Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy - 2002
Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy
[en] BACKGROUND: Locally advanced rectal carcinoma has a poor prognosis. However,
since the introduction of preoperative radiotherapy, the outcome of patients with
rectal carcinoma has been reported to have improved. Nevertheless, to the authors’
knowledge few data are available regarding the histopathologic response to
radiotherapy as assessed on surgical specimens as a potential predictive factor for
outcome.
METHODS: To estimate the effect of radiotherapy on rectal carcinoma, the authors
retrospectively reviewed the surgical specimens of 102 patients with T3-4, N0 or
N1 rectal carcinoma and 1 patient with T2 but N1 rectal carcinoma. All patients
were treated preoperatively with a hyperfractionated accelerated radiotherapy
schedule in a prospective protocol (Trial 93-01). Using a standardized approach,
tumor regression was graded using a system that varies from Grade 1 (tumor
regression Grade [TRG] 1) when complete tumor regression is observed to Grade 5
(TRG5) when no tumor regression is observed.
RESULTS: Radiotherapy resulted in tumor downstaging in 43% of the patients.
There were 2 pT1 tumors (2%), 21 pT2 tumors (20%), 66 pT3 tumors (64%), and 14
pT4 tumors (14%) after treatment. Regional lymph nodes were involved in 55
patients (53%). None of the patients demonstrated a complete tumor regression
after radiotherapy, but in 79% of the specimens a partial tumor regression was
observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5: 21%). The
median actuarial overall survival (OS) and disease-free survival (DFS) were 52
months. Actuarial local recurrence rates at 2 years and 5 years were 6.4% and 7.6%,
respectively. Univariate analysis showed the actuarial DFS to be significantly lower
in patients with lymph node metastases (P 0.0004) and advanced pT stages
(pT3-4) (P 0.03). A favorable outcome for OS, DFS, and local control was
observed in patients with TRG2-4 (i.e., responders) compared with patients with
TRG5 (i.e., nonresponders), but also in patients with low residual tumor cell
density (TRG2, 3, and 4). On multivariate analysis, TRG remained an independent
prognostic indicator for local tumor control.
CONCLUSIONS. Tumor regression as well as residual tumor cell density were found
to be predictive factors of survival in rectal carcinoma patients after preoperative
radiotherapy. Even after preoperative radiotherapy, the pathologic stage of the
surgical specimen remained a prognostic factor. The use of a standardized approach
for pathologic evaluation must be implemented to allow comparison between
the results of various treatment approaches.
Disciplines :
Oncology Hematology
Author, co-author :
Bouzourene, Hanifa; Centre Hospitalier Universitaire Vaudois (Lausanne)
Bosman, Fred; Centre Hospitalier Universitaire Vaudois (Lausanne) > Institute of Pathology
Seelentag, Walter; Centre Hospitalier Universitaire Vaudois > Institute of Pathology
Matter, Maurice; Centre Hospitalier Universitaire Vaudois > Surgery
COUCKE, Philippe ; Centre Hospitalier Universitaire Vaudois (Lausanne) > Radiothérapie
Language :
English
Title :
Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy
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