ORBi: Bouzourene Hanifa - Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy

Reference : Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Loc...


	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Hematology Human health sciences : Oncology
	To cite this reference:	http://hdl.handle.net/2268/11383

Title :	Importance of Tumor Regression Assessment in Predicting the Outcome in Patients with Locally Advanced Rectal Carcinoma Who Are Treated with Preoperative Radiotherapy
Language :	English
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 > > >]
Publication date :	15-Feb-2002
Journal title :	Cancer
Publisher :	Wiley
Volume :	94
Issue/season :	4
Pages :	1121-1130
Audience :	International
ISSN :	0008-543X
e-ISSN :	1097-0142
City :	Hoboken
Country :	NJ
Keywords :	[en] 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.
Target :	Researchers ; Professionals ; Students ; General public ; Others
Permalink :	http://hdl.handle.net/2268/11383
	also: http://hdl.handle.net/2268/16979

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