Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?
|dc.identifier.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. [In Press].|
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.
|dc.title||Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?|
|dcterms.source.title||ANZ J Surg|
|curtin.accessStatus||Fulltext not available|
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