Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system.

摘要: PURPOSE: Long-course preoperative radiotherapy has been recommended for rectal carcinoma when there is concern about the ability to perform a curative resection, example, in larger tethered tumors or those sited anteriorly near anal sphincter. “Downstaging” of tumor may occur, and this importance estimating prognosis selecting postoperative therapy patients. We studied effects chemoradiotherapy on pathology cancer, we propose simplified measurement regression, Rectal Cancer Regression Grade. METHODS: have reviewed patients who received followed by surgical resection carcinomas mid distal third rectum found be Stage T3/4 transrectal ultrasound CT between January 1995 December 1998. Patients 45 50 Gy irradiation an infusion 5-fluorouracil. The specimens were examined one pathologist, Grade was quantified. RESULTS: Forty-two patients, mean age 60 (range, 42–86) years, underwent before surgery carcinoma. There 28 anterior resections (67 percent; 9 with colonic pouch), 12 abdominoperineal (27 percent), 2 Hartmann’s procedures (5 percent). Comparison pathologic staging revealed that depth invasion downstaged 17 (38 status involved lymph nodes 13 (50 percent) 26 Tumor regression more than percent (Rectal Grades 1 2) 36 (86 7 (17 having complete absence residual cancer cells. CONCLUSION: Significant seen 86 cases after chemoradiotherapy, 19 showing “good” responsiveness. modified system irradiated Grade, which includes regression. utility proposed must tested against long-term outcomes its value predicting survival can determined.