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    Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?

    Access Status
    Fulltext not available
    Authors
    McCoy, M.
    Hemmings, C.
    Hillery, S.
    Penter, C.
    Bulsara, M.
    Zeps, Nikolajs
    Platell, C.
    Date
    2015
    Type
    Journal Article
    
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    Citation
    McCoy, M. and Hemmings, C. and Hillery, S. and Penter, C. and Bulsara, M. and Zeps, N. and Platell, C. 2015. Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression? ANZ Journal of Surgery. 87 (12): pp. E233-E239.
    Source Title
    ANZ Journal of Surgery
    DOI
    10.1111/ans.13394
    URI
    http://hdl.handle.net/20.500.11937/6041
    Collection
    • Curtin Research Publications
    Abstract

    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 to CRT.

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