Rectal Cancer by Brian G. G. Czito & Christopher G. G. Willett

Author:Brian G. G. Czito & Christopher G. G. Willett
Language: eng
Format: epub
Publisher: Humana Press, Totowa, NJ

9.4 Reporting Rectal Cancer Resections Following Neoadjuvant Therapy

Increasing numbers of rectal cancer patients now receive pre-operative (neoadjuvant) radiotherapy either alone or in combination with chemotherapy. This is associated with a variable degree of tumour regression, which ranges from no response through to a complete pathological response where no viable tumour cells remain. Patients with CRM negative tumours, which have undergone either complete or marked regression, have been shown to do better than those that have not markedly regressed (10). This requires confirmation from further studies but unfortunately to date there has been a lack of standardisation in the reporting of the degree of tumour regression, especially in large clinical trials.

A 5-point grading system for tumour regression was initially developed by Mandard for oesophageal cancer, (47) and modified systems have been used for rectal cancer patients including studies by Dworak, (48) Bouzourene (49) and Rodel (10). Unfortunately, these systems do not run in parallel and can cause confusion for both pathologists and clinicians if a numeric grade is given (Table 1). The grade determined is subjective and therefore open to considerable inter-observer variation (50,51). In addition to the above problems, there is little evidence to show that lesser degrees of tumour regression benefit the patient; therefore, in routine practice, we advocate the use of a simple three point descriptive scale to avoid confusion. This should grade tumours into those showing a complete pathological response (see below for definition), minimal residual tumour or no marked response. However, in clinical trials, the full 5-point system should be used.Table 1The different tumour regression grading (TRG) systems commonly used in clinical practice. Note the similarity of the Mandard (47) and Bouzourene (49) methods and how the ­numbering system contrasts with that used in the Dworak (48) and Rodel (10) systems

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