Tumour regression grading after chemoradiotherapy for locally advanced rectal cancer: A near pathologic complete response does not translate into good clinical outcome

Radiotherapy and Oncology

Volumn 112, Issue 1, 2014, Pages 44-51

  Swellengrebel, Hendrik A M ^a   Bosch, Steven L ^b   Cats, Annemieke ^a   Vincent, Andrew D ^a   Dewit, Luc G H ^a   Verwaal, Vic J ^a   Nagtegaal, Iris D ^b   Marijnen, Corrie A M ^a,c  

^a NETHERLANDS CANCER INSTITUTE   (Netherlands)

^b RADBOUD UNIVERSITY MEDICAL CENTER   (Netherlands)

^c LEIDEN UNIVERSITY MEDICAL CENTER   (Netherlands)

Author keywords

Chemoradiotherapy; Outcome; Rectal cancer; Tumour regression grade

Indexed keywords

CAPECITABINE; ANTINEOPLASTIC ANTIMETABOLITE; DEOXYCYTIDINE; FLUOROURACIL;

ADULT; ADVANCED CANCER; AGED; ARTICLE; CHEMORADIOTHERAPY; DISEASE FREE SURVIVAL; DISTANT METASTASIS; DISTANT METASTASIS FREE SURVIVAL; FEMALE; FOLLOW UP; HISTOPATHOLOGY; HUMAN; LOCALLY ADVANCED RECTAL CANCER; LYMPH NODE METASTASIS; MAJOR CLINICAL STUDY; MALE; OVERALL SURVIVAL; POLYMERASE CHAIN REACTION; PREOPERATIVE RADIOTHERAPY; RADIATION DOSE; RECTUM CANCER; SURVIVAL RATE; SURVIVAL TIME; TUMOR CLASSIFICATION; TUMOR REGRESSION GRADING; ADENOCARCINOMA; ADENOCARCINOMA, MUCINOUS; ADJUVANT THERAPY; ANALOGS AND DERIVATIVES; CANCER GRADING; CANCER STAGING; COMPUTER ASSISTED RADIOTHERAPY; INTENSITY MODULATED RADIATION THERAPY; LYMPH NODE; MIDDLE AGED; MINIMAL RESIDUAL DISEASE; PATHOLOGY; PREOPERATIVE CARE; PROPORTIONAL HAZARDS MODEL; RECTAL NEOPLASMS; RECTUM; REMISSION; RETROSPECTIVE STUDY; SURGERY; VERY ELDERLY;

ADENOCARCINOMA; ADENOCARCINOMA, MUCINOUS; ADULT; AGED; AGED, 80 AND OVER; ANTIMETABOLITES, ANTINEOPLASTIC; CHEMORADIOTHERAPY; DEOXYCYTIDINE; FEMALE; FLUOROURACIL; HUMANS; LYMPH NODES; MALE; MIDDLE AGED; NEOADJUVANT THERAPY; NEOPLASM GRADING; NEOPLASM STAGING; NEOPLASM, RESIDUAL; PREOPERATIVE CARE; PROPORTIONAL HAZARDS MODELS; RADIOTHERAPY, CONFORMAL; RADIOTHERAPY, INTENSITY-MODULATED; RECTAL NEOPLASMS; RECTUM; REMISSION INDUCTION; RETROSPECTIVE STUDIES; SURVIVAL RATE;

EID: 84908211741     PISSN: 01678140     EISSN: 18790887     Source Type: Journal    
DOI: 10.1016/j.radonc.2014.05.010     Document Type: Article

References (36)

1. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 1997;12:19-23.
2. Maas M, Nelemans PJ, Valentini V, Das P, Rodel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010;11:835-44.
3. Gerard JP, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne PL, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 2010;28:1638-44.
4. Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 2011;29:2773-80.
5. Habr-Gama A, Perez RO, Nadalin W, Nahas SC, Ribeiro Jr U, Silva E Sousa Jr AH, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg 2005;9:90-9.
6. Habr-Gama A, Gama-Rodrigues J, São Julião GP, Proscurshim I, Sabbagh C, Lynn PB, et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 2014;88(4):822-8. http://dx.doi.org/10.1016/j.ijrobp.2013.12.012.
7. Maas M, Beets-Tan RG, Lambregts DM, Lammering G, Nelemans PJ, Engelen SM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 2011;29:4633-40.
8. Vuong T, Belliveau PJ, Michel RP, Moftah BA, Parent J, Trudel JL, et al. Conformal preoperative endorectal brachytherapy treatment for locally advanced rectal cancer: early results of a phase I/II study. Dis Colon Rect 2002;45:1486-93.
9. Gerard JP, Chapet O, Nemoz C, Hartweig J, Romestaing P, Coquard R, et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. J Clin Oncol 2004;22:2404-9.
10. Aumock A, Birnbaum EH, Fleshman JW, Fry RD, Gambacorta MA, Kodner IJ, et al. Treatment of rectal adenocarcinoma with endocavitary and external beam radiotherapy: results for 199 patients with localized tumors. Int J Radiat Oncol Biol Phys 2001;51:363-70.
11. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996-9.
12. Sobin LH, Wittekind C. TNM atlas: illustrated guide to the TNM classification of malignant tumours. 5th ed. UICC; 1997 [p. 66-9].
13. Capirci C, Valentini V, Cionini L, De PA, Rodel C, Glynne-Jones R, et al. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 2008;72:99-107.
14. Duldulao MP, Lee W, Streja L, Chu P, Li W, Chen Z, et al. Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer. Dis Colon Rect 2013;56:142-9.
15. Glynne-Jones R, Wallace M, Livingstone JI, Meyrick-Thomas J. Complete clinical response after preoperative chemoradiation in rectal cancer: is a "wait and see" policy justified? Dis Colon Rect 2008;51:10-9.
16. Park IJ, You YN, Skibber JM, Rodriguez-Bigas MA, Feig B, Nguyen S, et al. Comparative analysis of lymph node metastases in patients with ypT0-2 rectal cancers after neoadjuvant chemoradiotherapy. Dis Colon Rect 2013;56:135-41.
17. Gosens MJ, Klaassen RA, Tan-Go I, Rutten HJ, Martijn H, van den Brule AJ, et al. Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clin Cancer Res 2007;13:6617-23.
18. Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, et al. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 2005;62:752-60.
19. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23:8688-96.
20. Janjan NA, Crane C, Feig BW, Cleary K, Dubrow R, Curley S, et al. Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 2001;24:107-12.
21. Mawdsley S, Glynne-Jones R, Grainger J, Richman P, Makris A, Harrison M, et al. Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival? Int J Radiat Oncol Biol Phys 2005;63:745-52.
22. Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology 2007;51:141-9.
23. Nagtegaal ID, Tot T, Jayne DG, McShane P, Nihlberg A, Marshall HC, et al. Lymph nodes, tumor deposits, and TNM: are we getting better? J Clin Oncol 2011;29:2487-92.
24. Bouzourene H, Bosman FT, Seelentag W, Matter M, Coucke P. Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer 2002;94:1121-30.
25. Gavioli M, Luppi G, Losi L, Bertolini F, Santantonio M, Falchi AM, et al. Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rect 2005;48:1851-7.
26. Hermanek P, Merkel S, Hohenberger W. Prognosis of rectal carcinoma after multimodal treatment: ypTNM classification and tumor regression grading are essential. Anticancer Res 2013;33:559-66.
27. Wheeler JM, Warren BF, Mortensen NJ, Ekanyaka N, Kulacoglu H, Jones AC, et al. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rect 2002;45:1051-6.
28. Beddy D, Hyland JM, Winter DC, Lim C, White A, Moriarty M, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy. Ann Surg Oncol 2008;15:3471-7.
29. Rullier A, Laurent C, Vendrely V, Le BB, Bioulac-Sage P, Rullier E. Impact of colloid response on survival after preoperative radiotherapy in locally advanced rectal carcinoma. Am J Surg Pathol 2005;29:602-6.
30. Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 2005;241:829-36.
31. Pucciarelli S, Toppan P, Friso ML, Russo V, Pasetto L, Urso E, et al. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rect 2004;47:1798-807.
32. Ruo L, Tickoo S, Klimstra DS, Minsky BD, Saltz L, Mazumdar M, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg 2002;236:75-81.
33. Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 2005;47:141-6.
34. Hughes R, Glynne-Jones R, Grainger J, Richman P, Makris A, Harrison M, et al. Can pathological complete response in the primary tumour following pre-operative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision? Int J Colorectal Dis 2006;21:11-7.
35. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative shortcourse radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:1215-23.
36. Bujko K, Kolodziejczyk M, Nasierowska-Guttmejer A, Michalski W, Kepka L, Chmielik E, et al. Tumour regression grading in patients with residual rectal cancer after preoperative chemoradiation. Radiother Oncol 2010;95:298-302.