Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?ANZ Journal of Surgery (2015)
Background: Pathological complete response following neoadjuvant
chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with
reduced local recurrence and improved long-term outcome. However, the prognostic
value of a partial response, or of tumour regression in patients with metastatic disease,
is less clear.
Methods: We present a single-centre cohort study of 205 patients with stage II–IV
rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013.
Tumour regression was assessed using the Dworak system.
Results: The probability of 3-year recurrence-free survival (RFS) was 95% for
Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P =
0.0005). In univariate regression analysis, Dworak grade was associated with RFS
(hazard ratio (HR) 0.51, P < 0.0001; trend analysis) and cancer-specific survival
(HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent
predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage,
resection margin status, the presence or absence of extramural venous invasion and
type of surgical procedure.
Conclusions: Tumour regression grade after neoadjuvant CRT was an independent
prognostic factor for RFS, highlighting the importance of the degree of local response
Citation InformationMcCoy, M., Hemmings, C., Hillery, S., Penter, C., Bulsara, M., Zeps, N., and Platell, C. (2015). Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression? ANZ Journal of Surgery. DOI: 10.1111/ans.13394