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Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer : a near pathologic complete response does not translate into good clinical outcome

Swellengrebel, Hendrik A M ; Bosch, Steven L ; Cats, Annemieke ; Vincent, Andrew D ; Dewit, Luc G H ; Verwaal, Vic J LU ; Nagtegaal, Iris D and Marijnen, Corrie A M (2014) In Radiotherapy and Oncology 112(1). p.44-51
Abstract

BACKGROUND: After preoperative chemoradiotherapy (CRT) for rectal cancer, clinically undetectable residual tumour deposits or pathologic lymph nodes may remain in the mesorectum.

AIM: The aim of this study was to report histopathological effects of CRT and factors affecting outcome in a uniformly treated series of locally advanced rectal cancer (LARC) patients.

METHODS: Between 2004 and 2008, 107 patients with cT3 (threatening the mesorectal fascia or <5 cm from the anal verge), cT4 or cN2 rectal cancer were treated with preoperative CRT (25 × 2 Gy with capecitabine) and TME 6-8 weeks later. Central histopathological review followed. Tumour regression grade (TRG) was scored in pCR, near-pCR, response and no response. Cox... (More)

BACKGROUND: After preoperative chemoradiotherapy (CRT) for rectal cancer, clinically undetectable residual tumour deposits or pathologic lymph nodes may remain in the mesorectum.

AIM: The aim of this study was to report histopathological effects of CRT and factors affecting outcome in a uniformly treated series of locally advanced rectal cancer (LARC) patients.

METHODS: Between 2004 and 2008, 107 patients with cT3 (threatening the mesorectal fascia or <5 cm from the anal verge), cT4 or cN2 rectal cancer were treated with preoperative CRT (25 × 2 Gy with capecitabine) and TME 6-8 weeks later. Central histopathological review followed. Tumour regression grade (TRG) was scored in pCR, near-pCR, response and no response. Cox regression was performed to identify prognosticators.

RESULTS: The 3-year distant metastasis-free interval, disease-free rate and overall survival rate were 82%, 73% and 87% (median 44 months follow-up). TRG consisted of 20% pCR, 11% near-pCR, 55% response and 14% no response. 6/21 pCR patients harboured nodal metastases. 5/12 near-pCR had ypT3 disease, while 6 harboured node metastases. 5/12 near-PCR patients developed distant metastases. ypN and TRG were powerful outcome discriminators.

CONCLUSION: The high number of near-pCR with ypT3 or ypN1/2 and their poor outcome demonstrates that "watch-and-wait" in LARC patients should be applied with care.

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author
; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adenocarcinoma/pathology, Adenocarcinoma, Mucinous/pathology, Adult, Aged, Aged, 80 and over, Antimetabolites, Antineoplastic/therapeutic use, Capecitabine, Chemoradiotherapy, Deoxycytidine/analogs & derivatives, Female, Fluorouracil/analogs & derivatives, Humans, Lymph Nodes/pathology, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Grading, Neoplasm Staging, Neoplasm, Residual, Preoperative Care, Proportional Hazards Models, Radiotherapy, Conformal, Radiotherapy, Intensity-Modulated, Rectal Neoplasms/pathology, Rectum/surgery, Remission Induction, Retrospective Studies, Survival Rate
in
Radiotherapy and Oncology
volume
112
issue
1
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:84908211741
  • pmid:25018000
ISSN
1879-0887
DOI
10.1016/j.radonc.2014.05.010
language
English
LU publication?
no
additional info
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
id
84c7b1fe-ae56-4a3b-b151-e8c1b6fdf249
date added to LUP
2022-04-05 09:44:24
date last changed
2024-04-24 07:03:42
@article{84c7b1fe-ae56-4a3b-b151-e8c1b6fdf249,
  abstract     = {{<p>BACKGROUND: After preoperative chemoradiotherapy (CRT) for rectal cancer, clinically undetectable residual tumour deposits or pathologic lymph nodes may remain in the mesorectum.</p><p>AIM: The aim of this study was to report histopathological effects of CRT and factors affecting outcome in a uniformly treated series of locally advanced rectal cancer (LARC) patients.</p><p>METHODS: Between 2004 and 2008, 107 patients with cT3 (threatening the mesorectal fascia or &lt;5 cm from the anal verge), cT4 or cN2 rectal cancer were treated with preoperative CRT (25 × 2 Gy with capecitabine) and TME 6-8 weeks later. Central histopathological review followed. Tumour regression grade (TRG) was scored in pCR, near-pCR, response and no response. Cox regression was performed to identify prognosticators.</p><p>RESULTS: The 3-year distant metastasis-free interval, disease-free rate and overall survival rate were 82%, 73% and 87% (median 44 months follow-up). TRG consisted of 20% pCR, 11% near-pCR, 55% response and 14% no response. 6/21 pCR patients harboured nodal metastases. 5/12 near-pCR had ypT3 disease, while 6 harboured node metastases. 5/12 near-PCR patients developed distant metastases. ypN and TRG were powerful outcome discriminators.</p><p>CONCLUSION: The high number of near-pCR with ypT3 or ypN1/2 and their poor outcome demonstrates that "watch-and-wait" in LARC patients should be applied with care.</p>}},
  author       = {{Swellengrebel, Hendrik A M and Bosch, Steven L and Cats, Annemieke and Vincent, Andrew D and Dewit, Luc G H and Verwaal, Vic J and Nagtegaal, Iris D and Marijnen, Corrie A M}},
  issn         = {{1879-0887}},
  keywords     = {{Adenocarcinoma/pathology; Adenocarcinoma, Mucinous/pathology; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic/therapeutic use; Capecitabine; Chemoradiotherapy; Deoxycytidine/analogs & derivatives; Female; Fluorouracil/analogs & derivatives; Humans; Lymph Nodes/pathology; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Neoplasm, Residual; Preoperative Care; Proportional Hazards Models; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Rectal Neoplasms/pathology; Rectum/surgery; Remission Induction; Retrospective Studies; Survival Rate}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{44--51}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer : a near pathologic complete response does not translate into good clinical outcome}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2014.05.010}},
  doi          = {{10.1016/j.radonc.2014.05.010}},
  volume       = {{112}},
  year         = {{2014}},
}