Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease‐free survival after preoperative radiochemotherapy for advanced rectal cancer

Suárez, Javier; Vera, Ruth; Balén, E; Gómez, Marisa; Arias, Fernando; Lera, José Miguel; Herrera, Javier; Zazpe, C.

doi:10.1111/j.1463-1318.2007.01424.x

Cited by 116 publications

(100 citation statements)

References 33 publications

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“…pTR was defined as Mandard Tumor Regression Grade (TRG) of 3 or less, after dedicated review by a consultant cellular pathologist (27). The Mandard TRG was used in preference to alternative TRGs, being the most frequently used TRG for esophageal cancer (28), with optimal prediction of survival (29,30).…”

Section: Data and Variablesmentioning

confidence: 99%

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

et al. 2016

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Only a minority of esophageal cancers demonstrates a pathologic tumor response (pTR) to neoadjuvant chemotherapy (NAC). 18 F-FDG PET/CT is often used for restaging after NAC and to assess response. Increasingly, it is used during therapy to identify unresponsive tumors and predict pTR, using avidity of the primary tumor alone. However, definitions of such metabolic tumor response (mTR) vary. We aimed to comprehensively reevaluate metabolic response assessment using accepted parameters, as well as novel concepts of metabolic nodal stage (mN) and metabolic nodal response (mNR).Methods: This was a single-center retrospective U.K. cohort study. All patients with esophageal cancer staged before NAC with PET/CT and after with CT or PET/CT and undergoing resection from 2006 to 2014 were identified. pTR was defined as Mandard tumor regression grade 1-3; imaging parameters included metrics of tumor avidity (SUV max/mean/peak ), composites of avidity and volume (including metabolic tumor volume), nodal SUV max , and our new concepts of mN stage and mNR. Results: Eighty-two (27.2%) of 301 patients demonstrated pTR. No pre-NAC PET parameters predicted pTR. In 220 patients restaged by PET/CT, the optimal tumor DSUV max threshold was a 77.8% reduction. This was as sensitive as the current PERCIST 30% reduction, but more specific with a higher negative predictive value (P , 0.001). DSUV max and Dlength independently predicted pTR, and composite avidity/spatial metrics outperformed avidity alone. Although both mTR and mNR were associated with pTR, in 82 patients with 18 F-FDG-avid nodes before NAC we observed mNR in 10 (12.2%) not demonstrating mTR. Conclusion: Current definitions of metabolic response are suboptimal and too simplistic. Composite avidity/volume measures improve prediction. mNR may further improve response assessment, by specifically assessing metastatic tumor subpopulations, likely responsible for disease relapse, and should be urgently assessed when considering aborting therapy on the basis of mTR alone.

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Section: Data and Variablesmentioning

confidence: 99%

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

et al. 2016

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“…Histopathologists grade tumour response in three ways: firstly assessment of the status of the CRM, secondly the depth of tumor spread and nodal status (ypT and ypN stage), and thirdly by evaluating tumor regression grade (ypTRG) [10,11]. A number of studies have shown that both ypT and ypN stage are independent predictors of outcome, and several retrospective studies report a link between outcome and histopathology assessment of final stage or tumor regression after NACRT [12,13].…”

Section: Introductionmentioning

confidence: 99%

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

West

Dimitrov

Moyses

et al. 2016

European Journal of Surgical Oncology (EJSO)

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Purpose: There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT;T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery. Patients and Methods:We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.

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“…While other studies in rectal cancer patients with chemoradiation showed a downstaging rate between 43.5 and 60.4% [26,27,33], in the present study, a remarkable 81.8% of the patients reduced their tumor stage, which correlated with a significant shrinking of the tumor (90.9%). Therefore, EB treatment of these patients does not seem to promote tumor growth when anemia correction is achieved following current guidelines.…”

Section: Resultsmentioning

confidence: 50%

“…Moreover, treatment with EB was able to elude preoperative anemia in patients with levels of Hb B 11 g/dl without greatly interfering in the rate of surgical complications usually encountered in this setting, either in alpha-epoetin-treated patients (16%) [25] or regardless of hematopoietic correction (27.7-31.2%) [26,27].…”

Section: Resultsmentioning

confidence: 99%

“…The Mandard's classification is been widely used as a regression system and is been shown to predict local failure, disease-free survival, and overall survival [10,27,28]. The complete pathological response (18.2%) recorded in this study in patients with corrected anemia is slightly higher than that obtained with a similar dose of radiotherapy and fluoropyrimidine-based chemotherapy before surgery in advance rectal cancer, regardless of hemoglobin levels (14.2%) [27]. As for the percentage of good responses (54.5%), which includes Mandard TGR 1-2, it is superior to that of preoperative approaches in esophageal (42.0%) and rectal cancer (20-31.0%) [9,10,[27][28][29].…”

Section: Resultsmentioning

confidence: 99%

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Anemia response and safety to epoetin-beta treatment in patients with neoadjuvant therapy prior to primary digestive tract tumor surgery

Gómez

Salgado

Valladares‐Ayerbes

et al. 2009

Cancer Chemother Pharmacol

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Purpose Anemia is common during anticancer treatment. This study aimed to evaluate the response and safety of treatment with epoetin-beta (EB) in patients with neoadjuvant therapy prior to primary digestive tract tumor surgery. Patients and methodsIn this open-label, single-arm study, patients (n = 22) with hemoglobin (Hb) levels below 11 g/dl who received epoetin-beta 450 IU/kg (30,000 IU) weekly until the hemoglobin level reached 12 g/dl.Results After treatment with EB, a mean absolute increment of 2.6 g/dl was attained. The mean hemoglobin values during the study were pretreatment 10.1 g/dl, half-way through treatment 12.3 g/dl, 4 weeks after concomitant radiochemotherapy 12.7 g/dl, the week prior to surgery 12.5 g/dl, and after surgery 10.9 g/dl. No patient required transfusion before or after surgery. The probability or risk of postoperative complications was 27.3%, and included one rectovaginal fistula, one parastomal hernia, one case of ileus and two surgical wound infections. In this series, downstaging was observed in 81.8% of patients, and downsizing in 90.9%. Most interestingly, histopathological complete response rate was achieved by 18.2%. Conclusions Epoetin-beta (EB) treatment in our series of patients with digestive malignancies subjected to neoadjuvant radiochemotherapy proved effective and safe, avoiding the need for transfusion during surgery.

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Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease‐free survival after preoperative radiochemotherapy for advanced rectal cancer

Cited by 116 publications

References 33 publications

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

Predicting Pathologic Response of Esophageal Cancer to Neoadjuvant Chemotherapy: The Implications of Metabolic Nodal Response for Personalized Therapy

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

Anemia response and safety to epoetin-beta treatment in patients with neoadjuvant therapy prior to primary digestive tract tumor surgery

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