Article (Scientific journals)
Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy
Bouzourene, Hanifa; Bosman, Fred; Seelentag, Walter et al.
2002In Cancer, 94 (4), p. 1121-1130
Peer Reviewed verified by ORBi
 

Files


Full Text
Importance of Tumor Regression Assessment in.pdf
Publisher postprint (961.77 kB)
Download

All documents in ORBi are protected by a user license.

Send to



Details



Keywords :
tumor regression; survival; locally advanced colorectal carcinoma; preoperative radiotherapy
Abstract :
[en] BACKGROUND: Locally advanced rectal carcinoma has a poor prognosis. However, <br />since the introduction of preoperative radiotherapy, the outcome of patients with <br />rectal carcinoma has been reported to have improved. Nevertheless, to the authors’ <br />knowledge few data are available regarding the histopathologic response to <br />radiotherapy as assessed on surgical specimens as a potential predictive factor for <br />outcome. <br />METHODS: To estimate the effect of radiotherapy on rectal carcinoma, the authors <br />retrospectively reviewed the surgical specimens of 102 patients with T3-4, N0 or <br /> N1 rectal carcinoma and 1 patient with T2 but N1 rectal carcinoma. All patients <br />were treated preoperatively with a hyperfractionated accelerated radiotherapy <br />schedule in a prospective protocol (Trial 93-01). Using a standardized approach, <br />tumor regression was graded using a system that varies from Grade 1 (tumor <br />regression Grade [TRG] 1) when complete tumor regression is observed to Grade 5 <br />(TRG5) when no tumor regression is observed. <br />RESULTS: Radiotherapy resulted in tumor downstaging in 43% of the patients. <br />There were 2 pT1 tumors (2%), 21 pT2 tumors (20%), 66 pT3 tumors (64%), and 14 <br />pT4 tumors (14%) after treatment. Regional lymph nodes were involved in 55 <br />patients (53%). None of the patients demonstrated a complete tumor regression <br />after radiotherapy, but in 79% of the specimens a partial tumor regression was <br />observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5: 21%). The <br />median actuarial overall survival (OS) and disease-free survival (DFS) were 52 <br />months. Actuarial local recurrence rates at 2 years and 5 years were 6.4% and 7.6%, <br />respectively. Univariate analysis showed the actuarial DFS to be significantly lower <br />in patients with lymph node metastases (P 0.0004) and advanced pT stages <br />(pT3-4) (P 0.03). A favorable outcome for OS, DFS, and local control was <br />observed in patients with TRG2-4 (i.e., responders) compared with patients with <br />TRG5 (i.e., nonresponders), but also in patients with low residual tumor cell <br />density (TRG2, 3, and 4). On multivariate analysis, TRG remained an independent <br />prognostic indicator for local tumor control. <br />CONCLUSIONS. Tumor regression as well as residual tumor cell density were found <br />to be predictive factors of survival in rectal carcinoma patients after preoperative <br />radiotherapy. Even after preoperative radiotherapy, the pathologic stage of the <br />surgical specimen remained a prognostic factor. The use of a standardized approach <br />for pathologic evaluation must be implemented to allow comparison between <br />the results of various treatment approaches.
Disciplines :
Oncology
Hematology
Author, co-author :
Bouzourene, Hanifa;  Centre Hospitalier Universitaire Vaudois (Lausanne)
Bosman, Fred;  Centre Hospitalier Universitaire Vaudois (Lausanne) > Institute of Pathology
Seelentag, Walter;  Centre Hospitalier Universitaire Vaudois > Institute of Pathology
Matter, Maurice;  Centre Hospitalier Universitaire Vaudois > Surgery
COUCKE, Philippe  ;  Centre Hospitalier Universitaire Vaudois (Lausanne) > Radiothérapie
Language :
English
Title :
Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy
Publication date :
15 February 2002
Journal title :
Cancer
ISSN :
0008-543X
eISSN :
1097-0142
Publisher :
Wiley, Hoboken, United States - New Jersey
Volume :
94
Issue :
4
Pages :
1121-1130
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 15 July 2009

Statistics


Number of views
121 (2 by ULiège)
Number of downloads
402 (1 by ULiège)

Scopus citations®
 
253
Scopus citations®
without self-citations
247
OpenCitations
 
225

Bibliography


Similar publications



Contact ORBi