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Research on Virology and Cytopathology
Title
Research on Virology and Cytopathology
Editor
iConcept Press
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USD$39.00
ISBN
978-1-922227-70-6
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14043

Chapter 4

Research on Virology and Cytopathology

Tumor Regression – A Capital Feature in Rectal Cancer Therapy Decision Tree

by Marisa D. Santos and Carlos Lopes

Viewed: 2075

Abstract

Neoadjuvant chemoradiation (CRT) followed by total mesorectum excision (TME) surgery, and systemic chemotherapy still remains the standard of care for locally advanced rectal cancer, but not all cases benefit from this treatment modality. This multimodal treatment improves disease pelvic control but better survival is achieved only if pathological response is present. TRG scales provides a system to assess tumor chemoradiotherapy response. This response can range from absent - no fibrosis with extensive residual cancer (zero evidence of treatment efficacy) - to a complete response (ypCR) with no viable tumor cells identified. The pathological response to neoadjuvant CRT has been reported in several studies to be closely related to oncologic outcomes. Mandard tumor regression grade (TRG) proved to be a good system to measure neoadjuvant CRT response. To identify the group of patients with better prognosis, Mandard TRG seems more effective than Dworak TGR. Mandard was the one that best correlated with the presence of therapeutic response and prognosis. In our research, the Mandard system proved to be a good determinant of outcome, when cases were grouped into TRG1-2 (good responders) and TRG3-5 (poor responders). This methodology proved superior than division in groups ypCR (TRG1) versus all others (TRG2-5) regarding DFS and OS. The presence of a good response in terms of Mandard tumor regression grade was associated with a lower incidence of locoregional recurrence and improved survival. Mandard system provides an important tool for survival analysis. None of the clinical or the biopsy characteristics assessed, had a predictive value of Mandard response, except the distance from anal verge. Only pathological parameters related with tumor response to chemoradiotherapy have predictive value for Mandard response. There’s a lack of clinical and pathological preoperative variables able to predict Mandard response, only postoperative pathological parameters related with nCRT tumor response have a predictive value. Based on these results it's impossible at this moment , to identify the group of patients who truly benefits of neoadjuvant CRT , but we can identify the group of patients ( the Mandard bad responders) that will benefit with a more aggressive adjuvant treatment.

Author Details

Marisa D. Santos
Department of Surgery, Centro Hospitalar do Porto, I.C.B.A.S., University of Porto, Portugal
Carlos Lopes
Department of Surgery, Centro Hospitalar do Porto, I.C.B.A.S., University of Porto, Portugal

Citation

Marisa D. Santos and Carlos Lopes. Tumor Regression – A Capital Feature in Rectal Cancer Therapy Decision Tree. In Research on Virology and Cytopathology. ISBN:978-1-922227-70-6. iConcept Press. 2016.

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