visually or microscopically identified cancer seen. This is the best result after surgery.
• R1 implies no visual cancer seen, but microscopically tumor can be seen at the margin of resection and suggests some tumor left behind. Likely needs additional resection, or if not feasible, XRT or chemotherapy afterwards to treat the area.
• R2 implies visual tumor left (macroscopic) and means the same as R1 but a less successful outcome ("I had to leave some tumor behind, it was attached to an artery or major vein, etc").

[Deb W]

Tom - This is so helpful.  Thank you so much!  Now I see why I've been so confused by the terms!

[alascerca]

This is wonderful. I'm now reading your story. So appreciated. Thank you. ~  joana
OK, just finished your story. Wonderful. I will be checking out this site on which you have t published. You are an inspiration and your work is so, so valuable. Thank you. ❤️

[Saskgirl]

Thank you Tom, very helpful!