Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment

Abstract

In the scope of a prospective multi-centre study after neoadjuvant combined chemotherapy (carboplatin, ifosfamide, etoposide, vindesine) and radiotherapy (45 Gy) 40 resection specimens of locally advanced non-small-cell lung cancer were analysed in order to establish reproducible pathological/anatomical results of tumour regression. Resection specimens of 28 squamous cell carcinomas and 12 adenocarcinomas were investigated using serial sections of the primary lesion. The mean age of the patients was 57 years. The results were compared to spontaneous regressive changes in a control group of 50 untreated non-small-cell lung cancers. Marked scarry fibrosis in the region of the former primary tumour, concentric foci of fresh tumour necroses and surrounding foam cell clusters with transition into vascular granulation tissue could be established as characteristic features of therapy-induced tumour regression, whereas untreated carcinomas revealed necroses with adjoining vital tumour tissue. Using a three-step regression system, 3 tumours could be classified as grade I (no or only slight tumour regression), 10 tumours as grade IIA (marked but incomplete tumour regression, more than 10% vital tumour tissue), 20 tumours as grade IIB (less than 10% vital tumour tissue) and 7 tumours as grade III (complete tumour regression without vital tumour tissue). After a median follow-up period of 32.3 months in patients with grade IIB or III tumour regression ("responders") the median survival time of 27.9 months was found to be significantly longer than in patients with grade I or IIA tumour regression ("non-responders") with a median survival period of 13.7 months (log-rank test, P = 0.020). The resection specimens analysed, which were obtained 7 weeks (on average) after the end of radiochemotherapy, did not show specific changes due to preoperative therapy, but quite characteristic histological alterations in the former tumour area were registered, which had been induced by combined neoadjuvant radiation and chemotherapy. The grade of therapy-induced tumour regression could be shown to be a significant prognostic factor in non-small-cell lung cancer.

Immune contexture and histological response after neoadjuvant chemotherapy predict clinical outcome of lung cancer patients

“…We confirmed that clinical and pathological responses were good indicators of survival after neoadjuvant chemotherapy in stage III-N2 NSCLC patients. As previously reported, 3,19 less than 10% of viable tumor cells after neoadjuvant chemotherapy is a relevant threshold to identify patients with good or poor clinical outcome. Since it represents a reliable prognostic marker, we recommend to evaluate and report the percentage of living cancer cells after neoadjuvant chemotherapy.…”

18F-FDG PET/CT of Non–Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response

“…Only the primary tumors were analyzed. All hematoxylin- and eosin-stained resection specimens processed for the original sign-out were reviewed by two of the authors to determine the score, which was based on a 4-tiered scale as described by Junker et al (24,25). This system evaluates the proportion of viable tumor cells in relation to the degree of tumor necrosis and fibrosis.…”

“…As an independent reference for tumor response, we chose the histopathologic tumor regression score of the corresponding formalin-fixed and paraffin-embedded surgical specimens, as described by Junker et al (24,25). …”

ERCC1 and XRCC1 Gene Polymorphisms Predict Response to Neoadjuvant Radiochemotherapy in Esophageal Cancer

“…16,17 This analysis was performed by two independent staff pathologists who were blinded for all other clinical data (S.E.B. and H.P.D.).…”