Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer : a near pathologic complete response does not translate into good clinical outcome
(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.
(Less)
- author
- 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
- publishing date
- 2014-07
- 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 <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}}, }