Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer

• Published in: European journal of cancer (1990) Vol. 47; no. 8; pp. 1138 - 1145
• Main Authors: Dhadda, A.S, Dickinson, P, Zaitoun, A.M, Gandhi, N, Bessell, E.M
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-05-2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Disease-Free Survival; Dose-Response Relationship, Radiation; Drug Therapy - methods; Hematology, Oncology and Palliative Medicine; Humans; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Staging - methods; Pharmacology. Drug treatments; Prognosis; Proportional Hazards Models; Radiotherapy; Radiotherapy - methods; Rectal cancer; Rectal Neoplasms - diagnosis; Rectal Neoplasms - therapy; Response grading; Treatment Outcome; Tumors; Rectal cancer; Response grading; Radiotherapy; Histological grading; Rectal disease; Prognosis; Regression; Malignant tumor; Rectum cancer; Chemotherapy; Treatment; Cancerology; Digestive diseases; Intestinal disease; Locally advanced stage; Anorectal disease; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2010.12.006

Abstract Purpose To assess the prognostic value of the Mandard tumour regression score (TRG) following pre-operative chemo/radiotherapy in patients with locally advanced rectal cancer. Methods and materials The study involved 158 patients with locally advanced rectal cancer treated with pre-operative long course chemo/radiotherapy at Nottingham University Hospital between April 2001 and December 2008. Patients were treated with radiotherapy to a dose of 50 Gy in 25 fractions over 5 weeks with or without concurrent capecitabine chemotherapy at a dose of 1650 mg/m2 /day. Surgery was normally performed after an interval of 6–10 weeks. The response to pre-operative treatment was carefully graded by a single pathologist using the five point Mandard score. The median follow-up was 40 months (range 3–90 months). Results Of the 158 patients 14% were TRG1, 41% were TRG2, 31% were TRG3, 13% were TRG4 and 1% were TRG5. The groups were combined into TRG1, TRG2 and TRG3–5 to simplify further analysis. The Mandard score was clearly related to both disease-free ( p < 0.001) and overall survival ( p = 0.012). On multivariate analysis perineural invasion, nodal status, TRG and circumferential resection margin status were the most powerful predictors of disease-free survival. Conclusions The Mandard tumour regression score is an independent prognostic factor and predicts for long-term outcome following pre-operative chemo/radiotherapy in rectal cancer.