Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer

Abstract

In this exploratory analysis, complete (TRG 4) and intermediate pathologic response (TRG 2 + 3) suggested improved DFS after preoperative CRT. TRG assessment should be implemented in pathologic evaluation and prospectively validated in further studies.

Phase II study of capecitabine and oxaliplatin given prior to and concurrently with preoperative pelvic radiotherapy in patients with locally advanced rectal cancer

“…Pathological complete tumour response is a reliable and reproducible surrogate for tumour response and is linked to improved outcome (Roh et al, 2004;Roedel et al, 2005). Although achievement of a pCR is not the primary goal of neoadjuvant therapy, it has become a commonly used end point in many phase II trials aiming to improve the efficacy of rectal cancer treatment.…”

“…The number of tumour-infiltrated lymph nodes (ypN status) following preoperative radiochemotherapy is a strong and independent prognostic factor for survival. Sterilising lymph nodes reflects the impact of effective neoadjuvant treatment and consistently translates into improved long-term outcome (Bouzourene et al, 2002;Chan et al, 2005;Chapet et al, 2005;Roedel et al, 2005).…”

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

“…In the phase II study, we have analysed the pathologic response using the TRG score, because it has been shown to be more accurate in defining the tumour regression after primary therapy, and to predict the long-term outcome (Bouzourene et al, 2002;Rödel et al, 2005;Vecchio et al, 2005). Notably, the number of TRG1 or 2 required by our statistical design had already been reached in the first 31 treated patients, with an overall activity (71%) by far greater than that hypothesised.…”

“…Phase II We have chosen as primary end point the achievement of a complete or nearly complete pathologic response, because it has been repeatedly reported to predict the long-term survival of patients (Bouzourene et al, 2002;Rödel et al, 2005;Vecchio et al, 2005). To define the sample size, a Simon's two-stage design was utilised (Simon, 1989), setting a and b errors as 0.05 and 0.20, and defining as minimum activity of interest (p0) a TRG1 -2 rate ¼ 30%.…”

Tumor response is predicted by patient genetic profile in rectal cancer patients treated with neo-adjuvant chemo-radiotherapy

“…9,10 In addition, the tumor regression grade (TRG) characterization of the pathologic response has shown to be a prognostic factor for local failure, metastasis-free and overall survival with significant better outcome for patients reporting TRG 1-2 (absence or scattered residual isolated cancer cells) compared with those reporting TRG 3-5 (increase in the number of residual cancer cells). 11,12 Nonetheless, TRG 3 could be considered an intermediate prognostic status and some investigators suggested a three-point classification system (TRG 1-2, TRG 3 and TRG 4-5) as a good predictor of pCRT outcome in rectal cancer. 13 For patients with pathologic complete response after pCRT, some investigators advocate an observational approach without any surgical treatment, 14 and others suggest that the transanal local excision may be appropriate.…”