Skip to main content

Advertisement

SpringerLink
Log in

Tumour regression grading in the evaluation of tumour response after different preoperative radiotherapy treatments for rectal carcinoma

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Preoperative radiotherapy (PRT) for rectal carcinoma has been shown to cause tumour regression and increase local control and patient survival. The aim of this study was to examine the usefulness of tumour regression grading (TRG) in quantifying the effect of PRT.

Methods

Depending on the tumour stage (uT), as defined by preoperative endorectal ultrasound (ERUS), fixity and distance from the anal verge, 126 patients with rectal cancer underwent either surgery alone, or received short-course 25-Gy radiotherapy or long-course 50-Gy radiotherapy combined with 5-fluorouracil (5-FU) before surgery. TRG in each group was assessed and compared with the downstaging, defined as a change in preoperative uT stage and pathologic stage (pT).

Results

Complete response (no residual tumour, TRG 1) was seen in 7% of the patients (3/44) and total or major regression (TRG 1–3) in 73% of the patients (32/44) treated with 50-Gy chemoradiation. Of those treated with 25-Gy PRT, 21% (9/42) showed major tumour regression. Of the patients who underwent ERUS and PRT, 32% (26/83) were downstaged when comparing uT with pT, but 53% (14/26) of the downstaged tumours showed no response by TRG. In comparison, 50% (28/57) of the tumours with no downstaging showed a marked response by TRG (p=0.05).

Conclusions

Tumour regression grading offers detailed information of the effect of PRT and shows that tumour regression is more marked after long-term chemoradiation than after short-course radiotherapy (p=0.02). In contrast, T-stage downstaging was similar in both groups and did not correlate with the TRG results (p=0.05).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Krook JE, Moertel C, Gunderson LL, Wieand HS, Collins RT, Beart RW, Kubista TP, Poon MA, Meyers WC, Maillard JA et al (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324:709–715

    Google Scholar 

  2. Minsky B, Cohen A, Enker W, Saltz L, Guillem J, Paty P, Kelsen D, Kemeny N, Ilson D, Bass J, Conti J (1997) Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer. Int J Radiat Oncol Biol Phys 37:289–295

    Google Scholar 

  3. Elsaleh H, Joseph D, Levitt M, House A, Robbins P (1999) Pre-operative chemoradiotherapy in locally advanced rectal cancer. Aust NZ J Surg 69:737–742

    Google Scholar 

  4. Delaney CP, Lavery IC, Brenner AJ, Hammel J, Senagore AJ, Noone RB, Fazio VW (2002) Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. Ann Surg 236:203–207

    Google Scholar 

  5. Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987

    Google Scholar 

  6. Kapitejn E, Marijnen C, Nagtegaal I, Putter H, Steup W, Wiggers T, Rutten H, Pahlman L, Glimelius B, Krieken J, Leer J, van de Velde C (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Google Scholar 

  7. Pahlman L, Dahlberg M, Glimelius B (1997) Perioperative radiation therapy. World J Surg 21:733–740

    Google Scholar 

  8. Simunovic M, Sexton R, Rempel E, Moran B, Heald RJ (2003) Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Br J Surg 90:999–1003

    Google Scholar 

  9. Bozzetti F, Andreola S, Baratti D, Mariani L, Stani S, Valvo F, Spinelli P (2002) Preoperative chemoradiation in patients with resectable rectal cancer: results on tumor response. Ann Surg Oncol 9:444–449

    Google Scholar 

  10. Wagman R, Minsky B, Cohen A, Guillem J, Paty P (1998) Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys 42:51–57

    Google Scholar 

  11. Rullier E, Goffre B, Bonnel C, Zerbib F, Caudry M, Saric J (2001) Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 234:633–640

    Google Scholar 

  12. Luna-Perez P, Rodriguez-Ramirez S, Rodriguez-Coria D, Fernandez A, Labastida S, Silva A, Lopez M (2001) Preoperative chemoradiation therapy and anal sphincter preservation with locally advanced rectal adenocarcinoma. World J Surg 25:1006–1011

    Google Scholar 

  13. Crane CH, Skibber JM, Feig BW, Vauthey JN, Thames HD, Curley SA, Rodriguez-Bigas MA, Wolff RA, Ellis LM, Delclos ME, Lin EH, Janjan NA (2003) Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma. Cancer 97:517–524

    Google Scholar 

  14. Meade P, Blatchford G, Thorson A, Christensen M, Ternent C (1995) Preoperative chemoradiation downstages locally advanced ultrasound-staged rectal cancer. Am J Surg 170:609–613

    Google Scholar 

  15. Theodoropoulos G, Wise W, Padmanabhan A, Kerner B, Taylor C, Aguilar P, Khanduja K (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903

    Google Scholar 

  16. Onaitis M, Noone R, Fields R, Hurwitz H, Morse M, Jowell P, McGrath K, Lee C, Anscher M, Clary B, Mantyh C, Pappas T, Ludvig K, Seigler H, Tyler D (2001) Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. Ann Surg Oncol 8:801–806

    Google Scholar 

  17. Bozzetti F, Andreola S, Rossetti C, Zucali R, Meroni E, Baratti D, Bertario L, Doci R, Gennari L (1996) Preoperative radiotherapy for resectable cancer of the middle-distal rectum: its effect on the primary lesion as determined by endorectal ultrasound using flexible echo colonoscope. Int J Colorectal Dis 11:283–286

    Google Scholar 

  18. Wheeler JMD, Warren BF, Jones AC, Mortensen N (1999) Preoperative radiotherapy for rectal cancer: implications for surgeons, pathologists and radiologists. Br J Surg 86:1108–1120

    Google Scholar 

  19. Pahlman L, Glimelius B (1990) Pre- and postoperative radiotherapy in rectal and rectosigmoid carcinoma: report from a randomized multicentre trial. Ann Surg 211:187–195

    Google Scholar 

  20. Hildebrandt U, Feifel G (1985) Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 28:42–46

    Google Scholar 

  21. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

    Google Scholar 

  22. Sobin LH, Wittekind C (eds) (1997) UICC TNM classification of malignant tumours, 5th edn. Wiley-Liss, New York

    Google Scholar 

  23. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee S-H, Madoff R, Rothenberger D (2003) A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 46:298–304

    Google Scholar 

  24. Ruo L, Tickoo S, Klimstra D, Minsky B, Saltz L, Mazumdar M, Paty P, Wong D, Larson S, Cohen A, Guillem J (2002) Long-term significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg 236:75–81

    Google Scholar 

  25. Dworak O, Keilholz L, Hoffman A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Colorectal Dis 12:19–23

    Google Scholar 

  26. Bouzourene H, Bosman F, Matter M, Coucke P (2003) Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy. Hum Pathol 34:541–548

    Google Scholar 

  27. Marijnen C, Nagtegaal I, Kranenbarg E, Hermans J, van de Velde C, Leer J, van Krieken J (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

    Google Scholar 

  28. Adams D, Blatchford J, Lin K, Ternent C, Thornson A, Christensen M (1999) Use of preoperative ultrasound staging for treatment of rectal cancer. Dis Colon Rectum 42:159–166

    Google Scholar 

  29. Kumar A, Scholefield J (2000) Endosonography of the anal canal and rectum. World J Surg 24:208–215

    Google Scholar 

  30. Akbari R, Wong W (2003) Endorectal ultrasound and the preoperative staging of rectal cancer. Scand J Surg 92:25–33

    Google Scholar 

  31. Wheeler JMD, Warren BF, Path MRC, Mortensen NJ, Ekanyaka N, Kulacoglu H, Jones AC, George BD, Kettlewell MGW (2002) Quantification of histologic regression of rectal cancer after irradiation. A proposal for a modified staging system. Dis Colon Rectum 45:1051–1056

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland

    J. Vironen

  2. Department of Pathology, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    M. Juhola

  3. Department of Surgery, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    M. Kairaluoma & I. Kellokumpu

  4. Department of Oncology, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    I. Jantunen

Authors
  1. J. Vironen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Juhola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kairaluoma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Jantunen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Kellokumpu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Kellokumpu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vironen, J., Juhola, M., Kairaluoma, M. et al. Tumour regression grading in the evaluation of tumour response after different preoperative radiotherapy treatments for rectal carcinoma. Int J Colorectal Dis 20, 440–445 (2005). https://doi.org/10.1007/s00384-004-0733-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-004-0733-y

Keywords

Search

Navigation