Gastrointestinal Oncology

Annals of Surgical Oncology

, Volume 15, Issue 12, pp 3471-3477

A Simplified Tumor Regression Grade Correlates with Survival in Locally Advanced Rectal Carcinoma Treated with Neoadjuvant Chemoradiotherapy

  • D. BeddyAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , J. M. P. HylandAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital Email author 
  • , D. C. WinterAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , C. LimAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , A. WhiteAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , M. MoriartyAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , J. ArmstrongAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , D. FennellyAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
  • , D. GibbonsAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital
    • , K. SheahanAffiliated withCentre for Colorectal Disease, St Vincent’s University Hospital

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Abstract

Background

Locally advanced rectal cancer is frequently treated with neoadjuvant chemoradiotherapy to reduce local recurrence and possibly improve survival. The tumor response to chemoradiotherapy is variable and may influence the prognosis after surgery. This study assessed tumor regression and its influence on survival in patients with rectal cancer treated with chemoradiotherapy followed by curative surgery.

Methods

One hundred twenty-six patients with locally advanced rectal cancer (T3/T4 or N1/N2) were treated with chemoradiotherapy followed by total mesorectal excision. Patients received long-course radiotherapy (50 Gy in 25 fractions) in combination with 5-flourouracil over 5 weeks. By means of a standardized approach, tumor regression was graded in the resection specimen using a 3-point system related to tumor regression grade (TRG): complete or near-complete response (TRG1), partial response (TRG2), or no response (TRG3).

Results

The 5-year disease-free survival was 72% (median follow-up 37 months), and 7% of patients had local recurrence. Chemoradiotherapy produced downstaging in 60% of patients; 21% of patients experienced TRG1. TRG1 correlated with a pathological T0/1 or N0 status. Five-year disease-free survival after chemoradiotherapy and surgery was significantly better in TRG1 patients (100%) compared with TRG2 (71%) and TRG3 (66%) (P = .01).

Conclusion

Tumor regression grade measured on a 3-point system predicts outcome after chemoradiotherapy and surgery for locally advanced rectal cancer.