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What Is the Prognostic Value of the (Y)pN Status After Chemoradiotherapy in Rectal Cancer?

  • Rob Glynne-Jones
  • David Tan
  • Nicholas P. West
Chapter

Abstract

NCCN and ESMO guidelines recommend neoadjuvant chemoradiotherapy (CRT) and /or short-course preoperative radiotherapy (SCPRT) for clinically staged T3/T4 rectal cancers. Both strategies are widely used in Europe to reduce the risk of local recurrence but have made little impact on the incidence of distant metastases. Hence intensification or the additional use of systemic chemotherapy has been advocated, although controversy remains regarding the utility of postoperative chemotherapy. It remains uncertain how to interpret histopathology after CRT or SCPRT who is most at risk of distant metastases and whether some groups will benefit more from chemotherapy than others. Validated early histopathological endpoints after CRT or SCPRT would therefore be useful for investigation of phase I/II novel agents, to shorten the time to assessment of the different arms in phase III trials and to define patients with a suitable risk for the use or avoidance of adjuvant chemotherapy. Hence ypN status has been proposed as a relevant early endpoint along with pCR, ypT and tumour regression grading. However, all these early alternative endpoints are dependent on factors such as quality of TME surgery, radiation field size, type and dose of chemotherapy used, the diligence of the pathologist in finding lymph nodes and adequate sampling, timing of surgery following CRT or SCPRT and possibly also the route by which the changes were achieved, i.e. chemotherapy, chemoradiation or radiotherapy alone. In this chapter we will discuss the relevance and issues surrounding the utility of ypN status.

Keywords

Rectal cancer Preoperative chemoradiotherapy Lymph node status Prognosis ypN 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • Rob Glynne-Jones
    • 1
  • David Tan
    • 2
  • Nicholas P. West
    • 3
  1. 1.Mount Vernon Centre for Cancer TreatmentMiddlesexUK
  2. 2.National Cancer Centre SingaporeSingaporeSingapore
  3. 3.Pathology and Tumour BiologyLeeds Institute of Cancer and Pathology, School of Medicine, University of LeedsLeedsUK

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