Bouzourene et al evaluated the effect of preoperative radiation therapy on patients with locally advanced rectal carcinoma. The degree of regression seen in the resected specimen correlates with disease free survival. The authors are from Hospitalier Universitaire Vaudois in Lausanne, Switzerland
Histologic parameters for assessing tumor regression:
(1) amount of tumor
(2) amount of fibrosis
|
Amount of Tumor |
Amount of Fibrosis |
Tumor Regression Grade |
|
no residual tumor |
diffuse |
1 |
|
rare residual tumor cells |
diffuse |
2 |
|
some residual tumor |
fibrosis > tumor |
3 |
|
residual tumor |
fibrosis <= tumor |
4 |
|
no regression |
none or minimal |
5 |
Other parameters used to evaluate the original tumor (prior to radiation therapy):
(1) cytonuclear atypia
(2) tumor necrosis
(3) intra-tumor inflammation
|
Parameter |
Finding |
Grade |
|
cytonuclear atypia |
mild |
1 |
|
|
moderate |
2 |
|
|
marked |
3 |
|
tumor necrosis |
< 25% |
1 |
|
|
25 - 50% |
2 |
|
|
51 - 75% |
3 |
|
|
> 75% |
4 |
|
intra-tumor inflammation |
none |
0 |
|
|
mild |
0 |
|
|
moderate |
1 |
|
|
extensive |
2 |
|
Tumor Regression Grade |
Response |
Rate 5 Year Disease Free Survival |
|
TG1 |
complete responder |
NA |
|
TG2 |
partial responder |
75% |
|
TG3, TG4 |
partial responder |
52% |
|
TG5 |
non-responder |
30% |
from Figure 5, page 1127
where:
• At 7 years the disease free survival was 52% for TRG4 and 36% for TRG3. This may reflect the influence of other factors such as pathologic stage.
Factors associated with prognosis in locally advanced rectal tumors treated preoperatively with radiation:
(1) tumor regression grade
(2) pathologic stage of surgical specimen
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
