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,
<br />since the introduction of preoperative radiotherapy, the outcome of patients with
<br />rectal carcinoma has been reported to have improved. Nevertheless, to the authors’
<br />knowledge few data are available regarding the histopathologic response to
<br />radiotherapy as assessed on surgical specimens as a potential predictive factor for
<br />outcome.
<br />METHODS: To estimate the effect of radiotherapy on rectal carcinoma, the authors
<br />retrospectively reviewed the surgical specimens of 102 patients with T3-4, N0 or
<br /> N1 rectal carcinoma and 1 patient with T2 but N1 rectal carcinoma. All patients
<br />were treated preoperatively with a hyperfractionated accelerated radiotherapy
<br />schedule in a prospective protocol (Trial 93-01). Using a standardized approach,
<br />tumor regression was graded using a system that varies from Grade 1 (tumor
<br />regression Grade [TRG] 1) when complete tumor regression is observed to Grade 5
<br />(TRG5) when no tumor regression is observed.
<br />RESULTS: Radiotherapy resulted in tumor downstaging in 43% of the patients.
<br />There were 2 pT1 tumors (2%), 21 pT2 tumors (20%), 66 pT3 tumors (64%), and 14
<br />pT4 tumors (14%) after treatment. Regional lymph nodes were involved in 55
<br />patients (53%). None of the patients demonstrated a complete tumor regression
<br />after radiotherapy, but in 79% of the specimens a partial tumor regression was
<br />observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5: 21%). The
<br />median actuarial overall survival (OS) and disease-free survival (DFS) were 52
<br />months. Actuarial local recurrence rates at 2 years and 5 years were 6.4% and 7.6%,
<br />respectively. Univariate analysis showed the actuarial DFS to be significantly lower
<br />in patients with lymph node metastases (P 0.0004) and advanced pT stages
<br />(pT3-4) (P 0.03). A favorable outcome for OS, DFS, and local control was
<br />observed in patients with TRG2-4 (i.e., responders) compared with patients with
<br />TRG5 (i.e., nonresponders), but also in patients with low residual tumor cell
<br />density (TRG2, 3, and 4). On multivariate analysis, TRG remained an independent
<br />prognostic indicator for local tumor control.
<br />CONCLUSIONS. Tumor regression as well as residual tumor cell density were found
<br />to be predictive factors of survival in rectal carcinoma patients after preoperative
<br />radiotherapy. Even after preoperative radiotherapy, the pathologic stage of the
<br />surgical specimen remained a prognostic factor. The use of a standardized approach
<br />for pathologic evaluation must be implemented to allow comparison between
<br />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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